HIV-Aids: South Africa’s journey and the road ahead

Every year, on 1 December, South Africa joins other countries in observing World Aids Day — a day of remembrance, resilience and renewed commitment to combatting one of humanity’s most enduring health crises. 

As I pause to reflect on this year’s theme, Take the Rights Path, I’m struck by the progress we’ve made as a nation and the hurdles we still face. 

I am especially humbled by the work of civil society organisations in the fight against HIV-Aids, compounded by other pandemics such as gender-based violence (GBV). The work of civil society reflects our humanity and our commitment inherited from our forefathers and the great mothers that walked this earth before us.

I remember vividly the fear and stigma that enveloped communities in the early 2000s. Recently, through the hard work and great commitment of people living with HIV, supported by many partners including academia and institutions such as the Human Science Research Council, we delivered the 2016 Stigma index research report. Stigma Index 2.0 is in progress, led by the people living with HIV sector, through the resourcing support of The Global Fund to End Aids, Tuberculosis and Malaria. We look forward to these outcomes.

Today, South Africa boasts the world’s largest antiretroviral treatment (ART) programme, a testament to what political will and collective action can achieve. The tireless work of activists, healthcare workers and ordinary citizens has saved millions of lives. People living with HIV can now expect to lead full, productive lives. 

However, beneath these triumphs lies a sobering reality — the inequalities that fuel the epidemic remain deeply entrenched.

The statistics paint a stark picture. South Africa is home to 7.8 million people living with HIV, with young women aged between 15 and 24 bearing the brunt of new infections. Poverty, GBV, and limited access to education perpetuate a cycle that makes young women particularly vulnerable. As a society, we cannot separate the fight against HIV-Aids from the broader struggle against inequality.

This year’s World Aids Day theme challenges us to address these structural barriers head-on. But how do we translate this lofty goal into tangible action? For me, the answer lies in the stories of resilience I’ve encountered.

Take Thandi, a peer educator I met during a community outreach programme in KwaZulu-Natal. At just 19, she’s already a force to be reckoned with, using her own experience of living with HIV to educate and empower others. 

Thandi’s story underscores the importance of investing in local initiatives that centre the voices of those most affected. When we give young people the tools and platforms they need, they become powerful agents of change.

We must also tackle the pervasive stigma and discrimination which continues to hinder progress. Despite decades of awareness campaigns, misconceptions and disinformation about HIV persist, often isolating those who need support the most. 

Normalising conversations about HIV in schools, workplaces and homes can go a long way in breaking down these barriers. It starts with education, but it also requires empathy and compassion — a willingness to see beyond the virus and recognise the humanity of every individual affected.

Finally, we need to hold our leaders accountable. The fight against HIV-Aids cannot succeed without sustained political and financial commitment. This means not only funding ART programmes but also addressing the social determinants of health that drive vulnerability. 

South Africa spends over R30 billion annually on its HIV-Aids programs, which includes the costs of its extensive ART programme. Thanks to bulk procurement and partnerships, the per-person cost of ART is approximately R1 800 to R2 000 per year. 

While international donors like The Global Fund and PEPFAR provide crucial support, South Africa shoulders more than 80% of these expenses, demonstrating its commitment to combating the epidemic. It means ensuring that every clinic, no matter how remote, has the resources to provide comprehensive care. And it means standing up against policies or practices that perpetuate inequality, whether in healthcare, education or employment.

On World Aids Day 2024, Deputy President, Paul Mashatile reinforced this commitment, emphasising community-led interventions as key to reducing stigma and improving health literacy. 

He highlighted the vulnerability of adolescent girls and young women, advocating for targeted strategies like the “Zikhala Kanjani” Youth HIV Prevention Strategy. 

Mashatile also underscored the importance of leveraging technology, including digital platforms like the B-Wise Health app, to enhance youth engagement and access to healthcare. Recognising global disparities, he called for efforts to make innovations like injectable antiretrovirals more accessible in South Africa. 

His speech reaffirmed the nation’s dedication to ending Aids in children by 2030 and achieving universal health coverage.

The Treatment Action Campaign also made waves on World Aids Day, issuing a powerful memorandum with actionable demands to improve South Africa’s HIV-Aids treatment framework. 

One key request was to extend the supply of ARVs to six months for stable HIV patients. This measure aims to reduce clinic visits, improve patient adherence and ease the burden on the healthcare system. 

The organisation emphasised the importance of addressing stigma and the marginalisation of LGBTQIA+ individuals and sex workers within the healthcare system. 

Health Minister Dr. Aaron Motsoaledi expressed support for these proposals, recognising their potential to benefit patients and the broader healthcare infrastructure. While logistical challenges remain, the commitment to prioritise these reforms highlights the nation’s determination to innovate and lead in the global fight against HIV-Aids.

As I reflect on South Africa’s journey, I’m filled with both pride and urgency. Pride in the strides we’ve made as a nation and urgency to tackle the challenges that remain. World Aids Day is more than just a moment to commemorate; it’s a call to action. Ending inequalities is not an abstract ideal — it’s a tangible goal we can achieve if we work together and uphold the human rights of all people living with HIV.

The road ahead is daunting but it’s also filled with promise. When I think of Thandi and countless others like her, I’m reminded that hope and resilience are powerful forces. 

Let’s honour their courage by redoubling our efforts to create a South Africa where no one is left behind in the fight against HIV-Aids. Let’s take the rights path — not just for today, but for generations to come.

Solly Nduku is the chair of the Civil Society Forum at the South African National Aids Council and the general secretary of the National Unitary Professional Association for African Traditional Health Practitioners in South Africa.