Speaking notes by Minister of Health, Dr Joe Phaahla during a panel discission on – “how countries work towards achieving national and global prevention targets as defined in the road map” – Montreal, Canada

South Africa has made remarkable progress against HIV and AIDS, showing us that a lot can be achieved. Since 2010, new HIV infections have declined in the country by a remarkable 45% representing one of the steepest declines in HIV incidence in the Eastern and Southern Africa region. More than 90% of South Africans know their status and we have initiated more than 5 million people on treatment (ARVs).

Despite successes, new infections remain high in South Africa (200 000) with more than 150 AGYW (15-24) being infected daily. An intensified focus on HIV prevention is a priority for our country to achieve the 2025 prevention coverage target of 95% and the target of fewer than 74 000 new infections by 2025.

Critical priorities for South Africa in HIV prevention

HIV infection irreversibly shapes the lives of hundreds of thousands of adolescent girls and young women so reaching our national targets for reducing HIV is unthinkable without prioritizing adolescent girls and young women. It is estimated that a third of all new HIV infections in the country occur in AGYW age 15-24 years.

Approximately 20–25% of new HIV infections in young women in South Africa are attributable to gender-based violence. In addition, early sexual debut and age disparate relationships are common for AGYW. Genotyping

shows that such relationships fuel the cycle of HIV transmission in South Africa. Tailored integrated SRHR and HIV interventions which focus on adolescent girls and young women remains a priority for the South African HIV response.

Though South Africa has a generalized HIV epidemic, it is characterized by distinct sub-epidemics. The national, HIV prevalence is estimated at 53% among female sex workers, 25.7% among men who have sex with men, 21% among PWID and although no national HIV prevalence estimates exist, programmatic data indicates HIV positivity as high as 49% among Transgender populations. We continue to prioritise a ‘precision prevention approach’ for key and priority populations.

Medical science has given us new HIV prevention tools and even more options are on the horizon. We have prioritised the expansion our basket of combination prevention tools to include recent evidence based long-acting HIV prevention technologies such as the Dapivirine containing vaginal ring (SAHPRA approved) and the long acting injectable Cabotegravir (Still awaiting approvals). A priority is ensuring all vulnerable persons, particularly young people, have choices of a prevention method that works for them.

Taking the right steps now could mean HIV prevention options fulfil their lifesaving, epidemic-ending potential, and to do so requires working faster and more efficiently than ever before. In addition we continue to provide male and female condoms and water-based lubricant in all public health facilities and other non-traditional sites (in communities).

We know that Education is one of the best HIV prevention tools available. We are committed to keep adolescent girls in secondary school (at least till Matric) to reduce their risk of HIV infection, child marriage and teenage pregnancy.

South Africa’s commitment to HIV prevention through national strategies and targets

South African understands the urgency to address the priorities I have mentioned above in order to turn off the tap of new HIV infections.

In addition to the updated National Health Prevention Strategy (2020-2025), South Africa launched a three-year the National Youth HIV Prevention Campaign 2022 to 2025 on 30th June, 2022.

• The strategy focuses on the 9.6 million young people in South Africa aged 15-24 years in and out of school including the 700,000 young people living with HIV.

• It seeks to reach all young people in their diversity to ensure that adolescent boys and young men, youth with disabilities and youth living with HIV are not left behind in the country’s response to HIV, TB and STIs.

• The development of the strategy has been guided by priorities outlined in various policy documents as well as a robust youth-led consultative processes.

• The youth-led HIV prevention strategy aims to strengthen the integration of quality health and social services with youth development programmes that combat poverty and other inequalities.

• The Youth HIV Prevention strategy will be driven through a robust communications campaign including stepping up engagement in digital spaces to reach young people.

Furthermore, South Africa is also developing our 5th generation National Strategic Plan for HIV, TB and STIs for the period 2023-2028.

• This will be the final Strategy before the Sustainable Development Goal of ending AIDS as a pandemic by 2030.

• The new NSP will align with the Global AIDS Strategy 2025 prevention coverage target of 95% and the new global road map for combination HIV prevention.

• It will prioritise the critical programmatic, policy, legal and societal enablers for scaling up primary prevention of HIV infections.

• The COVID-19 pandemic and other humanitarian crises have widened inequalities and are pushing the HIV response further off track. We are committed to build resilient health and HIV systems to respond to pandemics and protect the gains we have made in the HIV response.

South Africa’s political leadership and commitment to domestic HIV prevention financing

1. In 2021, Deputy President of South Africa, H.E. David Mabuza and other heads of state came together at the United Nations in New York and agreed on a ground-breaking Political commitment for ending the AIDS pandemic by 2030. We have less than 8 years to go to reach this common goal.

2. In light of this renewed commitment, South Africa is mobilizing leadership structures at all levels to engage all relevant sectors to take meaningful actions for HIV prevention.

3. As you are all aware, the world is facing the worst economic downturn in a century, adding additional pressure to already stretched public health budgets. This crisis comes sharp on the heels of a devastating Covid-19 pandemic from which they have not yet fully emerged.

4. Nevertheless, based on the South African HIV investment case, we are committed to ensuring sufficient investments in HIV prevention, sustainable financing, and improvements in allocative efficiency.

5. Based on the country’s investment needs, the South African Government is committed to provide domestic funding to support financing transitions of pilots and evaluations of biomedical interventions such as PrEP based interventions, as well as engaging in sensitisation for health care workers and implementers to provide services for key populations among others.

6. We are grateful for the partnership with PEPFAR, the Global Fund, UNAIDS and all our development partners for your commitment to South Africa’s efforts to end AIDS and TB pandemics.

Source: Government of South Africa