In December 2013, the Joint United Nations Programme on HIV and AIDS (UNAIDS), laid down an ambitious global plan described as the 90-90-90 plan to end the AIDS epidemic by 2030. The 90-90-90 plan proposes that by 2030, 90% of all people living with HIV should know their status, 90% of people living with diagnosed HIV infection should receive sustained antiretroviral therapy (ART) and 90% of all people receiving ART should have viral suppression. According to UNAIDS latest progress report on the 90-90-90 targets, significant progress has been made, largely due to the increase in ART. More than two thirds of all people living with HIV globally knew their HIV status in 2016, and of this group, 77% were on ART. This translates to 20.9 million people who have access to anti-retrovirals, compared to the 685 000 in 2000. Furthermore, 82% of all people on treatment have supressed viral loads. So, globally these targets are well on track to being realised.
In South Africa, 7.1 million people were living with HIV in 2016 – roughly one in eight people – and 56% of this group had access to ART. HIV prevalence in South Africa varies greatly according to age, geography and gender. South Africa also has the largest ART programme in the world. In June 2017, 4.2 million people were receiving treatment in the public sector. This is remarkable if one considers that in the year 2000, only 90 people had access to ART in the public sector.
However, despite these significant advances, one cannot ignore the 270 000 new infections in 2016. Also, the fact that adolescent girls and young women between the ages of 15 and 24 record the highest HIV prevalence in South Africa. South Africa’s latest National Strategic Plan (NSP) 2017-2022 for HIV, TB and STIs stated that of these 270 000 new infections, young women and girls account for 100 000. This translates to 2 000 new infections per week. It seems the key issue driving this group’s high HIV prevalence is specifically transactional sexual relationships, specifically with men five to 10 years older, as well as social and economic gender power differences.
The question is, what is being done now to address this crisis. There are some innovative programmes and developments, which have to be recognised. In September 2017, the Higher Education and Training HIV/AIDS Programme (HEAIDS) announced that for the first time, students at seven universities will access Truvada (a pre-exposure prophylaxis or PrEP) recommended by the World Health Organisation (WHO) as an antiretroviral pill that reduces the risk of contracting HIV by 90%. PrEp has also been rolled out to 3 000 HIV negative sex workers in terms of the South African National Sex Worker HIV Plan, 2016-2019.
Furthermore, a national three-year multi-sectoral campaign, She Conquers, was launched by the National Department of Health in 2016, which specifically focuses on reducing the levels of HIV infections among adolescent girls and young women by 30% over this period. She Conquers also focuses on decreasing teen pregnancies, creating economic opportunities for young people and providing support to ensure that young girls do complete their schooling. The campaign sets out a core package of interventions relating to biomedical and behavioural interventions that has been rolled out to 22 priority sub-districts. In relation to HIV prevention, the core package of intervention includes life skills training and sexual education, HIV testing and prevention services, as well as psychosocial support programmes.
In its first year, the She Conquers campaign tested 230 000 adolescent girls, young women and their partners for HIV, 18 000 of whom were found to be positive and linked to a treatment programme. Over 60 000 adolescent girls also received life skills training and sexual education. Furthermore, one of the identified targets in the NSP is to reduce new infections among adolescent girls and young women from 2 000 per week, to 800 per week within the next five years. This is to be achieved by a multi-departmental and multi-sectorial approach that not only focuses on biomedical interventions but also focuses on increasing information, education and communication programmes to address these social and structural drivers.
The above measures and targets are admirable but as the NSP recognises, more of the same will not solve this specific crisis. There is an urgent need to extend this beyond a limited campaign. The focus needs to shift to empowering adolescent girls and young women, and to equip them with knowledge to break this cycle. The huge strides made in fighting this global threat should be celebrated, while noting that within the 16 Days of Activism for No Violence Against Women and Children campaign there is the need to do more, so much more, to fight for adolescent girls and young women. It will require active financial commitment and long-term investment, from government and the private sector, to give effect to the NSP and not to defer this responsibility.
By Ms Christine Botha: Legal Officer, Centre for Constitutional Rights
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