Sixteen years ago an 11-year-old South African boy, tiny for his age, stood alone on a huge stage. He had a microphone in his hand and a smile on his face. And he spoke truth to power.
“I hate having AIDS because I get very sick,” he said. “I get very sad when I think of all the other children and babies that are sick with AIDS… Babies are dying very quickly…”
The occasion was the 13th International AIDS Conference, held in Durban in July 2000. The boy was Nkosi Johnson. He died just a few months later.
This year, as South Africa prepares to host the International AIDS Conference for the second time – in Durban again, from 18 to 22 July – it’s worth reflecting how different Nkosi Johnson’s story would have been today.
Since then, South Africa has done much to tackle HIV, rolling out the world’s largest treatment programme to its citizens and improving primary healthcare. Sixteen years ago HIV infection was a death sentence, particularly for the poor and vulnerable – and especially children. In 2000, in South Africa, the lifetime risk of dying of AIDS was as high as 50%.
Today HIV is a chronic condition, controlled as many chronic conditions are – such as diabetes – with medication. Children like Nkosi Johnson, infected at birth, now live, flourish and grow into healthy adults.
This progress, and the lives saved, is borne out by South Africa’s life expectancy. After years of steady improvement in the late 20th century, it suddenly dropped to a low of 51.7 years in 2005. At the same time countries such as India and Brazil continued their steady rise.
Thanks to our HIV treatment programme, life expectancy has begun to rise again. Today, Statistics South Africa puts our life expectancy at 60.6 years for men and 64.3 years for women.
Why the change? What happened in 2005? In 2005 South Africa embraced the problem with energy, rolling out a massive antiretroviral treatment programme through its public health system.
Today our response to HIV is framed by broad global policy – including our own National Development Plan, the African Union’s Agenda 2063 and the UN Sustainable Development Goals – to vigorously provide comprehensive treatment and care to as many as possible.
We know treatment alone is not enough. Our policies and programmes also aim to change risky behaviour and find solutions to the social and economic conditions that make people vulnerable to HIV infection.
In 2010, the fight against the epidemic was ramped up with the launch of the world’s biggest programme to test for infection, the HIV Counselling and Testing campaign. Within 18 months of the launch of the campaign, which is ongoing, a full 18 million South Africans, over a third of the country’s population, had tested and knew their HIV status.
Today, about 10 million South Africans take the test every year. Testing is a major weapon in the fight against HIV. Simply knowing they are HIV-positive makes people far less likely to risk infecting others.
The fruits of South Africa’s decade-long fight against HIV can also be found elsewhere. AIDS-related deaths have declined from 345,600 in 2005 – when the disease claimed half of all deaths in the country – to 151,000 in 2014, when 29.2% of all deaths were AIDS-related.
Significantly, the transmission of the virus from mother to child during or after birth has dropped from 70,000 babies in 2004 to fewer than 7,000 in 2015.
In 2000, when South Africa hosted the International AIDS Conference for the first time, people living with HIV had no access to treatment and the country was under attack by the global community for its stance on HIV and AIDS.
Today, we have more than 3 million people on publicly funded antiretroviral treatment. We aim to have 4,2 million people on treatment in the next two years.
But HIV is a powerful enemy. There are still problems to be unearthed and tackled. One is a worrying prevalence of new HIV infection in adolescent girls and young women. It is estimated that some 2,000 young women aged 15 to 24 are infected by HIV in South Africa every week. This is by far the highest rate of infection in any age or sex category – and one of the highest infection rates in the world.
HIV thrives in conditions of ignorance and poverty, and in situations of gender inequality. This infection rate is intertwined with other critical social problems directly experienced by South Africa’s young people: high rates of teenage pregnancy, high school drop-out rates, widespread sexual violence and high youth unemployment.
In an effort to tackle the problem, in late June 2016 South Africa launched the National Campaign for Girls and Young Women. This aims to fight practices that put adolescent girls and young women at risk of HIV, such as unsafe sex, destructive behaviour, and drug and alcohol abuse.
Another goal is to build adolescent girls and young women’s confidence and resilience, and give them greater economic opportunities. It will also target men, encouraging them to help effect the crucial, fundamental change in South Africans’ sexual behaviour.
Working with NGOs and local AIDS councils, the new campaign will encourage men – both young and older – to use condoms, stick to one sexual partner and not prey on young girls and women. It will task men with joining the call for safer sexual behaviour and an end to violence and the abuse of women.
The project is supported by over $140 million in funding from the US and German governments and the Global Fund. It will be rolled out over the next three years to 51 municipalities with the highest incidence of new HIV infections. At its core is the principle that our best weapon in South Africa’s new battle against HIV and AIDS is knowledge and education.
It is clear that having the largest treatment programme on the planet isn’t enough. As we welcome the world to the 21st annual International AIDS Conference on 18 July – Nelson Mandela Day – we must remember that it is only through education that we will find our path towards an AIDS-free generation. DM
Cyril Ramaphosa is Deputy President and co-chair of the South African National AIDS Council.