Health minister Dr Aaron Motsoaledi has identified men as a major challenge in South Africa’s efforts against HIV. The problem: men are less likely to test for HIV, get started on antiretroviral therapy (ART), and stay on treatment.
He was speaking at the launch of a campaign aimed at getting an additional 1.1 million people on HIV treatment by December 2025. Motsoaledi called out men, saying, “It is us who are holding it back. I was told that when we go to clinics, women come there in large numbers but men are nowhere to be seen.”
Women are more likely to test, and more likely to stay on treatment. Treatment interruption is higher among men than women. HIV-related deaths are also higher among men than women.
The latest South African National HIV Prevalence Survey (SABSSM V1) shows that men make up 2.6 million of the 7.8 million people with HIV in the country, 1.8 million (76%) of these men are on ART and 78.8% had viral load suppression. This means they have an undetectable viral load and have an almost risk of transmitting HIV sexually to their partners.
The three indicators – get tested, get on treatment, and stay on treatment – are the cornerstone of the global campaign to end AIDS as a public threat by 2030. To reach this goal, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 95-95-95 targets.
“This means by 2025, 95% of people living with HIV should be aware of their status, 95% of those who know their status should be on treatment, and 95% of those on treatment should achieve viral load suppression,” Motsoaledi says.
Why men default on treatment
Gordon Didiza, 44, from Soweto, attended the launch and shared his personal experience, explaining that he was diagnosed with HIV in December 2018.
“I was very sick and went to the clinic. When I tested for HIV, the results came back positive and I was put on ART treatment. It wasn’t a shock because I knew my lifestyle,” he says.
Didiza was immediately placed on ART. But just three months later, in March 2019 he stopped taking his medication.
“The nurses at the clinic were rude and disrespectful. They made me feel small. I hated going to the clinic and avoided it to escape the embarrassment of being told ‘no one sent you to get HIV’,” he says.
After not taking his HIV medicine for four months, Didiza decided to go to a different clinic to restart treatment following advice from the People Living with HIV and Treatment Action Campaign (TAC) group working with people in his neighbourhood.
Interrupting ART increases the risk of HIV transmission, the development of drug resistance, and opportunistic infections.
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Mluleki Zazini, chairperson of the people living with HIV sector of the South African National AIDS Council (SANAC), says removing barriers in healthcare facilities is crucial to achieving the second 95% target of getting people who know their HIV status on ART treatment.
“The barriers are related to the attitudes and insults men receive from healthcare providers. It’s one of the reasons why men avoid clinics,” he says.
Zazini adds that to fight the barriers in healthcare facilities, people living with HIV are calling to have a desk at every healthcare facility so they can handle complaints directly, instead of relying on suggestion boxes.
Show of commitment
UNAIDS Regional Director for Eastern and Southern Africa Anne Githuku-Shongwe expressed optimism about the South African government’s continued commitment to the HIV acceleration plan, despite the service disruptions caused by the US 90-day freeze on foreign aid.
She says the country has demonstrated its commitment to end the HIV pandemic as it has domestic resources that account for 74% of South Africa’s HIV response. The US government funding only accounted for 17% of the country’s financing of HIV response.
“We need a prevention agenda to ensure that everybody continues to get the services. Our analysis shows that the private sector only provides 2% of services in our country. It is high time they show their support. I am sure we can have solidarity funds against HIV,” she says.
Progress in the fight against HIV
The SABSSM V1 found that HIV prevalence for all ages decreased from 14.0% in 2017 to 12.7% in 2022 translating to a decline from 7.9 million (2017) to 7.8 million (2022) people living with HIV. The number of people receiving ART increased from 63.7% in 2017 to 80.9% in 2022. This translates to an estimated 5 700 000 people living with HIV receiving ART, an increase from 4 500 000 in 2017.
“We should not accept that AIDS is here forever. It is not. We want to end it. It’s all in our hands and it depends on our will. We can stop it so that in future we can work on other diseases. We are taking the last mile,” the minister says.
The SABSSM V1 shows that in 2022, 89.6% of people aged 15 and older living with HIV were aware of their status; 90.7% of those aware were on ART; and 93.9% of those on ART had a suppressed viral load. – Health-e News
