As the country prepares to roll out lenacapavir, a groundbreaking HIV prevention injection, HIV/Aids activists warn that SA is still battling a treatment crisis with an estimated 1.1-million people defaulting on their antiretroviral (ARV) treatment.
Treatment Action Campaign (TAC) chairperson Sibongile Tshabalala said systemic failures within the public health-care system continue to drive people out of care despite years of progress in expanding access to HIV treatment.
“Our system is overburdened and does not have the capacity to cater for everyone, and that frustrates patients,” Tshabalala told Sowetan ahead of President Cyril Ramaphosa’s official launch of the lenacapavir rollout in Mpumalanga on June 5.
According to the national department of health, Gauteng carries the country’s largest HIV treatment gap with 326,346 people needing to be initiated or reinitiated on treatment as of July 2024. KwaZulu-Natal had more than 200,000 people who had defaulted on treatment by May 2025, while the Western Cape recorded 111,000 by September 2025.
Last month the Mpumalanga health department said it needed help to trace 31,540 people who had defaulted while the Northern Cape recorded 16,872 defaulters by May 2025.
Although the treatment gap remains significant, it has declined from an estimated 1.9-million people in 2023.
Research by the Human Sciences Research Council (HSRC) continues to identify Mpumalanga, particularly the Gert Sibande district, as a key concern.
According to professor Sizulu Moyo, senior research director at the HSRC, the district has consistently recorded high HIV prevalence and challenges with treatment adherence.
“The 2022 SA National HIV Prevalence, Incidence, Behaviour and Communication Survey found Mpumalanga had the highest HIV prevalence among provinces in both 2017 and 2022. We also found higher risks of ARV non-adherence among young people and people living in urban areas,” said Moyo.
Tshabalala said many patients face barriers that extend beyond simply collecting medication.
“What we found through our campaign with the department of health is that data systems are not properly updated. Sometimes a patient passes away, but the records remain active. The health system also does not communicate effectively with other government databases,” she said.
She said that stigma remains a major challenge, forcing some patients to seek treatment far from their homes to avoid being recognised at local clinics.
Some people miss appointments and when they return, they are turned away or pushed to the back of the queue. Others face poor treatment from staff, which discourages them from coming back.
— Sibongile Tshabalala, TAC chairperson
“Transport costs become a burden. Some people miss appointments and when they return, they are turned away or pushed to the back of the queue. Others face poor treatment from staff, which discourages them from coming back.”
Tshabalala said mental health challenges and treatment fatigue also contribute to patients defaulting.
“The system does not adequately cater for the mental health needs of people living with HIV. Over time, people become exhausted and disengage from care.”
Mpumalanga health department spokesperson Chris Nobela said tracing patients remains difficult because many provide incorrect contact details or relocate without informing clinics.
He said some patients also choose not to disclose their HIV status to family members, while others delay treatment because they do not feel emotionally ready to start lifelong medication.
Tshabalala welcomed the rollout of lenacapavir but cautioned that access would initially be limited.
“Lenacapavir is a game changer, but the doses available will only reach a fraction of the population that could benefit from it. Only 400,000 will benefit from this,” she said.
Tshabalala said that interrupting HIV treatment can weaken the immune system, increase vulnerability to diseases such as tuberculosis, and in some cases lead to drug resistance, making future treatment more difficult.
Sowetan
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