Although  South Africa has come a long way in treating HIV, considerable challenges remain in closing the gaps to reach the UN 95-95-95 target by 2030.

The aim is to have 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025.

South Africa is currently at 94-77-92.

Speaking during the 11th SA AIDS Conference held last week in Durban, Dr Nkhensani Nkhwashu, Executive Manager: NSP Implementation at the SA National Aids Council (SANAC) says a major challenge is getting people on treatment.

“We have a gap of about two million people who are living out there, who are HIV positive but they have not yet started on treatment and we have got the highest percentage of those who still do not know that they are HIV positive and we need to find them,” she says.

HIV stigma remains a stumbling block

Stigma, discrimination, risky sexual behaviour and the wait for the decriminalisation of sex work are some of the other challenges that need urgent attention, says Nkhwashu.

She says the high number of people who stopped taking HIV treatment altogether is also a concern. “If you look, we have got treatment drop-outs or people who we call lost to follow-up, which might constitute maybe 800 000″.

Nkhwashu says human rights related to sex workers is a critical issue. This key population remains one of the most vulnerable groups in terms of contracting HIV, as they are not being protected by any laws.

“They are still imprisoned, because the communities out there, especially their clients, know that they will not report them to the law enforcement agencies because they risk being arrested themselves. Sometimes they are beaten and they are forced to have sex without using condoms which puts them at more risk of acquiring HIV. Our struggling economy also continues to expose women to HIV infections and GBV,” says Nkhwashu.

Progress made

Nkhwashu says strides have been made over the past ten years, as the country has managed to reduce the number of deaths related to both HIV and TB.

“We have managed to enrol thousands of people in treatment. Initially, this was not the case because people were afraid to get tested and people were even afraid to go and start with the treatment but now as a country, we have gone beyond that,” she says.

She says that the other improvement is demystifying HIV as a ‘killer disease’.

“Yes, HIV still kills. But our communities have now embraced the issue of HIV testing and now when they are offered HIV testing they accept it, we do not see the resistance that we used to see in previous times,” says Nkhwashu.

Way Forward

The Minister of Health Dr Joe Phaahla says more effort is needed to place and retain more people with HIV on treatment, to achieve the 95-95-95 targets. 

“We must initiate an additional 1.4 million people on treatment. We need to double our efforts, and raise awareness about the disease and its terrible health, social and economic implications, as well as to reinforce the message and efforts to prevent the further spread of disease,” says Phaahla.

According to Dr Thandi Dlamini-Miti, Senior Technical Advisor at Right to Care, South Africa continues to face challenges in the management of HIV-TB co-infection, as most deaths among people living with HIV (PLHIV) are due to TB.

“These may be due to delays in diagnosis of TB and HIV, particularly in males as they tend to wait until they are very sick, before coming for help. Diagnosis of TB becomes very difficult in PLHIV that have very low CD4+counts, and even when diagnosed, they may have other opportunistic infections, making the treatment very complex, with less chance of success,” says Dlamini-Miti. 

Dlamini-Miti says that the country needs to improve community awareness and improve access to testing and early diagnosis of both diseases.

“We also need to lessen the number of facility visits for patients that have completed the intensive phase of TB treatment and are clinically stable. Too frequent visits mean that patients spend too much money on transport, and take too much time off work, or school. We also need to improve the home delivery of TB treatment, like being done for ART,” says Dlamini-Miti.

According to the World Health Organization (WHO) in 2021, 38.4 million people were living with HIV worldwide.-Health-e News.