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Address by Health Minister Dr Joe Phaahla, delivered on behalf of the Chairperson of the South African National AIDS Council, at the World AIDS Day commemoration, Dr Rantlai Petrus Molemela Stadium, Bloemfontein

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Co-Programme Directors, 
Our host, Premier of the Free State Province, Ms Sefora Ntombela,
SANAC IMC Members, 
Executive Mayor of Mangaung Metro, Cllr Mxolisi Siyonzana,
Chairperson of the SANAC Civil Society Forum, Ms Steve Letsike,
Deputy Chairperson of the SANAC Private Sector Forum, Dr Tshegofatso Gopane,
MECs present, 
Chairperson of the Free State House of Traditional and Khoi-San Leaders, Morena Neo Mopeli,
President of COSATU, Ms Zingiswa Losi,  
U.S. Ambassador to the Republic of South Africa, Ambassador Reuben E. Brigety II, 
UNAIDS Country Director, Ms Eva Kiwango, 
Distinguished guests,
Ladies and Gentlemen,

Today, we join the world to commemorate World AIDS Day.
 
This day provides an opportunity for communities to unite in the fight against HIV, AIDS, and STIs. We also stand to support those living with HIV, and remember those who have passed on as a result of AIDS-related illnesses.
 
Today, we also take stock of the progress that we have made as a country in the fight to eliminate AIDS as a public health threat by 2030, as set by UNAIDS.
 
The official theme for this year is "Equalise and Integrate to End AIDS,"reflecting the gravity of the epidemic's impact on marginalised communities.
 
This theme is a wake-up call to deal with the inequalities that make it harder for the country to eradicate AIDS.
 
These inequalities include poverty, exclusion, and inadequate access to services, particularly for vulnerable populations such as transgender people and sex workers, which were further compounded by the COVID-19 pandemic.
 
In contrast to early predictions, the pandemic has not been a major equalizer. Even while we are dealing with the same pandemic, its effects have tended not to be equally felt, afflicting more severely those who were already on the margins of society and their livelihoods.
 
Low-income households that are situated in the poorest and most marginalised areas of our cities, small towns, and rural villages constitute the majority of those affected.
 
As the world economy recovers from the unprecedented pandemic, communities are counting the social and economic damage caused by the lockdowns put in place to stop the virus from spreading. Inadvertently, these lockdowns have hurt the country's HIV treatment programme.
 
The issue of equalization, as per this year’s theme, is critical because we understand that the burden of HIV and AIDS falls mostly on the most vulnerable communities.
 
So, as a Government, our main goal is to make sure that all parts of a person's health care work together in a single system so that everyone always gets the best care possible. If anything, the COVID-19 pandemic has highlighted the need for primary health care to be at the centre of all health systems. 
 
We must equalise and integrate our services to speed up HIV prevention, treatment, care, and support.
 
Just like the concerted and urgent effort that we put out in the face of the COVID-19 pandemic, as a country, we should fight HIV/AIDS and ensure that we reverse the impact that the pandemic had on our HIV prevention and treatment services.
 
Together as multisectoral role-players in the country’s HIV response, we must integrate our efforts to improve coordination, synergy, and inclusivity in order to restore the time lost in the fight against HIV/AIDS and TB in the past two years.
 
We must work together to provide equitable and high-quality healthcare services.

NSP 2023-2028 development is progressing

Ladies and Gentlemen, 
 
In order to make up for the delays caused by the COVID-19 pandemic, the government has put in place catch-up plans for HIV and TB so that services and care can be better integrated.
 
There has also been the process of developing the new National Strategic Plan for 2023–2028, which places people and communities at the centre of the country's efforts to overcome inequities in the response to HIV, tuberculosis, and sexually transmitted infections, as well as to end AIDS. Substantial progress has been made in this regard through the collaboration of all sectors and partners in the fight against HIV/AIDS.
 
The draft plan has been published for public comment, and we are set to launch the new Plan during the commemoration of World TB Day on March 24, 2023. This will be the last national strategic plan ahead of Agenda 2030 to end AIDS as a public health threat.
 
This Plan is, therefore, critical for us as a country, and its implementation will require the alignment of all national, provincial, and district municipality entities.
 
