Human Immunodeficiency Virus (HIV) 

The HIV pandemic and related infections remain the biggest challenge in South Africa, despite the global advances in treatment and care over the years, which has seen new HIV infections decline by 38% between 2001 and 2013. 

In an effort to address this and other social, economic, environmental and educational challenges affecting all nations, world leaders agreed in September 2000 to commit towards addressing those issues, with clear targets being set. This commitment was documented through leaders signing The United Nations Millennium Declaration which includes what is known as Millennium Development Goals (MDG).

HIV/AIDS MDGs 

Globally, two important targets were set for MDG 6:

By 2010, to achieve universal access to treatment for HIV and AIDS for all those who need it.

By 2015, to halt and begin to reverse the incidence of major diseases such as HIV, TB and malaria. Already, there are gains being chartered, but not enough to say MDG goals have been met. 

The South African National HIV/AIDS Strategic Plan 2007-2011 (NSP) provides a guiding framework for all HIV/AIDS and STI programmes which includes the following key priority areas: 

        •       Prevention

        •       Treatment, care and support

        •       Human Rights and Access to Justice

        •       Monitoring, research and surveillance 

The South African Challenge 

South Africa, and the KwaZulu-Natal province in particular, lies at the epicentre of the HIV battle, with five million South Africans (39.5% of the population) living with the virus. Recent Medical Research Council statistics on HIV reported more than 54,337 HIV and AIDS related deaths in 2010/11 while HIV prevalence among 15-19 year old pregnant women decreased from 22% in 2009 to 16.8% in 2012. 

Of significance is the mass increase in Antiretroviral Therapy (ARV) being offered, with KZN now having the biggest ARV programme in the world - surpassing the two million patient mark. However, despite the numbers, the quality and timeliness of data about this programme remain poor. The Negotiated Service Delivery Agreement (NSDA) signed between the Minister of Health and other ministers in October 2010 provided a target of increasing the total number of adults and children on ARV to 3.2 million by 2014/15. 

The combined efforts to turn the tide on HIV and AIDS being regarded as a death sentence is slowly bearing results.  Life expectancy has risen to 60 years, up from 56.5 years in 2009 as fewer people die of AIDS.

Rise in HIV amongst youth 

Young adults under the age of 30 continue to remain most at risk, recording the highest number of new HIV infections, with young women under the age of 20 three to six-fold more at risk compared to their male counterparts. The majority of those infected with HIV include the vulnerable i.e. black Africans, women, children, the economically active age group, those in rural and informal areas and those affected by poverty.

Transmission 

The main mode of HIV transmission in South Africa is through heterosexual sex, accounting for about 80% of all HIV infections and by mother-to-child transmission.  The major drivers include: 

■  Low rates of medical male circumcision

■  Multiple sexual partnerships

■  Frequent transactional sex

■  Risky sexual behaviour amongst youth

■  Lack of knowledge of HIV status

■   Gender disparities which a woman’s ability to negotiate condom use

■  High burden of other sexually transmitted diseases.

South Africa’s success in HIV/AIDS 

Despite the challenges still facing the country in meeting its MDG goals on HIV and AIDS, there are areas of success in the country’s National HIV/AIDS programme which need to be recognised, including: 

• Increased use of condoms especially among the youth - from 35% in 2005 to 62% in 2008. 

• Success in the counselling and testing campaign – South Africa has shifted from the passive process of voluntary counselling to provider-initiated testing.  

• Government workplace programmes have been well developed at national and provincial levels which addresses work place stigma and discrimination. 

• Home based care and increased support for families and children affected by AIDS has been a real success story. It is clear that an increasing number of families are receiving support from both Department of Health and Department of Social Development services, as well as through numerous. 

• PMTCT roll out has also been very positive. 95% of public health facilities now provide PMTCT services, 80% of pregnant women attending antenatal care have received HIV testing and 76% of HIV positive pregnant women receive PMTCT prophylaxis (compared to 70% targeted).

Where to now? 

The HIV epidemic possesses far-reaching consequences beyond the health sector and has resulted in an excess of a million children being orphaned. This economic impact has resulted in loss of productive employees, rise in childheaded households, increase in the social grant system and a greater strain on the country’s finances. 

South Africa continues to press ahead with its multi-sectoral interventions to ensure it turns the tide on HIV and AIDS until it achieves a zero rate new infection level. The battle is far from over, but the commitment and drive to addressing the virus means the country is on the right path to realising an AIDS free generation, in our lifetime.