Our key takeaways from SA AIDS 2019

eThekwini Declaration
The SHARE team

Reflecting on this year’s South African AIDS Conference, the SHARE team identified the following key messages:

  1. We need to sustain momentum for the HIV response. Much has been achieved, but the epidemic is far from over: we need to ensure that the more than six million people on ART in South Africa are retained in care and provide treatment to two million more people to achieve universal coverage. This requires a renewed sense of urgency, innovation, and ongoing funding commitment.
  2. We need to escalate the HIV response among young people. Population-based HIV prevalence data from 2012 to 2017 shows that over one in three new HIV infections are among those aged 15-24 years old, with prevalence three times higher among females than among males of the same age. HIV prevalence is increasing among this age group due to new infections, and we are not achieving our prevention goals. Only 39% of youth living with HIV in this age group are on treatment. Of those on treatment, only 48% are virally suppressed.
  3. Prevention needs more attention. HIV incidence is decreasing but is still large enough to sustain the epidemic. Universal test and treat is not a magic bullet which will make the HIV epidemic disappear: prevention needs to remain a critical component of the HIV response. Social behavior change interventions such as Vhutshilo, RISE Young Women’s Clubs, and Soul Buddyz Clubs have demonstrated effects on personal skills and awareness and uptake of services, as well as on outcomes such as teenage pregnancy, medical male circumcision, and HIV status.
  4. Men are a critical group that need ongoing support. While more young women are getting infected, more young men are dying of AIDS. We must incorporate research findings on men’s relationship with, perceptions of, and treatment at HIV service points and work within existing gender frameworks to transform them into places where men are welcomed and affirmed.
  5. Human rights need further attention. A baseline assessment on human rights-related barriers to HIV services in South Africa identified ongoing violence and abuse of key populations despite progressive laws protecting human rights. In addition, populations at risk of arrest (such as sex workers and undocumented migrants) tend to avoid health services. South Africa’s National AIDS Council (SANAC) launched a new three-year plan to tackle gender inequality and human rights-related barriers to HIV and tuberculosis health services at the conference.
  6. It matters who is left out of the 90-90-90 cascade: While there is clear evidence on the value of universal coverage of ART to reduce HIV incidence, recent research findings indicate that generalized HIV epidemics can be sustained based on who is left behind – including populations which have high potential for onward transmission, such as sex workers and men who have sex with men. In addition, structural barriers can critically hamper success: sex workers who live in criminalized settings have an eight times higher risk of HIV infection.
eThekwini Declaration
SA AIDS 2019 chairperson, Prof. Refilwe Phaswana-Mafuya,
presents South Africa's Deputy President David Mabuza with
the "eThekwini Declaration" at the conference closing ceremony

During the closing session, SANAC presented priorities for the country’s HIV response in terms of prevention; treatment and care; and social, structural, and behavioral interventions. Key enablers include ensuring that the response is community-driven and multi-sectoral, utilization of quality data, increasing resource mobilization, revitalizing a robust national communications campaign, and implementing the unique patient identifier system. Success requires deeper, stronger foundations for resilient and sustainable systems for health, speaker Sandile Buthelezi claimed, though integration of HIV, TB and STI services, stronger procurement and supply chain systems, and increased human resources for health.

Access the oral and poster abstracts presented at the conference at www.saaids.org.za.