In the interim, the continued implementation of the catch-up plans remains important for helping the country reach the new 95-95-95 targets by December 2025.
 
Obstacles in the HIV/AIDS battle

Ladies and Gentlemen, 
 
As of 2021, 85 percent of people living with HIV knew their HIV status, 88 percent of those who knew about their condition were getting treatment, and 92 percent of those who were getting treatment had their virus under control.
 
The Free State province has done exceptionally well in terms of testing, having already surpassed the 94 percent threshold. 
 
The overall population served by the public and private sectors in the province is now at 94 percent of people who are living with HIV knowing their status; 86 percent of those who know their status are on antiretroviral treatment; and 92 percent of those who are on treatment are virally suppressed.
 
But it is concerning that three of the province's districts don't meet the goal of increasing the number of people who know their status and get treatment.
 
Furthermore, results from the districts of Xhariep and Lejweleputswa demonstrate that people with HIV and on treatment fare poorly on the target of being virally suppressed.
 
This is very concerning, and we must urgently intervene to create a balance among the targets in order to achieve zero new infections by 2030. This includes ensuring that services are brought closer to the people and that our health facilities are adequately resourced with medicine and related necessities.
 
Despite the fact that the country's HIV prevalence has remained stable at 13.5 percent over the last five years, the number of people living with HIV continues to rise every year as the country's population grows.
 
The path that our country has taken, as well as our contribution to the mission of achieving the objective of zero AIDS-related deaths, zero new infections, and zero prejudice, has been a difficult one.
 
Again in 2021, KwaZulu-Natal, Mpumalanga, and the Free State provinces had the highest HIV prevalence rates at 18.3 percent, 15.9 percent, and 14.8 percent, respectively, while the Western Cape had the lowest at 8.3 percent, followed by the Northern Cape at 10 percent.
 
According to research, the majority of our epidemic burden falls on black Africans, with crucial and vulnerable populations being disproportionately excluded from accessing health care. We must never relent in our efforts to stop the spread of the virus.
 
Vulnerable Groups and HIV/AIDS

Our concerted effort now needs to address the alarming and substantial increase in our nation's youth population, which continues to experience high rates of new HIV infections.

This is a critical issue if we are to stem the tide of rising HIV infections.
 
These new HIV infections occur in young people aged between 15 and 24, and according to research done through the Thembisa 4.3 model, in 2019, there were roughly 14 000 new infections in young males and 55 000 in young women.
 
In light of these numbers, we need to keep working together across all sectors to raise awareness and improve our messages about prevention and sticking to treatment.
 
In this context, we applaud SANAC for the development and launch of the South African National Youth HIV Prevention Strategy in June 2022 as a three-year Youth HIV Prevention Campaign.
 
This is a key part of targeting young people, particularly adolescent girls, who are most vulnerable to new infections.
 
The strategy will focus on the integration of key health and social services, youth development programmes, social and behaviour change communication, and mobilisation for increased access to and improved quality of health products and services.
 
The ultimate goal of the campaign is to reduce by 40 percent the number of young South Africans who get HIV and other sexually transmitted diseases. This is especially true for young women.
 
Similarly, our targeted social behaviour change programme, such as "You Only Live Once," aims to provide a secure and supportive environment in which young people can safely engage in conversations about HIV prevention.
 
Additionally, in the same vein as targeted interventions, we have established the National Sensitization Training Initiative, which aims to reduce stigma and prejudice against HIV-positive and TB-risk people. 
 
Because HIV is more common in key and vulnerable communities than in other communities, this programme was made to make it easier for them to get justice and redress while building an environment that protects their legal and human rights.
 
To sustain our efforts towards ending AIDS, it is critical that we unite as AIDS Council structures, from the provincial to the ward level, in support of these initiatives and programmes.
 
In this regard, we urge Premiers, Mayors, and Councillors to play their part in the AIDS response and to work with all social partners. We can only meet our targets if we work side by side with civil society, development partners, Traditional and Khoi-San leaders, traditional health practitioners, organised labour, and business.
 
However, each of us must step up and be counted in the fight against the HIV epidemic, because while we may not all be infected, we are all affected.

