Ten years ago Nomvula*, a 20-year old mother of two living with HIV, would have been extremely ill, but with a CD4 count of over 400, she would not have been eligible for treatment.
It is likely that at least one of Nomvula’s children would have contracted HIV from her because she mix-fed her babies (breast and bottle feeding).
Nomvula’s partner might also have contracted HIV from her and her quality and length of life would have been severely compromised.
Today, the picture is very different for Nomvula and millions of South Africans like her.
Research on prevention and treatment has accelerated the pace of change in the HIV and Aids response, leading to new policy and strategic directions such as the introduction of test and treat, which immediately puts people on treatment when they test HIV positive.
We are now in an entirely different era. Increases in treatment access in South Africa is a marked success story.
The more than 4 million people currently on antiretroviral treatment (ART) represent a 44% increase since 2012. As a result, Aids-related deaths declined sharply and life expectancy has increased from 60 years in 2012 to 64 years in 2017. The mother-to-child transmission rate is less than 3%.
But with an estimated 260 000 new infections annually, South Africa’s HIV epidemic is not only the largest in the world (with 7.9 million people living with HIV), it is also the fastest growing.
Women face a disproportionate HIV burden, particularly adolescent girls and young women (AGYW) aged 15 to 24 years.
Also at greatest risk are key populations: sex workers, men who have sex with men, people who inject drugs and transgender people.
PEP is provided to rape survivors and other people who have been exposed to HIV and PrEP is offered to men who have sex with men, sex workers and, most recently, adolescent girls and young women.
The roll-out of PrEP is expected to yield results for South Africa’s new infections rate but creating demand for PrEP and supporting people who choose to take it will be critical to its success.
There are an estimated 280 000 children, ages 0-14 living with HIV in South Africa, with 13 000 newly infected per year. Only half of children living with HIV under 15 in South Africa who need ART are receiving it. South Africa is home to 15% of all adolescents living with HIV globally, with an estimated 320 000 10-19-year-olds who are HIV-positive.
Girls aged 15 to 19 are becoming HIV-infected at eight times the rate of their male peers, but often only access testing, care and treatment services if pregnant. Poor rates of testing of children and adolescents and a lack of child and adolescent-friendly health services underpins the higher rates of HIV-related illness and death in young people.
The de-centralisation of HIV testing, treatment and support services means that civil society organisations are now more integrally involved than ever before - reaching into communities and populations that health systems simply cannot reach. According to UNAIDS:
As a society, we have become much more sophisticated in our response to the Aids epidemic but we still have a long way to go to in dismantling stigma and discrimination to reach the global target of ending Aids by 2030. Let’s work harder together to get there.
Hobbs holds a BA Dramatic Art (Hons) and has over 15 years’ experience in non profit communications and marketing in South Africa and the UK, where she worked for leading youth charity, The Prince’s Trust