A quick update on HIV: Are we winning the fight? via News24

On World AIDS Day, we traditionally take stock of the progress made during the year in addressing HIV/AIDS – one of humanity’s greatest emergencies. Again this year we do so, but with the youth in sharp focus as we endeavour to reach an ambitious, but not unachievable target: zero new infections by 2030.

In South Africa – the country with the largest HIV burden in the world where 1000 new infections occur every day – we are looking back with a view to looking forward. Our current National Strategic Plan (NSP) on HIV, STIs and TB 2012-2016 expires at the end of the year. Its successor should recognise that our epidemic is different from epidemics in other parts of the world, such as Eastern Europe and North America.

It is an African epidemic, heterogeneous in nature. Our epidemic is linked to sexual intercourse. Our strategy needs to use relevant preventive methods. Rather than doing everything, we need priority-focused interventions that are innovative and evidence-based. Youth are our real ‘key population’.

Championed by the Department of Health and the South African National AIDS Council, the NSP is the combined effort of various sectors and individuals who are now hard at work to define the next five-year strategy, the National Strategic Plan on HIV, STIs and TB 2017-2022.

The new NSP is supposed to take us to just eight years before the big goal: how to decrease the large national incidence rate, which is currently 1.2%, to zero percent by 2030.

Targets are obvious and steep: if in 2016 the annual incidence is 1.2%, then by 2022, it should be 0.7% and by 2027, it has to be 0.3%.

If we meet this target, then we will know that by 2030, the incidence is likely to be zero per cent per annum.

In that sense, this incoming NSP is the roadmap for the path to zero. It is up to us to define which signposts – and measurements – we erect along the path so we can tell whether we are going in the right direction, getting closer to the destination and with what speed and efficiency.

Young people a focal point

For two solid reasons, the path leads through territory that belongs to the South African youth.

Firstly, in South Africa, new HIV infections occur mainly among youth aged 15 to 25. Tragically every week HIV infects 2000 South African girls and young women. This is a five times greater infection rate than in any other country where other young women are being infected.

Secondly the youth are a large and important section of the population and carry on their shoulders the responsibility of advancing the country’s economy and future.

This is acknowledged in the National Development Plan (NDP) which is infused with priorities and strategies targeted at the youth. The NDP notes that HIV/AIDS has had a profound effect on the population, increasing mortality and morbidity across all population groups including women of child-bearing age. We fully concur with the stated priority that efforts should ensure that young women achieve much greater opportunities for empowerment and socio-economic independence.

We want to argue that the youth-centred spirit of the NDP should apply to the next NSP. The intersection between socio-economic factors, youth involvement, youth education and youth health means that only healthy youth will be able to drive a healthy economy and a prosperous society.

What success looks like

Success in decreasing HIV infection, and mitigating the epidemic is most frequently measured in terms of HIV incidence, which is the annual rate of infection.

The current HIV incidence rate in South Africa is among the world’s highest – but the NSP 2012-2016 has done well because in 2012, the rate was 1.37% a year. This trend is clearly something we should continue to drive.

The real goal though is to get to zero by 2030.

To achieve that, the incoming NSP needs to define the path to zero by setting concrete milestones. As we continue to measure progress against them, we should find the incidence dropping – provided that appropriate strategies are being effectively implemented.

So, rather than try to be all things to all people, it would be wise that the new NSP is boldly and proudly focused, prioritised and strategic in its interventions – this will generate the success we are looking for.

In the current constrained global economic climate, we must find cost-effective innovative ways where we can get optimal results. Clearly youth has to be the focus in the NSP and require appropriate strategies.

As HEAIDS (Higher Education and Training HIV/AIDS Programme), we coordinate efforts across all 76 public higher education institutions to enable better student and youth health across more than 400 campuses nationwide for over two million beneficiaries.

We believe in working through youth structures and deploying peer-to-peer methods that are meaningful for youth and expand reach into the communities. Efficient use of proven youth-friendly, HIV-preventive methodologies that match our epidemic is a must if we want to see a significant reduction in infection rates.

Tools for change

Alignment with the NDP and other relevant interventions which seek to address the behind-the-scenes structural drivers of the HIV epidemic will help facilitate the uptake of HIV-prevention tools.

Keeping girls in school will reduce teenage pregnancies which combine with HIV as a dual risk to their health. Enhanced job creation will ensure young people can enter the workplace or re-enter tertiary education to pursue additional training while working – which in turn reduces risks like HIV and alcohol and substance use. The latter helps reduce tendencies to have unprotected sex.

It’s clear that, apart from being youth-focused, we need to make the incoming NSP a priority-focused one. This entails wise use of available resources, thinking and deploying innovations quickly and cost-effectively, and involving more stakeholders and real people as we traverse the path to zero.  

In the age of growing resistance to available medications and treatments, it is not possible to overemphasise the risk that soon, we will have run out of treatment options – so smarter application of existing and faster discovery of new medical tools are a must.

Much has been done to move forward but the path ahead is critical. We need to reach a tipping point that will maintain downward momentum while empowering our youth to put HIV and TB in the history annuals. 

As seen on News24 at http://www.news24.com/Columnists/GuestColumn/a-quick-update-on-hiv-are-we-winning-the-fight-20161201