Global call for people to “Know your status”

THIS year World AIDS Day marks its 30th anniversary with the theme “Know your status”.

Significant progress has been made in South Africa to the AIDS response since 1988 with substantial expansion to the human immunodeficiency virus (HIV) testing services, conducting in excess of 10 million HIV tests in the 2017/2018 period and linking people who have tested positive to treatment, care and support, according to Dr. Sandile Buthelezi, chief executive officer at the South African National AIDS Council (SANAC).

He says the impact of the strides made has contributed to improvements in life expectancy, with more people living beyond the age of 62. In 2001 there were around 70 000 babies born HIV positive in South Africa with some areas the percentage of HIV positive births being as high as 19%, whereas, today, the Prevention of Mother to Child Transmission has resulted in the transmission of HIV from mothers to children dropping to below 2% in certain districts, thus ensuring child survival.

However, despite the aforementioned strides, Buthelezi says there are significant challenges that have the potential to lead to a regression of the progress made in addressing the pandemic of HIV. For instance, the high incidence of HIV among adolescent girls and young women is cause for great concern. Among other factors contributing to this is the vulnerability of young women and adolescents – including, but not limited to the high prevalence of gender-based violence.

“With an estimated 7.1-million South Africans living with HIV and accounting for 19% of the burden of HIV globally, South Africa has to accelerate its prevention programmes to ensure that the majority of South Africans who are HIV negative remain negative,” says Buthelezi.

“The implementation of the 10-point plan of the UNAIDS HIV Prevention 2020 Roadmap will take centre-stage as we count down to our 2020 prevention targets. For us to reach the target of 75 percent reduction in HIV infections, we need concerted effort to optimally implement the biomedical and behavioural interventions that have been proven to work.

“We will also bring all the role players to work together in addressing the social and structural drivers of the epidemic; with specific emphasis on inequality, poverty and unemployment.,” says Buthelezi.

He says part of South Africa’s challenge is to reach people living with HIV who do not know their status and ensuring that they are linked to quality care and prevention services.

HIV testing is essential for expanding treatment and ensuring that all people living with HIV can lead healthy and productive lives. It is also crucial to achieving the 90–90–90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners to diagnose 90% of all HIV-positive persons, provide antiretroviral therapy (ART) for 90% of those diagnosed, achieve viral suppression for 90% of those treated by 2020, as well as empower people to make choices about HIV prevention so they can protect themselves and their loved ones.

Buthelezi says many barriers to HIV testing remain. Stigma and discrimination still deter people from taking an HIV test. Access to confidential HIV testing is still an issue of concern. Many people still only get tested after becoming ill and symptomatic.

“HIV testing is also essential to the promotion of HIV prevention.

“The good news is that there are many new ways of expanding access to HIV testing. Self-testing, community-based testing and multi-disease testing are all helping people to know their HIV status.

“HIV testing programmes must be expanded. For this, we need political will and investment, as well as novel and innovative approaches to HIV testing that are fully leveraged,” says Buthelezi.

He reports that South Africa has started to see a drop in new HIV infections.

“Ten years ago we had 680 000 new infections per annum, today, we have 231 000 new infections a year, which although it is an improvement is still very high.

“Our target for 2020 is to cut down new infections to 88 000 or less, which is a 75% reduction using the 2010 baseline rate.

“The road ahead to eliminate HIV is still very tough and to succeed prevention is critical, prevention, prevention and prevention. However, it seems that the sense of urgency to combat HIV has dropped in South Africa.

“We need to ramp-up our communication efforts in terms of promoting behavioural change, but more critically we have programme interventions that need to be scaled up. For example, condom promotion and usage, which is a basic requirement to improve HIV prevention, needs to be increased dramatically.

“In short, the urgency that was recognizable in South Africa to overcome the threat of HIV needs to be revived and reinforced with each person taking responsibility to ‘know their own status’ a prerequisite,” says Buthelezi.

He contends that SANAC is uniquely placed to facilitate both the expansion of HIV testing and a multi-sectoral and comprehensive response to the HIV epidemic as it is recognised as the only organisation able to convene all stakeholders of the South African HIV, TB and STI response and to monitor that each stakeholder is fulfilling its role in the implementation of HIV, TB and STI programmes in South Africa.

“SANAC’s role is to foster dialogue and build consensus so that government, civil society, the private sector and donors cooperate to achieve the same goals in respect of HIV, TB and STIs.

“SANAC has the mandate to coordinate a truly multi-sectoral response to the epidemics at a national and sub-national level and also to ensure that the response is holistic and includes consideration for the social and structural drivers of the epidemic,” says Buthelezi.