SA’s commitment to ending Aids by 2030 demands addressing stigma at all levels

As we commemorate World Aids Day on 1 December 2024, South Africa stands at a pivotal juncture in its response to the Aids pandemic. The global theme for this year, “Take the Rights Path”, underscores the critical role of human rights in achieving our goal of ending Aids as a public health threat by 2030.

Globally, 39.9 million people are living with HIV, with South Africa accounting for about 20% (or 7.8 million) of them. The country has made significant strides in expanding access to antiretroviral therapy, with about 5.9 million people currently on treatment.

However, challenges persist. Access to HIV-prevention interventions, and services to address stigma, discrimination and gender inequality continue to hinder our progress, particularly affecting adolescent girls and young women, who remain disproportionately at risk.

Globally every week, 4,000 adolescent girls and young women aged 15 to 24 became infected with HIV in 2023 – 3,100 of these infections were in sub-Saharan Africa where women and girls of all ages accounted for 62% of all new HIV infections.

As we observe 16 Days of Activism of No Violence Against Women and Children, we cannot ignore gender-based violence as one of the drivers of new HIV infections.

As inequalities persist, a growing number of young women and homes headed by the girl child are left vulnerable to transactional sex and violence. According to UNAids’ latest World Aids Day report, in South Africa, women with disabilities who are living with HIV are twice as likely to experience intimate partner violence compared with women without disabilities who are HIV-negative.

To address these challenges we must empower young people – especially adolescent girls and young women – with knowledge and access to prevention options. Interventions like oral pre-exposure prophylaxis (PrEP), the dapivirine ring, long-acting injectables like CAB-LA, and lenacapavir hold immense potential to protect those most at risk. Yet, their uptake remains critically low.

The Human Science Research Council’s 6th Behavioural Survey found declining condom use among young people, compounding risks of both unintended pregnancies and sexually transmitted infections, including HIV. Immediate investments in targeted education campaigns are critical to reversing these trends and ensuring a future free from HIV.

An HIV-free generation is also dependent on the success in testing and treatment of children living with HIV. While South Africa is home to the highest number of children in the world living with HIV (148,000), according to UNAids estimates, about 45,000 children are not on antiretroviral treatment.

South Africa has demonstrated commitment to addressing this through its membership of the Global Alliance to End Aids in Children formed with 12 African first-phase countries in 2023.

UNAids’ World Aids Day report states that three Global Alliance countries (South Africa, Uganda and Tanzania) have achieved coverage of antiretroviral therapy among pregnant and breastfeeding women above 95%, and four Global Alliance countries (Kenya, South Africa, Uganda and Zimbabwe) in 2023 provided HIV testing within the first two months of life to at least 80% of infants exposed to HIV.

As we celebrate these successes, we remain cognisant of the challenges that continue to prevail, including stigma and discrimination which fuel misinformation and disinformation. Disinformation has long harmed efforts to respond effectively to HIV, including during the pre-digital era.

As South Africa confronted the world’s most severe national HIV epidemic at the start of the 21st century, senior leaders embraced the disproven assertion that Aids is not caused by HIV, blocking essential research and the provision of antiretroviral therapy for the prevention of vertical HIV transmission.

As a result of Aids denialism more than 330,000 lives were lost in South Africa between 2000 and 2005. In the intervening years, South Africa has become a leader in the global effort to end Aids as a public health threat, but disinformation continues to imperil HIV prevention and treatment efforts. The digital world has amplified the reach and impact of false or misleading information about HIV.

Youth leaders like 21-year-old Nomonde Ngema are blazing a trail in the fight against stigma. Living openly with HIV, Nomonde uses platforms like TikTok to dispel myths, share her journey and inspire others.

She is changing the HIV narrative from what she says was seen as “a condition of shame but can be a condition of love with the right support system and access to health and education”.

Her advocacy highlights the importance of addressing stigma at both community and institutional levels. Meeting her earlier this year before her address at the UN Summit of the Future, Nomonde talked about the challenges facing young people and vulnerable populations in accessing accurate information and the stigma and discrimination experienced by many young people at some health facilities in the country.

This is a fact echoed in the findings from the Ritshidze community-led monitoring project. From their patient surveys at 400 health facilities across the country, unfriendly experiences were reported by all members of key population categories, including men who have sex with men, people who inject drugs, sex workers and transgender men.

Real or perceived discrimination in healthcare settings worsens outcomes across the 95-95-95 cascade, diminishing initiation of antiretroviral therapy, treatment adherence and retention in care.

Through the Breaking Down Barriers initiative, the Global Fund to Fight Aids, TB and Malaria (GFATM) has supported activities to reduce stigma and discrimination, strengthen human rights training for healthcare workers, legal and policy reform efforts, legal literacy programmes to help people living with or affected by HIV know their rights, legal services, and initiatives to reduce violence against women.

With GFATM support, community-led partners in South Africa sensitise police and healthcare personnel to reduce stigma and discrimination towards people who use drugs.

The “Take the Rights Path” campaign calls for the removal of punitive laws and policies that marginalise key populations, including sex workers, men who have sex with men and people who inject drugs. By fostering an inclusive environment that upholds the rights and dignity of all individuals, we can ensure equitable access to prevention, testing and treatment services.

In the words of UNAids executive director, Winnie Byanyima, “to end Aids as a public health threat, we MUST take the Rights Path”. South Africa’s journey is a testament to resilience, but we must deepen our commitment to human rights, gender equality and equitable access to services.

By investing in education, prevention tools and community-led responses, we can eliminate HIV-related stigma, empower our young people and secure an Aids-free generation.

This World Aids Day, let us walk the rights path together and affirm our commitment to ending Aids by 2030. DM

Eva Kiwango is the UNAids country director for South Africa.

The UNAids ‘Take the Rights Path’ report can be downloaded here.