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South Africa's HIV Response: Hope, Tools, and Resolve

South Africa's HIV Response: Hope, Tools, and Resolve

IOL News4 days ago
South Africa has the world's largest HIV treatment programme, with over 5.5 million people receiving antiretrovirals (ARVs). Yet we still see more than 100 000 new HIV infections each year. That is unacceptable — and preventable.
Image: Tumi Pakkies/ Independent Newspapers
Earlier this month, more than 3,600 scientists, activists, policymakers, and journalists gathered in Kigali, Rwanda, for the 13th International AIDS Society (IAS) Conference on HIV Science.
It was the first time this major global event took place in an African city outside South Africa, marking a powerful recognition of the continent's critical role in the global HIV response.
The conference came on the heels of deeply concerning news: in January, the US government announced sharp cuts to funding for the President's Emergency Plan for AIDS Relief (PEPFAR), a move that cast a long shadow over the global fight against HIV, particularly in Africa. The numbers are staggering: of the 40.8 million people living with HIV globally, over 26 million (65%) are in Africa. And more than half of all new infections in 2024 occurred on the continent.
A Call to Stay the Course
Despite fears about reduced funding, the mood in Kigali was one of resolve. Delegates affirmed their commitment to ending HIV, recognising the extraordinary progress made in Eastern and Southern Africa. Many echoed a common sentiment: "We cannot stop now. We must fight to the end", emphasising the need for sustained commitment and effort to achieve an AIDS-free future.
That optimism was reinforced by encouraging developments. The pharmaceutical company Gilead announced that Lenacapavir, a new HIV prevention drug administered via two injections a year, has shown high efficacy in clinical trials. If made widely accessible, this could be a game-changer— especially for those who struggle with daily pill regimens.
Further hope came when the US Congress ultimately approved continued PEPFAR funding, although uncertainties remain around the duration and scope of future support.
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What This Means for South Africa
South Africa has the world's largest HIV treatment programme, with over 5.5 million people receiving antiretrovirals (ARVs). Yet we still see more than 100 000 new HIV infections each year. That is unacceptable — and preventable.
To address this, the government launched the '1.1 Million Campaign' in February to close the gap between those who know their HIV status and those who are virally suppressed. But for this initiative to succeed, we need national mobilisation.
Every political leader, community organiser, religious institution, and employer must actively support the campaign. Unfortunately, media coverage has been limited, and public awareness remains low.
Doing More with Less
With reductions in funding from the Global Fund and PEPFAR, and despite increased domestic investment, every rand in our HIV response must count. Managers and community activists in the health and social development sectors must track data rigorously: Who is being tested? Who is on treatment? Who is virally suppressed? Who is using Pre-Exposure Prophylaxis (PrEP) — and who should be, but isn't?
We must also stand firm against stigma. There is no justification for discrimination against people living with HIV or those using preventive treatments like PrEP. They are taking responsible steps to protect themselves and others. They should be commended and supported, not shamed.
The Tools Are in Our Hands
We now have powerful tools to fight HIV. HIV self-test kits are available free at public clinics and affordable at private pharmacies. Oral PrEP— a once-a-day pill to prevent HIV — is also free at government health facilities. And injectable PrEP, which could significantly improve adherence, is expected to be available next year.
Condoms remain a highly effective prevention method. Let's not forget—they also prevent sexually transmitted infections like syphilis and gonorrhoea and help avoid unplanned pregnancies. They are free at all public clinics.
Let's also remember the link between HIV and tuberculosis (TB). People with HIV are more susceptible to TB. If you have symptoms or have been in contact with someone with TB, get tested. Early detection saves lives.
Health Is Everyone's Business
Building a healthier South Africa is not just about medicine—it is about national prosperity. A healthy population is more productive, more resilient, and more able to seize economic opportunity. Each of us has a role to play in protecting our health and the health of our communities.
Let's work together to end HIV. The finish line is in sight—but only if we don't stop now.
Prof Yogan Pillay is the Director for HIV and TB delivery at the Bill & Melinda Gates Foundation. He was previously the Country Director of the Clinton Health Access Initiative in South Africa and senior director for universal health coverage. He has worked in various capacities at the National Department of Health. In 2021, the University of Cape Town awarded him an honorary doctorate, and in the same year, he was appointed extraordinary professor in the Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University.
Foster Mohale is the National Department of Health Spokesperson
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Small win for activists, but SA's HIV projects won't get reopened
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Small win for activists, but SA's HIV projects won't get reopened

