In keeping with this, UNAIDS has made an urgent call on communities to mobilise to ensure that the fight against HIV remains on the political agenda. Breaking down barriers in fighting this epidemic fall within the constitutional mandate of the State, which is tasked with taking active steps – within its resources – to ensure that access to healthcare is “progressively” made available to everyone. 

According to the Global Aids Update 2019 (the 2019 Update), an estimated 37.9 million people worldwide were living with HIV in 2018. The 2019 Update also worryingly highlighted that although substantial progress has been made in the fight against HIV for the first time since 2000, resources available for the AIDS response have declined globally. South Africa, according to UNAIDS, has the largest number of people living with HIV, with 7.7 million as at 2018. In 2018 alone, 240 000 new HIV infections were recorded. This alarming statistic, however, must be weighed against the fact that UNAIDS reported that the number of new HIV infections fell from 390 000 since 2010. There has also been a 50% decrease in AIDS-related deaths since 2010. South Africa, according to the 2019 Update, manages the world’s largest anti-retroviral programme. There has further been positive news on the roll-out of a new HIV drug by the Department of Health, described as ‘three-in-one-pill’. It combines a new antiretroviral (ARV), dolutegravir with the more well-known ARVs’ tenofovir and lamivudine. This innovative drug apparently has fewer side effects.

Despite the decrease in AIDS-related deaths in South Africa, a great cause for concern remains the high number of new HIV infections, specifically young women between the ages of 15 and 24, who remain particularly vulnerable. According to UNAIDS, the Thembisa Model, a mathematical model evaluating the impact of HIV/AIDS (developed by the Centre for Infectious Disease Epidemiology and Research at the University of Cape Town), found that women accounted for 62% of new HIV infections from 2017 to 2018. The Thembisa Model also showed that young women between the ages of 15 and 24 accounted for 31% of all cases of sexually-transmitted HIV.

The urgent need for targeted interventions reaching young women that specifically break down social and structural barriers contributing to the high HIV prevalence, are key goals of South Africa’s National Strategic Plan for HIV,TB and STIs 2017-2022 (National HIV Plan). The National HIV Plan recognises that various stakeholders – from the Department of Education, NGOs and private sector – need to work together to find solutions to reduce HIV prevalence in this group. Some of the targeted interventions identified include: peer-led outreach, youth-friendly sexual and reproductive health services in schools, family planning services, provision of condoms in schools and the provision of PrEP (Pre-exposure prophylaxis), a preventative drug reducing the risk of getting HIV for over 18-year-olds.

In terms of the National HIV Plan, South Africa remains committed to achieving the UNAIDS 90-90-90 target: 90% of all people living with HIV know their HIV status by 2020; 90% of all people diagnosed with HIV receive sustained ARV treatment by 2020; and 90% of all people on ARV treatment have viral suppression. 

However, much remains to be done in order to achieve this ambitious plan. Among others, targeted interventions focussing on young women should remain a key priority for the State. This World Aids Day provides an opportune moment for communities, the State and other stakeholders to make a renewed commitment to fighting HIV. 

By Ms Christine Botha, Manager and Ms Sarah Marx, Intern: Centre for Constitutional Rights
1 Decmber 2019