Battling the perfect storm

Leora Casey
Leora Casey, Key Populations Manager, NACOSA

At the 9th South African AIDS Conference (SA AIDS 2019), I can only reflect on the work we have done over the years in the fight against HIV. So many inspiring scientists, community representatives and activists in the room working to turn the tide on this virus. ‘Unprecedented innovation and technologies’ was a fitting theme for this year’s biennial conference: 19 years on from the first SA AIDS Conference, South Africa has become a world leader in the work to end AIDS.

One critical innovation launched at this year’s Conference is the South African Human Rights Strategy – aiming to address the human rights and gender-related barriers to HIV, sexually transmitted infections (STIs) and tuberculosis (TB) services. This strategy will go some way towards integrating human rights into programming in the country.

While we have a long road ahead of us to get an additional two million people on antiretroviral treatment (ART), we continue to be challenged by the criminalisation of key populations in South Africa. People who use drugs and sex workers are a microcosm of the human rights barriers that the country faces. Criminalisation in South Africa continues to fuel stigma and discrimination against these populations – and stigma and discrimination fuels a lack of access to services and human rights violations – a nasty cycle increasing HIV vulnerability.

Only by implementing the core package of services prescribed by the World Health Organisation (WHO) for these key populations will we achieve a reduction in HIV infection in these vulnerable groups. South Africa is implementing elements of this package and we are on the right track to supporting epidemic control.

Leora Casey
Leora Casey in front of her poster presentation
at this year's SA AIDS Conference

Innovative technologies and cutting edge research, such as the ECHO study, show us that, while we know what technologies to use, HOW we use them is the real question. HIV remains a growing pandemic and we need to be more innovative in the ways we programme. We need to get better at reaching populations that intersect with one another such as reaching girls that engage in age disparate sex and transactional sex.

HIV is a ‘perfect storm’ of a disease – it impacts and touches on every aspect of people’s lives and intersects with all sectors of society. I am reminded of how much work we need to do on a multi-sectoral level – the fight against HIV has to be multi-sectoral at every level. Public health interventions are not effective without fixing the structural factors that increase vulnerability.

Leora Casey is the Key Populations Manager at NACOSA. Find out more at

9th South African AIDS Conference, SA AIDS 2019, key populations, NACOSA, South African Human Rights Strategy, human rights, criminalized populations, structural barriers, access to health services, barriers to access