Credit: Festival Karsh Ottawa
Credit: Festival Karsh Ottawa

The 17th International Conference on AIDS and sexually transmitted infections (STIs) in Africa, held in Cape Town, South Africa, kicked off on December 7th on a sombre note due to the death of Nelson Mandela, former President of South Africa. His passing had speakers at the opening ceremony reflecting on his contribution to the global AIDS response.

It was once Mr Mandela had left office that he grew much more vocal and active in the fight against HIV/AIDS, and his involvement inspired scientists, activists and other political leaders to do more, noted conference chairperson Robert Soudré.

When UNAIDS Executive Director Michel Sidibe took up his position in 2009, he decided to hold his first official event in Khayelitsha, the township outside Cape Town, where Mandela had visited AIDS lobby group the Treatment Action Campaign and international medical charity Médecins Sans Frontières (MSF) in 2002.

“This was when he started to challenge the status quo; and this was where he also started talking about integrating TB and HIV at a time when we were still not doing this… he was a pathfinder,” Sidibe told journalists ahead of the opening ceremony.

Médecins sans frontières (MSF) had recently begun providing free antiretrovirals (ARVs) at a public health clinic in Khayelitsha, despite the South African government’s refusal to introduce HIV treatment in the public sector.

Mandela’s decision to put on a t-shirt emblazoned with the words “HIV Positive” when he met activists in Khayelitsha was a turning point. The head of South Africa’s National AIDS Council, Dr Fareed Abdullah, was a director general in the Western Cape health department, the first province to defy national government by offering ARVs to HIV-positive pregnant women, and he recalled the impact of Mandela’s gesture. “With Nelson Mandela behind us – doctors, nurses and people living with HIV – then who could be against us?”
According to Abdullah, Nelson Mandela also worked behind the scenes to get the government to change South Africa’s heavily discredited HIV policy. He clashed with his successor, Thabo Mbeki, over Mbeki’s denialist views, which questioned the link between HIV and AIDS.

After the South African government finally announced in 2003 that it would introduce free HIV treatment at state facilities, Mandela invited high-profile musicians to perform at the launch of his 46664 campaign to raise awareness of the global pandemic.

Another key moment came in 2005, when Mandela became one of the first leaders in the region to openly acknowledge the impact of AIDS on their family by disclosing that his only surviving son had died of an AIDS-related illness – an announcement still viewed as taboo in most communities.

Africa has come a long way since then. “Even the cynics and sceptics cannot say we are not making progress,” Sidibe commented. New infections have fallen by 38% in sub-Saharan Africa, and AIDS-related deaths by more than 34%, since 2001.

However, there is still work to be done: although 7.6m people are now on treatment in Africa, 14m more are still waiting for life-extending medicines. Children with HIV are still falling through the treatment cracks, and it is “unacceptable” that countries are still experiencing problems with drug supplies, causing frequent shortages and stockouts, Sidibe said.

Vulnerable groups such as men who have sex with men, injecting drug users, and prisoners are still being criminalized and marginalized in most countries, and are often unable to access basic HIV services, the conference heard.

Singer Annie Lennox threw down a challenge to the more than 5,000 delegates attending the event to make sure that Mandela’s legacy of addressing HIV/AIDS did not become a “static piece of history…Rhetoric comes cheaply, action is what truly counts… Madiba categorically walked his talk, now we must do the same.”

Renewed US Government Commitment to Combat HIV and AIDS

On December 2nd, President Barrack Obama signed into legislation the “PEPFAR Stewardship and Oversight Act of 2013.” This law reauthorizes and extends certain authorities related to the efforts to combat global HIV/AIDS, including the US contributions to the Global Fund to fight AIDS, Tuberculosis, and Malaria (Global Fund). The draft legislation had been approved by a unanimous vote of both houses of the U.S. Congress in previous weeks.

In remarks at a White House ceremony on December 1st, President Obama praised the extraordinary work that is being done in South Africa to combat the disease:

“On my visit to South Africa this year, I visited a clinic run by Bishop Desmond Tutu and had the honour of spending time with some of their extraordinary young patients and counsellors and outreach workers and doctors. Every day, they are doing extraordinary work. And when you visit this facility, you cannot help but be inspired by what they do each and every day, in part thanks to the support of the United States of America. They’re saving lives and they’re changing the way their country, and the world, approaches this disease. And that’s work that we have to continue to advance.”

The President renewed the commitment of the US to remain the global leader in the fight against HIV and AIDS. The new law reaffirms our commitment to give up to $5bn to the Global Fund over the next three years, matching $1 for every $2 pledged by other donors.

“We will stand with you every step of this journey until we reach the day that we know is possible, when all men and women can protect themselves from infection; a day when all people with HIV have access to the treatments that extend their lives; the day when there are no babies being born with HIV or AIDS, and when we achieve, at long last, what was once hard to imagine – and that’s an AIDS-free generation,” said the President.

PEPFAR in South Africa

As one of the countries most affected by HIV/AIDS, South Africa receives more PEPFAR resources than any other nation. To date, PEPFAR has invested over $4.2bn in prevention, treatment, and care for those with HIV and AIDS and, increasingly, to help strengthen the country’s health system.

In 2013, the PEPFAR program’s co-investment and partnership with the South African government and implementing partners has led to the following achievements:

· 2.4m HIV-positive individuals on antiretroviral treatment

· 6,617,000 individuals received HIV counselling and testing

· 294,900 men received medical male circumcision

· 177,000 orphans and vulnerable orphans and children were reached with care

Over the next five years, the US government will continue to provide comprehensive technical assistance for HIV/AIDS care and treatment services while also implementing targeted prevention programs, driving health systems innovation, supporting programmes for orphans and vulnerable children and building country capacity in data-driven decision making, laboratory diagnostics, human resource development and training, supply chain management and other areas critical to strengthen the national health system.

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