Today is an anniversary, and not a happy one. On World Aids Day, we look up from the mundane noise and tasks of the day — our meetings, our email and even our HIV data-laden spreadsheets — and we remember. We remember our beloved dead. To date, 39 million people have died from Aids-related illnesses since the early 1980s, when the first recognised cases were reported. HIV simultaneously connects and divides us. It connects us because it is one of the greatest health threats South Africa has ever faced, with 12% of South Africans currently living with HIV. It connects us because the South African epidemic is part of a global pandemic. For women today, HIV-related diseases comprise the leading cause of death among all women aged 18 to 49 years, worldwide. HIV also connects us because it defines the new South Africa. South Africa defied the odds and rolled out the world’s largest HIV treatment and prevention programme, based on a protracted social mobilisation campaign waged by civil society. Treatment and prevention have been scaled dramatically in this country on the back of a reforming public health system that exacts an immense toll on our nurses, lay counsellors and doctors. Those brave and committed individuals have been at the coalface of the national response. But this response is not yet sufficient.
Paradoxically, as much as HIV connects us — with more people living with HIV in South Africa than in any other country in the world — it also divides us. This is because the risk and burden of HIV disease is not distributed evenly across population groups in the country: opportunities to achieve good health in South Africa are still very uneven, drawn by the racial lines of old. The risk of acquiring HIV and dying from HIV-related diseases is greater for some. Prevalence figures are illustrative: HIV prevalence among black South Africans is significantly higher (15%), compared to HIV prevalence in coloured South Africans (3.1%), Indian South Africans (0.8%), and white South Africans (0.3%).
On this anniversary where we reflect on our losses and our gains, we need to ask: What is neglected? What gaps remain? Who is getting left behind? One answer (and not the only one), is South African women and girls. They are at higher risk of acquiring HIV, compared to boys and men. Figures routinely collected by the Human Sciences Research Council evince a systematic pattern of differential HIV prevalence by sex. For the age group 15 to 19 years, boys have an HIV prevalence of 0.7% (<1%), compared with a much higher HIV prevalence of 5.6% in girls. This 10% difference by sex recurs in every age group, showing up like a bad penny. By the 30-34 year group, HIV prevalence climbs to 25.6% in men, compared to an astonishing 36% in females. Girls’ and women’s greater risk of HIV infection is both biological and social. Violence in South Africa is widely considered a social norm; it is also a driver of HIV infection. South Africa has one of the highest levels of sexual and gender-based violence, globally. Through increasing mortality, illness and related impacts, the global HIV pandemic is illustrating the myriad ways in which gender inequalities impact negatively on women’s health.
High levels of violence against women, including intimate partner (domestic) violence, are accepted. A Wits study found that 60% of South African partnerships involve physical or sexual violence. In a Medical Research Council study, 27.6% of men interviewed disclosed having committed rape of a woman or girl: 2.9% disclosed raping a boy or man. If we want to avert new HIV infections, this social acceptance of violence, and the high prevalence of violence in South Africa, is fundamentally important because violence facilitates HIV transmission. The evidence base shows that violence against girls and women strongly correlates with their risk of acquiring HIV.
Despite all of the outstanding work that has been done in this country to roll out HIV treatment and prevention, unless and until gender-based violence is recognised in concrete and measurable policies and national strategic plans, we are failing to take the necessary steps to arrest this epidemic. We are failing to make a key link to address the problem of HIV in this country and the response. This will bar us from preventing new HIV infections. Moreover, fundamental rights of South Africans — sexual and reproductive health and rights, bodily integrity and freedom from violence — will not be realised. There is one takeaway message on this World Aids Day 2014: A national strategic plan to end gender-based violence is essential to achieving the bold vision of the national strategic plan on HIV, TB and sexually transmitted infections, including zero new HIV and TB infections. Twenty civil society organisations have called for a national strategic plan on gender-based violence, requesting leadership and financial commitments in this regard. Learn more here:
The petition is available here:
Image – Indian school students pose for a photograph in the shape of a ribbon during an awareness campaign to mark World Aids Day at a school in Amritsar on December 1, 2014. (AFP)