He has been hailed for as one of the many people who have contributed to ensuring that millions of South Africans living with HIV are on treatment and now he is about to leave the country in pursuit of other interests. But ahead of his departure, US Health Attaché Steve Smith concedes that the battle to reduce HIV infections in SA is still ongoing and will be for quite some time. 

Addressing colleagues and industry experts recently, Smith explained that through the United States President's Emergency Plan for AIDS Relief programme known as PEPFAR, the country has made significant strides in ensuring those affected live longer. The programme was established under the administration of former US President George W. Bush.

"In 2004, lots of people were dying and had been unnecessarily dying for a long time. The PEPFAR programme really showed that the partnership between our two countries, the United States and South Africa, was important and again it was not always an easy road. There were some particular challenges at the time but there was also some inspiration including the true heroes who recognised the need and committed the rest of their lives to the people of South Africa," he said.

Smith went on to say: "I arrived here six years ago and I couldn't believe we had two million people on treatment, We had a government that was supporting science-based public health. It was phenomenal and I was so proud to see the results of that partnership. But I also then very quickly realised that it is a house on fire issue and that we still have public health emergency as it was back then and frankly what it will be for some time to come."

Meanwhile, Smith who also worked with the U.S. Department of State in Cameroon and Haiti leading the HIV programs there recounted some of his experiences dating back to 33 years ago.

"In 1985, coming to Pretoria was a little traumatic. We were in a State of Emergency. There was a lot going on.  It was not great. Pretoria was the centre of a fair amount of that. I remember events around Pretoria were not as fun. I remember coming here for court cases and it just seemed like the bastion of what seemed wrong. In many parts of the country, there was so much of what was right. 

When I was here we worked with UDF, Black Sash, Legal Resources Centre. While they may mean nothing to you, they meant a lot to me. What I came away with from that experience and in meeting South Africans all around the country is that there were many people who were incredibly optimistic during this really difficult time," adding their optimism also signalled great things that were to come in the future.

Video: Noni Mokati

Last month the national department of Health welcomed the US government's decision to increase funding for the country’s HIV programme to U$730 million for the 2019/20 financial year following negotiation in Washington DC. There had been suggestions that the funding would be slashed.

Smith highlighted that with the right combination of evidence, political support and an intense level of commitment they were able to justify spending taxpayers money in the country, adding: "It is not because we are buying something but because we are seeing the future".

With President Cyril Ramaphosa's administration committing to getting two million more people on antiretroviral treatment by December next year, Smith said his wish as he moves on would be for South Africa to increase not only increase the number of people on ARVs but to also increase the quality of the programme as well as new scientific innovations.

Anova Health Institute chief executive officer Professor James McIntyre said Smith was unique as he had seen the growth and the health progress of the country since 1994 adding it was an occasion such as these that one needs to look back and the amazing progress SA has made.

Retired chief medical officer at Anglo American and Section27 board member Brian Brink said Pepfar had changed the game. 
"The convention that treatment could be provided to low-income developing countries is the reason why we have embarked on a successful journey thus far," he said.

Smith is in the country until June 18.