The $400m that US Congress hasn't cut with the rest of its funding programme doesn't undo the blow to global HIV and TB programmes By The $400m that the US Congress took off a list of programmes from which the Trump administration will now take back previously approved but unspent funds, doesn't mean the cuts to global HIV and TB programmes in February, including those in South Africa, are now reversed. HIV projects that have closed in South Africa, which were formerly funded by the US government, won't restart as a result of this decision. In fact, quite the opposite. The 'limited Pepfar waiver' that President Donald Trump announced in February remains in place. 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Rescissions happen when the presidential administration wants to cancel funding that was approved by Congress and then use it for something else. What the decision to remove the $400m from the package does, however, mean is that activism could finally be starting to pay off. Activists have had hundreds of meetings with US senators and Congress committee chairs. There have been 'Save Pepfar' social media campaigns, and plenty of media coverage about the devastating consequences of the funding cuts. Tens of modelling studies have also projected what could happen if the lost funds are not replaced. Opposition from within Trump's Republican Party against nonevidence-based cuts to a programme that has, for two decades, been supported by both the Democrats and Republicans and has saved over 25-million lives, is now at last emerging. 'It's a small win within the bigger context, but nonetheless, a huge win for advocacy, and a reminder that activism is powerful and alive, and making an impact,' Jirair Ratevosian, a former head of staff at Pepfar and fellow at Duke University's Global Health Institute, told Bhekisisa at last week's Conference on HIV Science in Kigali. Around $8bn of the money was for foreign aid and development programmes, including global health, and just over $1bn for public broadcast stations that the Trump administration has accused of being biased because they're too liberal. But the Rescissions Act is, in itself, bad news. 'It opens the floodgates for the Trump administration to say 'we don't want this or that in the budget that Congress approved',' says Mitchell Warren, the head of international advocacy organisation Avac. 'It's trying to take the congressional power of the purse and put it in the executive branch to usurp the role of Congress in deciding how much money — and on what to spend it.' So how did this all happen, and does it hold any good in the long term for South Africa? We break it down. 1. How did we get here? In the US, Congress — it consists of the Senate and the House of Representatives — decides how much government money goes to who, just like parliament does in South Africa. Both the Senate and the House have to pass budgets. But, as analysts at the Centre for Budget and Policy Priorities in Washington, DC point out, President Trump wants more control over how his administration's money is spent. In March, he signed the 2025 budget that Congress approved into law. Three months later, in June, he decided he wanted to change some of that and submitted a $9.4bn rescission request, which the House of Representatives (it has five more Republican than Democrat members) passed on June 12. 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We also know that the $400m was part of the financial budget for 2025, says Warren, but because the law gives Pepfar permission to spend money over five years, that money doesn't have to be legally spent until 2029. 3. What will the $400m now be used for? Again, no one knows. We don't even know if it will be used, because over the past few months, the Trump administration's main strategy has 'simply been to illegally impound funds — by announcing a 'funding freeze' or 'programmatic review' with no public notice at all — and force those harmed by the impoundments to pursue relief in court', the Centre on Budget and Policy Priorities explains in an analysis. But we do know what the money can't be used for. Unless the rules of Trump's 'limited waiver' are changed, Pepfar funds can mostly not be spent on any of the evidence-based strategies it paid for before Trump was elected in January. 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Why the world must aim to eliminate PEPFAR and end the HIV epidemic
Why the world must aim to eliminate PEPFAR and end the HIV epidemic

IOL News

timea day ago

  • IOL News

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WHO announces lenacapavir as a groundbreaking HIV prevention method
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