Communities are making the difference in SA's HIV response
It’s an honour for me to be in South Africa, at the invitation of the government, for my first World AIDS Day as UNAIDS Executive Director.
I am looking forward to being in the North West Province to commemorate World AIDS Day along with David Mabuza, Deputy President of South Africa and Chairperson of the South African National AIDS Council, Zweli Mkhize, Minister of Health, and the community of Orkney.
It is no coincidence that I wanted to spend my first World AIDS Day here, considering the 2019 World AIDS Day theme “Communities make a difference.”
Nowhere is this assertion more evident than in South Africa.
In the early 2000s, members of the Treatment Action Campaign (TAC), people living with HIV and social justice activists took to the streets and courts to demand life-saving HIV treatment for people living with HIV. They spent their time in communities, building treatment literacy, organizing themselves, helping people to speak truth to power and to demand their right to health.
Their bold actions paved the way for South Africa’s vibrant civil society of people living with HIV, most from community-led organizations, which has since been at the forefront of South Africa’s robust AIDS response.
Today communities in South Africa are driving progress towards reaching the UNAIDS 90–90–90 targets, with the Ugu, Umzinyathi and uMkhanyakude districts in KwaZulu-Natal Province reaching the targets this year.
Today communities have always played a huge part in the response to HIV. For people most vulnerable to HIV, it is no exaggeration to say that communities often make the difference between life and death.
For young women and girls and for marginalised and vulnerable groups of people such as gay men and other men who have sex with men, transgender people, sex workers, people who use drugs, prisoners and migrants, the pathway to health is not always as clear-cut as it should be. Stigma and discrimination, repressive laws, ignorance and even hate, can all prevent vulnerable people from accessing life-saving prevention, treatment and care.
This is where communities often step in. Communities of people living with HIV, women’s groups and young people, and other marginalized and vulnerable groups, lead and sustain the delivery of peer-to-peer HIV services, defend human rights and advocate for access to essential services. They fight every day to keep people at the centre of decision-making and implementation and help to make sure that no one is left behind.
Today, women most impacted by HIV, including young women, and inclusive networks of feminist activists that bring together sex workers, transgender women and other key populations, are at the forefront of a global movement for the human rights and dignity, and the sexual and reproductive health and rights of all women, and all people, living with HIV.
Community-based services often support fragile public health systems by filling critical gaps; they are led by or connect strongly with women and other marginalized populations; they provide services that complement clinic-based care and they extend the reach of health care to groups that would otherwise fall through the gaps.
This week I had the opportunity to visit the Ritshidze Project, which aims to improve the quality of HIV and TB service delivery in South Africa by empowering people living with HIV to monitor the health services they receive and to advocate for the changes needed.
Through Ritshidze - meaning “Saving Our Lives” in Tshivenda - TAC, in collaboration with four other organizations led by people living with HIV and other partners, implements a community-led accountability system to monitor the quality of HIV services in 419 high burden public healthcare facilities around South Africa.
I experienced first-hand a community-monitoring visit to a busy clinic in Tshwane. I heard from patients who experience long wait times, stockouts of essential medicines such as contraceptives, and healthcare workers who are grappling with the challenge of how to retain people in care.
At a time when reduced funding is putting the sustainability of HIV services in jeopardy, community activism remains critical. Indeed, a greater mobilization of communities is urgently required and barriers that prevent them delivering services and seeking funds must be dismantled. Communities must have the space and power to voice their demands and write their own solutions.
In 2016 world leaders signed the United Nations Political Declaration on Ending AIDS, which recognized the essential role that communities play in advocacy, participation in the coordination of AIDS responses and service delivery. Moreover, they recognized that community responses to HIV must be scaled up and committed to at least 30% of services being community-led by 2030.
Most countries are nowhere near reaching that commitment and where investment in communities is most lacking, there is often weaker progress against HIV and other health challenges.
Communities stand ready to play their part in building healthier and more resilient societies, but they need our support. On World AIDS Day, let’s celebrate communities, recognize the essential role they play in the response to HIV and commit to meeting the promises made to them.