Southern Africa: Ending AIDS by 2030?

By Lynnette Mudekunye

Today the world commemorates AIDS Day. This comes barely six months after world leaders gathered in New York for a High Level meeting (HLM) on HIV where they committed to reinvigorate global action to counter the spread of the virus which has caused untold suffering.

This is especially important in the Southern Africa Development Community (SADC) which is home to over 15 million people living with HIV. This is 42% of all people in the world that are living with HIV.

Against enormous odds the world, including SADC, has made great gains in increasing the number of people that are on ARV treatment.  When the first treatment goal of three million people by 2005 was set in 2000 it seemed an impossible dream.

Sceptics warned that the poorest countries, which needed treatment the most, did not have the health systems, personnel or laboratory facilities that were needed. And yet the most recent goal of 15 million people on treatment by 2015 was achieved nine months ahead of target and today,  in 2016 we  are pressing on to attempt to reach 20 million.

The Global Plan to eliminate mother to child transmission of HIV focused global attention on 21 worst affected countries.  In five years since the ambitious plan was launched these countries have succeeded in providing anti-retroviral therapy (ARVs) to 77% of pregnant women that are living with HIV.

It is estimated that 270 000 new infections in babies were averted in 2015, of which 167 000 were in SADC countries. Malawi boldly introduced treatment for all pregnant mothers who were living with HIV, irrespective of their CD4 count.  Few clinics could test CD4 count and waiting for this result was delaying treatment for many mothers.  Many never returned for their results and were lost.  This approach has been widely adopted throughout the region and beyond.  Having mothers on ARVs is also reducing the deaths of mothers due to AIDS related causes.

A number of countries are reaching over 80% of pregnant women living with HIV and some such as South Africa, Botswana, Mozambique, Namibia and Swaziland are now reaching more than 90%. South Africa hopes soon to be the first country in Africa to get certified to have eliminated mother to child transmission.

Clearly political will, donor support and determination by all can reverse the seemingly unrelenting flood of misery that HIV and AIDS unleashed in so many communities.

This same leadership and determination are now required to challenge deep seated social prejudices.  Until we are able to address our prejudices and the stigma that surrounds a number of key populations such as sex workers, men who have sex with men, transgender people, migrants and refugees to make sure that they receive prevention, care, support, testing and treatment we will not end AIDS.

HIV festers in situations of stigma and prevalence of HIV is much higher in these populations.  For instance, even in countries which have extremely high general prevalence, such as Swaziland with an overall prevalence of 27% in the adult population, prevalence in sex workers is 64%; in Lesotho 23% overall prevalence compared to 72% in sex workers. There are similar trends of much higher prevalence in the other key populations.

In many countries sex work and homosexuality are criminalised.  Thus, sex workers and men who have sex with men are often afraid to access health services, or if they do, afraid to disclose what their vulnerabilities are.  Many health workers treat sex workers and men who have sex with men with disdain. Ultimately health needs are not addressed.

There is also need to address current prejudices on young people having sex.  While the death rate from AIDS is declining in all other age groups it has continued to rise in adolescents. It is still the leading cause of death in adolescents in Africa.

Many adolescents have poor knowledge about HIV which puts them at risk of contracting it and are much less likely to be tested for HIV than other age groups and thus they are not accessing treatment.  When they are tested there are few services that support adolescents to come to terms with their diagnosis and to adhere to treatment.  In many communities, adults still struggle to speak openly about sex with young people. Health professionals often approach adolescents from a judgemental perspective rather than engaging with them.

However to end AIDS we must ensure that at least 90% of those living with HIV have been tested and know their status; 90% of those that know their status are on treatment and 90% of those that are on treatment are adhering well to it, with a suppressed viral load.  We cannot achieve these targets until we are working effectively with all those that are at highest risk in an open and welcoming way.

We have a window of opportunity – will we all be bold enough to grasp that opportunity?  Can we afford not to?  We have come so far in the struggle against this terrible virus. We must therefore continue, even when doing so, demands that we confront our own prejudices. We must persevere until we are able to control HIV, to have zero discrimination, zero new infections and zero AIDS related deaths.

Lynnette Mudekunye is a public health professional and the author of the SADC Gender Protocol Barometer HIV and AIDS chapter. She writes in her personal capacity. This article is part of a special series being offered for the Sixteen Days of Activism by Gender Links.

Author: Lynnette Mudekunye