Why we’re losing the fight against the HIV epidemic

The Covid-19 pandemic, an explosion of communicable diseases, social inequalities, gender-based violence (GBV), and stigma has dealt a crushing blow to efforts in bringing the HIV epidemic under control.

Theresa Rossouw, Professor in the Department of Immunology at the University of Pretoria, lamented that South Africa was still in the grips of a devastating HIV epidemic, with an estimated 7.5 million people living with the virus.

Covid-19

In her opinion piece, published on the university’s website, she pointed out that Covid-19 derailed gains made over the last decade due to shrinking resources and widening inequalities.

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“An estimated 1.5 million new infections occurred globally last year; only 3.6% fewer than in 2020 – the smallest decrease since 2016.

“Alarmingly, this is 1 million more infections than the global target. The number of people newly started on antiretroviral therapy has also slowed down to the smallest increase since 2009,” she noted.

GBV

Rossouw said the impact of gender-based violence, which greatly intensified during Covid-19, should also be acknowledged.

Data from 156 countries indicated that an estimated 245 million women aged 15 years and older who have ever been married or partnered experienced physical or sexual intimate partner violence in 2021.

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She explained that in 20 of the 26 countries with data available for 2017-2021, this equated to more than 10% of ever-married or partnered women, with the highest rate (47.6%) reported in Papua New Guinea, and Sierra Leone, with Liberia, and South Africa following closely behind.

“The numbers in South Africa are staggering with 30.3% of women aged 15 – 49 years and 30.1% of adolescent girls (15 – 19 years) having experienced recent intimae partner violence.

“It is an indictment on societies around the world that the World Health Organization had to set a target of reducing physical or sexual violence from an intimate partner to below 10% by 2025,” Rossouw said.

Stigma

Stigma also continues to be the HIV epidemic’s biggest enemy.

Despite education and advocacy campaigns, 59.1% of people across 55 countries reported discriminatory attitudes, and, in 11 countries, the proportion exceeded 75%.

According to Rossouw, important contexts where people experience stigma is in the community and healthcare settings.

She said in South African communities, 12.6% of people would not buy fresh produce from a person living with HIV; 7.5% believed children living with HIV should not be allowed to attend school with children not infected, and that 16.9% agreed with both statements. 

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Violence is also driven by prevailing discriminatory attitudes towards people living with HIV, with stigma and discrimination seen as among the key barriers for access to quality health-care services.

Non-communicable diseases

In 2021, one person in the world died of HIV every minute.

Rossouw noted that the increasing number of people living with HIV together with non-communicable diseases, such as cardiovascular disease, depression, diabetes, and cancer, is contributing to this mortality.

“For instance, cervical cancer, the leading cause of cancer death for women in Sub-Saharan Africa (killing 66% of those who develop it), is six times more likely to develop in women living with HIV.,” she said.

Rossouw said cervical cancer was a preventable and curable disease, but services were inequitably spread and integrated, and the implementation of vaccination against the human papilloma virus, the cause of cervical cancer, has been slow and erratic.

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