Port Elizabeth – More than 14 million South Africans took part in HIV counselling and testing campaign over the past year – that is the size of the urban populations of Johannesburg, Durban, Cape Town, Pretoria, Soweto and Port Elizabeth combined.

‘It is this kind of collective action and the decisive political leadership that can reverse the upward trend if HIV infection,’ said Dr Olive Shisana, CEO of the Human Sciences Research Council and co-chair of the Global HIV Prevention Working Group at the opening of the 6th SAHARA Conference.

Shisana, who established the Social Aspects of HIV/AIDS Research Alliance (SAHARA) network ten years ago, expressed the hope and resolve that the next ten years will see a drop in new infections, an end to discrimination against people with HIV, and a decrease in AIDS-related deaths.

In sub-Saharan Africa, the most severely affected region remains southern Africa. The country with the most people with HIV is Swaziland, where over a quarter of the adult population is HIV positive. Swaziland has now surpassed Botswana, which has diligently implemented HIV prevention interventions and reported decline in incidence.  

Women and vaginal gel

South Africa continues to be home of the largest number of people living with HIV. The tragedy is that a third of women in the age group 25 to 29 are HIV positive, the age where most begin to bear children. Interventions that enable women to bear children without risking HIV infection should be ‘implemented vigorously’, she said, referring to recent interim findings of the VOICE study that Tenofovir gel  – microbicides that can be applied to the vagina or rectum with the intention of reducing the acquisition of STIs, including HIV – does not protect women against HIV. This finding contradicting an earlier CAPRISA-04 study that showed the microbicide to work, and is a serious setback to finding effective methods that give women control over protecting themselves during sex.
‘The hunt for efficacious microbicides must continue’.

Stigma and discrimination

Referring to stigma and discrimination against people with HIV, she singled out women who have sex with women and men who have sex with men.  
The estimate is that since 1998, 31 lesbian women have been murdered simply because they have different sexual preferences, Shisana said, using as an example the South African soccer star Eudy Simelane who was raped and stabbed 25 times by a group of men.

The good news is, Shisana said, that AIDS deaths in sub-Sahara Africa have declined from 1.4 million to 1.3 million, or by 100 000, due to better access to life-saving antiretroviral drugs (ARV), and safer sexual practices. Botswana, Namibia and Rwanda now have universal access to ARV, made possible by a drop in the prices of the medication and the generous contributions of countries of the North to the South.

But in South Africa, despite the increase of facilities providing ARVs and improved funding and the will from government to provide treatment, for example to initiate treatment for all those who test positive with a CD4 count of 350 or less, and according to the Department of Health too few are using the service as shown by the level of spending on ARV treatment, which is lower than expected.

Shisana said the latest evidence that ARV treatment protects uninfected sexual partners from HIV infection as shown in HIV Prevention Trial Network 052 is ground breaking. To implement this intervention in communities, however, will require substantial human and financial resources and unprecedented mobilisation to encourage those living with HIV to seek care early, a call complicated by still high levels of stigma.

‘We will have to be intelligent in how we use the diminishing financial resources and select those interventions known to have a major impact on the epidemic,’ she said. This might mean a combination of methods, such as accelerating the uptake of women enrolling in the prevention of mother-to-child transmission; discouraging sex with sugar daddies and sugar mommies; promote, distribute and market condom use to young and old; the up-scaling of medical male circumcision to young men before they become sexually active; and encouraging the uptake of ARVs. Read the full speech here: