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On the move: Tutu Teen Trucks distribute HIV prevention pills to vulnerable populations. Picture: David Harrison
On the move: Tutu Teen Trucks distribute HIV prevention pills to vulnerable populations. Picture: David Harrison

Despite rapid progress in expanding access to HIV prevention drugs, SA still has the world’s largest number of people living with the disease and has faltered in its efforts to protect them from tuberculosis (TB), the latest global AIDS report from Unaids has found.

SA accounted for 7.3-million, or almost a fifth, of the world’s 38.4-million people living with HIV in 2021. It was home to 210,000 (14%) of the 1.5-million new infections and 51,000 (7.8%) of the 650,000 deaths that year.

The uptake of pre-exposure prophylaxis (PrEP) in SA soared from 8.2 per 1,000 people in March 2019 to 109 per 1,000 people in March 2021, despite the disruption to health services caused by the coronavirus pandemic. But over the same period the number of people living with HIV in SA who received preventive therapy for TB fell 30%, according to the report released on Wednesday at the 24th International AIDS conference in Montreal, Canada.

“It feels like the SA HIV programme is on autopilot. With some movement on PrEP and the amazing Ritshidze monitoring project in the report, you would not think SA has a problem. In fact we are still number one in the world, with a preventable and treatable epidemic that should, with TB, be a major priority for our government and society,” said Francois Venter, director of the Ezintsha research institute at Wits. Ritshidze is a community-led monitoring project that holds health workers to account and advocates for improvements at local clinics.

SA’s progress in expanding access to PrEP is one of the few positive findings in the report, which shows the global response to Aids been set back by Covid-19 and other crises. The war in Ukraine, for example, has increased global food prices and worsened hunger, increasing the risk of people experiencing interruptions in their HIV treatment.

“Insufficient investment and action are putting all of us in danger: we face millions of Aids-related deaths and millions of new HIV infections if we continue on our current trajectory,” said Unaids executive director Winnie Byanyima in the report’s foreward. Many high-income countries have scaled back their support for global health initiatives, and as a result the resources available for HIV were 6% lower in 2021 than in 2010.

Globally the number of new infections dropped by just 3.6% between 2020 and 2021, the smallest annual decline since 2016. Progress slowed in Southern and Eastern Africa, while gains were reversed in Asia and the Pacific, with new infections rising where they had previously fallen. In SA, new infections fell from 220,000 to 210,000 between 2020 and 2021, a drop of 4.54%, a significant slow down on the 8.3% decline reported between 2019 and 2020, when new infections fell from 240,000 to 220,000.

There were approximately 1.5-million new HIV infections in 2021, more than 1-million more than the global target.

Progress in expanding access to life-saving antiretroviral treatment also stalled, with the rate of growth in 2021 slowing to its lowest level in more than a decade. While three quarters of the people living with HIV do have access to treatment, the scale of the pandemic means approximately 10-million eligible people still do not, said Unaids.



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