OPINION | SA mustn’t lose momentum in its fight against HIV

For more than four decades, the global HIV community has shared a clear vision: zero new infections, zero discrimination and zero Aids-related deaths.

However, this year, that vision stands at a crossroads. The US, historically the largest global funder of HIV programmes through the President’s Emergency Plan for AIDS Relief (Pepfar), has imposed significant budget cuts. This decision has far-reaching consequences for countries such as SA.

Sub-Saharan Africa continues to bear the heaviest burden of HIV infection. It is home to about 26-million of the 41-million people living with HIV worldwide — about two-thirds of the global total — and still accounts for roughly half of all new infections each year.

The statistics further reflect persistent gender inequality and social drivers that continue to fuel the epidemic: 63% of all new HIV infections in the region were among women and girls, and 3,300 adolescent girls and young women contracted HIV every week.

SA remains among the hardest-hit countries. Nearly one in every eight South Africans ( eight-million in total) is living with HIV, but only 6.2-million (±78%) are on antiretroviral treatment.

While more work is needed to reach people who are not yet on treatment, this is one of the largest and most successful HIV treatment programmes ever implemented, but one that becomes vulnerable when global funding is uncertain.

Reductions in US global health funding are neither abstract nor distant.

They mean that fewer people are starting or remaining on treatment; there is less access to essential prevention tools; services for mothers, infants, key populations and rural communities are disrupted; and laboratories, supply chains and community health systems are strained. These cuts risk reversing years of life-saving progress.

This World Aids Day, we reaffirmed the importance of global solidarity. The HIV response has always been a testament to what the world can achieve when we stand united. However, solidarity cannot be synonymous with dependency.

Africa must accelerate its path toward scientific, manufacturing, clinical and financial independence. This includes producing our own antiretrovirals, diagnostics and prevention tools; strengthening regulatory and procurement systems; investing in African-led research, surveillance and innovation; protecting domestic budgets for HIV and public health; and supporting community-based organisations that anchor the HIV response.

Independence does not imply isolation. It means partnering with the world from a position of resilience and strength.

HIV science has advanced dramatically in recent years. The treatment is simple, effective and life-restoring.

However, some of the most transformative progress has been made in HIV prevention: viral suppression prevents sexual transmission entirely; long-acting cabotegravir – a two-monthly injection that, when administered on schedule, reduces the risk of HIV acquisition to effectively zero; and a promising twice-yearly PrEP option (Lenacapavir) that could revolutionise prevention for people who face daily adherence challenges or barriers to clinic access.

These innovations have the potential to drastically reduce new infections, especially among women and young people. However, they remain inaccessible to most Africans because of high prices, manufacturing constraints and donor uncertainty.

The science exists. The tools exist. Equitable access and sustained political commitment are lacking.

Getting to zero starts with taking responsibility: for ourselves, one another and the future. This means knowing your HIV status and, if you are living with HIV, staying on treatment and remaining undetectable.

Also, if you are HIV-negative and at risk, use PrEP, including long-acting options, where available, and advocate for strong health systems and African-driven solutions.

In a world marked by geopolitical instability and shrinking budgets, one truth remains: we cannot afford to lose momentum. Lives depend on it. The future depends on it.

• Rossouw is a professor in the department of medical immunology at the University of Pretoria.