The health of society?

24 July 2018

The health of South African society is a perennial concern for many, whether in relation to race relations and social cohesion, the state of governance and government, or the economy and livelihoods.

Corruption and crime, the collapse of infrastructure, the alienation of people based on race, sexual orientation, gender and other markers, continues to the detriment of many. For poor people, most - if not all of these - collide and compound already difficult lives. 

Perhaps in the midst of the frenetic news cycle including the hearings on land, the ANC provincial elections and service delivery protests, a critical barometer on the health of the country, through the lens of HIV infections, was lost on many. The release of the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017, launched mid-July 2018 by the Human Sciences Research Council (HSRC) “provides information on national and sub-national progress toward HIV epidemic control” in South Africa. This is of course a survey with a sample size of about 11 000 households and must be supplemented by statistics from Stats SA and the South African National AIDS Council (SANAC), in addition to excellent work done by NGOs and CBOs around the country.    

In a nutshell, the Survey found that 7.9% of the population is living with HIV, with broad trends by race, gender, age and geography identifying no dramatic shifts from previous years. An overall assessment indicates that rates of infection have increased - not significantly - but remain stubbornly high. Predictably women - almost one-fifth of those in their reproductive years - are infected and remain most at risk of contracting HIV. The HSRC Survey raises the alarm bells that prevalence rates amongst adolescent girls and young women (15 to 24 years) are too high. Again, KwaZulu-Natal has the dubious distinction of topping the provincial rates of infection.  

Perhaps in the heyday of pressure from the world and donors in particular, South Africa committed to the UNAIDS target of 90-90-90 by 2020, broken down as follows: 90% of all people living with HIV will know their status; 90% of people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART) and finally 90% of all people on ARTs will have viral suppression, which will result in fewer new infections and deaths overall.  It is estimated that 115 167 deaths were recorded, presumably over the last 12 months, according to Stats SA. In any country not at war, this remains a significant number. Perhaps we too easily take succour that this is a fraction of the deaths in South Africa from AIDS a few years before.     

With 18 months to go on this target, South Africans should be concerned that the Statistician-General announced on 23 July 2018 that the prevalence of HIV in South Africa has risen. The current estimate is that there are now 7.52 million people infected. Additionally, while these numbers are announced by the Statistician-General, the International AIDS Conference convenes in Amsterdam from 23 to 27 July, under the theme, “Breaking Barriers, Building Bridges”. The conference website describes the theme as focussing “attention to the need of rights-based approaches to more effectively reach key populations, including in Eastern Europe and Central Asia and the North-African/Middle Eastern regions where epidemics are growing … AIDS 2018 aims to promote human rights based and evidence-informed HIV responses that are tailored to the needs of particularly vulnerable communities -- including people living with HIV, displaced populations, men who have sex with men, people in closed settings, people who use drugs, sex workers, transgender people, women and girls and young people--and collaborate in fighting the disease beyond country borders”. It should be anticipated that with already limited donor funding available globally, “new” regions where infections are increasing will compete with South Africa for funding, which does not bode well for the country, already struggling to meet existing fiscal commitments in a time of low growth.        

The story of HIV/AIDS in South Africa has been well documented. Key messages around stigma and discrimination of people living with HIV/AIDS were commonplace, as were programmes to ensure the physical, mental and social wellbeing of infected and affected people. Massive amounts of donor support flowed into the country and overtook domestic fiscal commitments to fight the epidemic. The key question for consideration is why, despite all of the above and then some, including an ambitious rollout of ARTs, is the dial not moving substantially as the country struggles to curb the increasing rates of infection.

This is an issue that the country is going to have to seize itself with, again with a measure of urgency. We know what the causes of the epidemic are, including patriarchy, sexual violence against girls and women, reckless behaviours and the growing phenomenon of blessers. The impact of these undermine and have a corrosive effect on the health of society and the economy and mitigates against a people at peace with self and with each other.               

By Ms Zohra Dawood, Director, Centre for Unity in Diversity, 24 July 2018