Johannesburg, 24 March: On World TB Day, whose theme this year is “Yes! We Can End TB: Commit, Invest, Deliver”, we consider the impressive progress that the SADC region has made in the fight against HIV and also recognise that there are significant challenges to the fight against HIV. We call for greater solidarity to stand together against stigma and to ensure that we will continue to push forward, regardless of the challenges thrown against us. In our region, TB is still a leading cause of death among people living with HIV. In 2021, 11 SADC countries were on the WHO’s High Burden list (of 30 countries globally) for HIV-related TB. TB is the leading cause of death in people living with HIV. SADC had an estimated 66 836 deaths as a result of TB in people living with HIV (PLHIV), which was 39% of the global deaths from TB in PLHIV. This is a more than 70% decrease from the 283 044 TB related deaths in PLHIV in 2000.
SADC countries have made significant progress in controlling HIV, aiming to eliminate it as a public health threat by 2030. Despite challenges posed by COVID-19, which affected testing and prevention, treatment programs largely continued due to innovations like multi-month medication dispensing and community-based treatment. Community groups played a crucial role in this ongoing struggle against HIV.
SADC is the epicentre of the HIV epidemic, with six countries that still have antenatal prevalence rates above 10%, which are the highest in the world. Some of the impressive gains that have been made are: Eswatini, Botswana, Zimbabwe, Zambia, and Malawi have achieved the 95-95-95 targets set for 2030; Lesotho and Namibia are on track to meet these targets by 2025. AIDS-related deaths have decreased from 478 700 in 2010 to 207 000 in 2023, and new infections among children aged 0 to 14 have dropped from 246 600 to 44 300 in the same period. Botswana and Namibia are successfully working towards the elimination of vertical HIV transmission to children (or fewer than 750 new HIV infections per 100 000 births). Many other statistics bear testimony to the enormous effort that governments, communities and civil society, with support from many partners, have invested in pushing back on HIV.
Yet many challenges remain. An alarming increase in the numbers of people living with HIV in Madagascar is a stark reminder that a low-level epidemic that was believed to be mainly within key populations, especially people who inject drugs, the LGBTQI community and sex workers, can very rapidly spread into the general population. Continued vigilance is essential, as homophobic attitudes, fueled by conservative groups, perpetuate stigma against the LGBTQI community, hindering prevention, testing, and treatment. Stigma and inequalities in health service access lead to new infections and delays in care, particularly affecting marginalised groups, including at-risk adolescent girls and boys, especially those from poorer backgrounds.
The greatest challenge in the fight against HIV is the immediate suspension of all USAID funding, including PEPFAR funds. Established by President Bush in 2003, PEPFAR has been a significant commitment to combatting HIV globally, investing over $100 billion in more than 50 countries. In February, thousands of organisations received sudden termination letters for their funding, causing disruptions in patient care and leaving vulnerable populations without access to services. Many SADC countries depended on PEPFAR for more than half of their HIV budgets, making the funding cut especially detrimental.
Many countries are prioritising the continuity of treatment (ARVs), and the health minister of South Africa, for instance, has pledged that all PLHIVs will be able to access ARVs from government health facilities. It is very likely that specialised programmes for key populations, including prevention for adolescent girls and boys, will receive lower priority. At this grave moment in our region’s struggle against HIV, we call on all governments, civil society, communities and funders to respond positively and creatively to the challenge. This means integrating HIV prevention, testing, care and support into other funded programmes. It calls for different ways of sharing resources and collaboration. We know that we cannot afford to retreat from the progress that we have been making and must continue to press forward. On this World TB Day, we must commit to ending HIV as a public health threat so that we can also end TB. We must all rise to the occasion as “We are the ones we have been waiting for”.
(Lynette Mudekunye is the Author of the HIV and AIDS chapter in the 2024 Voice and Choice Barometer. This article is written in her personal capacity).