Urgent action needed to combat HIV and GBV

SOUTH Africa’s annual 16 Days of Activism Against Gender-Based Violence was launched on November 25 and runs to December 10. This year’s theme is “Time to Act Now”.

On December 1, the global community will come together, as has been done annually since 1988, to commemorate World Aids Day. Led by UNAids, this year’s theme is “Take the Rights Path: My health, My right”.

Why link sexual and gender-based violence with HIV? Data shows that women are more likely to acquire HIV than men, especially in the younger age groups.

Adolescent girls and young women aged 15 to 24 are more likely to be HIV-positive than adolescent boys and young men. The difference points to girls and women being infected by older men.

It has also been long known that many women who are living with HIV were infected through non-consensual sexual acts, often accompanied by physical and emotional violence linked to the imbalance in power between women and men.

Last year, the SAPS reported more than 53000 sexual offences of which almost 43 000 were rape, which is probably an underestimate as many instances of sexual violence against women go unreported. Ending sexual and gender-based violence would lead to a reduction in HIV rates.

As we approach the 36th World Aids Day, what can we report as progress and what more should be done to decrease new HIV infections and ensure that more people with HIV are tested, on treatment and virally suppressed?

There are about 150000 new HIV infections in South Africa annually. This adds to the estimated more than seven million people living with HIV, of whom around 5.5 million are on life-saving antiretroviral therapy.

While people we loved died around us over the past 30 years, especially between 1985 and 1995, there was much communication and awareness about HIV.

Mortality decreased significantly as we rolled out antiretroviral drugs, and fewer people we knew and loved died, which has resulted in a false sense that we have overcome one of the greatest epidemics to face humanity.

Therefore, the work is not yet done – globally 1.3 million people acquired HIV last year, of which 760000 were in Africa and 150000 in South Africa.

Globally, about 23% of people living with HIV do not have access to treatment. Regrettably, in South Africa, about one in four people living with HIV are not on treatment. This contributes to the 50000 or so people who die every year.

Many of the deaths could have been avoided if people who were vulnerable to HIV were tested, initiated on ARVs early and remained on treatment so that they were virally suppressed.

With more than 50% of people with HIV also infected with TB, we must also ensure that people with HIV are tested and treated for TB, because many of the deaths of people with HIV are the result of TB infection. We know that while HIV can be treated, TB can be cured.

What should we do?

First, we should all be aware of HIV and its cousin, TB, and the fact that we can all be infected. However, we can act, individually and collectively, to prevent the infections. Let’s spread the prevention messages we know well but seem to have forgotten.

The government, the private sector and civil society have the responsibility to improve and expand communication around HIV, TB and GBV. Most people regularly use social media; we could use the channels to communicate health messages effectively.

Second, we can prevent HIV and TB. For HIV, the use of condoms prevents HIV transmission and other sexually transmitted infections, as well as unwanted pregnancies. Syphilis and teen pregnancies have rocketed in recent years.

Public clinics provide free pre- and post-exposure prevention medication (PEP and PrEP). We hope that long-acting injectables for HIV prevention (injections every two or six months) will also be available soon. At the rate in which we are reducing new HIV infections, we will have more than 60000 new infections a year in 2044.

Third, we should encourage all those who are vulnerable to HIV and TB to get tested regularly. HIV self-testing kits are available for anyone to test themselves or be tested in public health clinics for free and be initiated on treatment. Similarly, TB tests in public clinics are free, as is treatment.

To get as many people on treatment for HIV as possible, we need to be more ambitious. An ambitious goal should be to add at least 1.1 million more people on HIV treatment and keep them virally suppressed. This will prevent new infections, as they will not transmit to others, thereby reducing new HIV infections.

Together with this ambition, we should test and treat many more people for TB, including those without symptoms. About 50% of people with TB have no symptoms. This means that people with previous TB, people with HIV and contacts of people with active TB, should also be tested, in addition to those with TB symptoms (coughing for longer than two weeks, weight loss, night sweats and chest pains).

Fourth, those who test positive for HIV and TB must be treated and stay on treatment as prescribed. It is lifelong for HIV and at least six months for TB. This means that health professionals, community health workers, family members and friends should support people with HIV, to stay on the chronic medicines, as we should do for other chronic conditions like diabetes and hypertension.

This World Aids Day, let’s commit to being a healthier nation by taking charge of our health, that of our family members as well as our communities – we can do this. A healthy nation is a productive nation.