One in five South Africans is infected with HIV. This is according to the president of the South African Medical Research Council, Professor Glenda Gray, who says the country has seen little decrease in the number of Aids cases over the years. 

Does a day like World Aids Day (WAD), then, achieve anything in a country with such high rates of infection? 

Professor Glenda Gray.
(Photo: en.Wikipedia.org)

“For me, no,” answered Hazel Tau, an HIV activist who was central in a court case that forced drug companies to allow generic manufacturers into the market, leading to a reduction in the price of antiretrovirals.

Tau was part of a case that forced big pharma to come to the table in the GlaxoSmithKline, Boehringer Ingelheim & others case at the South African Competition Commission in 2002. It resulted in patented antiretrovirals (ARVs) being licensed to local generic manufacturers.

“I thought we would be in a better situation now. But we’re not. We’re getting worse,” said Tau, “we still have a lot of work to do.” 

One day a year that focuses on the epidemic that has been affecting so many South Africans for decades seems inadequate, said Tau.

“I’m not going to go [to give talks] if companies need someone to talk about HIV. For me, that doesn’t give an impact, because I believe it should happen every day.”

The daily duel

As it currently stands, WAD is seen as a “jamboree”, characterised by political lip service, according to Anele Yawa, the general secretary of the Treatment Action Campaign (TAC), an organisation dedicated to the fight against the Aids epidemic in South Africa.

“[There hasn’t been] enough attention to prevention or finding undiagnosed cases, and not enough attention to calling out the nonsense that stops diagnosis — countries that still think it’s okay to have laws against gay rights, sex workers, drug users, etc,” said infectious disease expert and HIV doctor Francois Venter.

Anele Yawa, the general secretary of the Treatment Action Campaign. (Photo: Denvor de Wee)

While the response in SA has improved since the Mbeki-denialism days, Gray gave a diagnosis of “less than optimal”, adding that about three million people in the country are HIV-positive, but are not getting tested and are not on treatment. This means they don’t know their status.

“Our HIV response is in a comatose state and needs immediate resuscitation,” said Yawa.

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To resuscitate the state’s response, we need to ensure that services for those living with HIV are improved, more people are tested, that those initiated in care remain in care and that extensive treatment literacy is promoted, stated Yawa.

“HIV testing should be readily available and free wherever you are. There should be routine campaigns where [people] go and offer regular testing,” said Gray.

South Africa is still struggling to get patented licences for chronic medication, added Tau.

HIV testing should be readily available and free wherever you are. There should be routine campaigns where [people] go and offer regular testing. HIV testing also went down by more than 20% during Covid-19. (Photo: iStock)

For policies fighting the epidemic to be upgraded, Tau suggested that those in charge listen to the voices on the ground. 

“I’m in the clinics doing research and I can see the difficulties the nurses  encounter every day,” said Tau, explaining that healthcare workers are overburdened by the number of HIV patients.

The claws of Covid 

Covid-19 had a largely negative impact on the HIV response, with large diversions of financial and human resources.

Yawa said: “47.8% of adherence clubs have been suspended since the onset of Covid-19. Worryingly, only 11% of adherence clubs still function in the same way as they did before lockdown.”

HIV testing went down by more than 20% during Covid-19. One reason behind this drop was the lack of communication during the lockdowns, claimed Tau. 

“A lot of people didn’t know if they should go to the clinic. A lot of people who were HIV-positive also stayed home and didn’t get treatment.”  

The fumbled HIV focus further resulted in a lack of education about the epidemic. 

“Everyone was so focused on Covid. Education around many things, including HIV, was neglected. Education depends on donor funding as well, and if those people have changed their priority, then that will have a concomitant effect,” explained Gray.

Resuscitating the response

To recover from the setbacks produced by Covid-19, and the stagnated state response to the HIV epidemic more broadly, Tau suggested that a greater emphasis be placed on interventions and preventative measures. 

For instance, when patients do not return to refill their medication, Gray suggested that health workers routinely call to check up on them. 

“Doing one treatment saves your life and prevents onward transmission. And, so, it should be an emergency to make sure people continue to stay on treatment,” she said.

In addition, there is a dire need for sensitisation training of public healthcare workers where bad attitudes remain a barrier to care. 

“Stigma and discrimination remain rife in our public healthcare system. Ritshidze interviewed more than 21,000 patients in the last quarter [July to August], and only 67% reported that staff were friendly and professional. Out of 4,716 PLHIV [people living with HIV] interviewed, 429 were sent to the back of the queue for missing an appointment to collect ARVs and 295 were reprimanded by the staff,” said Yawa.

Aids fatigue and the TAC 

The TAC played a formative role in the fight against the Aids pandemic in South Africa, yet it is struggling financially.

The prevalence of what Gray terms “Aids fatigue” seems to be a large contributing factor towards this struggle.

“When funders get bored, they move on. Look at Covid; there’s Covid fatigue and funders move on to the next best sexy thing to fund… what happens is if you are donor-dependent, donors get fatigue and want to do other things.”  

With eight million documented HIV cases, the need for the TAC is more important now than ever before, said Gray. 

“TAC is monitoring facilities and in communities. Duty-bearers are routinely engaged and held accountable. Without it, the response to HIV would further stumble,” said Yawa, adding that TAC is planning to monitor a combined 620 facilities by April next year.

Closure of the TAC would be an unmitigated disaster, warned Yawa. DM/MC