Progress in the fight against HIV

Ladies and Gentlemen, 
 
As a Government, we are still working hard to reduce the effects of the HIV/AIDS and tuberculosis epidemics, and we have made a lot of progress so far.
 
You may remember that in the past, someone close to you died from an AIDS-related disease every week and in every community.
 
Those days are long gone and should never return.
 
There have been many scientific advances in how HIV is treated, and we now know a lot more about the virus and how to treat it.
 
Scientists are also hopeful about the benefits of treatment as a preventive measure and the progress being made toward ultimately finding a cure and a vaccine.
 
We are pleased that, in South Africa, the Government continues to be the principal funder of the country's comprehensive response, contributing around 80 percent of the resources to the battle against HIV/AIDS and Tuberculosis.
 
Today, we can celebrate the fact that South Africa has the world's largest HIV treatment programme, with over 5.7 million individuals on life-saving antiretroviral treatment.
 
Our antiretroviral treatment programme has resulted in increased life expectancy and low rates of HIV transmission from mother-to-child, which is one of the greater successes in our response efforts to save lives.
 
This means that millions of South Africans who previously had little chance of having a stable quality of life can now live longer and contribute to building the South Africa of our dreams.
 
We could not have done it without the collaboration and support of our global partners.
 
To this end, we appreciate the contribution of the global campaigns under UNAIDS that mobilised all of us in political leadership, civil society, and the private sector into coherent action that has breathed life into our collective response.
 
Indeed, tackling disparities and bridging the treatment gap necessitates a multi-sectoral approach centred on the impacted populations.
 
Children living with HIV

Ladies and Gentlemen, 

We must mobilise as communities to confront the inadequacies in child care. So far, insufficient progress has been achieved to meet the 90 percent target among children living with HIV, which now stands at 57 percent.
 
As a country, we agree with the Global Alliance's goal of eradicating AIDS among children by 2030.
 
We are committed to closing the treatment gap and making it easier for HIV-positive women who are pregnant or breastfeeding to stay on treatment.
 
In this respect, the introduction of more palatable antiretrovirals for children in South Africa is another milestone for children living with HIV, as it increases treatment adherence and retention.
 
Also, we are still committed to defending our ideas about human rights and getting rid of the social and structural barriers that make it hard for people to get health care.
 
Gender-Based Violence and Femicide

Ladies and Gentlemen,  

As we observe World AIDS Day, we also observe the 16 days of activism of no violence against women and children.
 
During this period, we raise awareness about the prevalence of violence against women and children, termed as Gender-Based Violence and Femicide.
 
Gender-based violence and femicide are regarded as the second pandemic after HIV in settings with high HIV prevalence, and intimate partner violence increases the risk of HIV acquisition.
 
Apart from being a social and structural driver of HIV, gender-based violence, and femicide, they remain a pervasive public health concern and a global human rights violation that transcends cultural and economic boundaries.
 
It threatens the health and social well-being of vulnerable groups, particularly women and children.
 
Gender inequities that have been normalised by social and patriarchal norms fuel gender-based violence, reinforcing male dominance over women, children, and other vulnerable groups.
 
It is wrong that one in four teenage girls and young women have been abused physically or sexually by a close friend or partner at least once in their lives.
 
There is a connection between gender-based violence and HIV, and we must collectively address this linkage. It is critical that our efforts to fight HIV include interventions to eliminate gender-based violence and femicide in our communities.
 
In this regard, through the second Presidential Summit on Gender-based Violence and Femicide that took place in November, we have come out with commitments that will address the interlinkages between HIV and gender-based violence. These include the following:
 
Development of a national implementation plan that addresses these dual epidemics by building on the 2021 "South African Inter-linkage Framework on GBVF and HIV, TB, and STIs NSP";
 
The SANAC Secretariat and the Department of Health will work to include obstetric violence, including forced sterilisation, as a type of gender-based violence; and
 
Commit resources to programmes that are focused on addressing harmful social and traditional norms.
 
In response to the intersectionality of HIV and gender-based violence, SANAC is working with the Department of Social Development to build comprehensive community support networks to raise awareness on these issues, manage and support survivors of gender-based violence, and prevent secondary victimisation.
 
To end this epidemic, we must all work together to strengthen our prevention efforts by utilising every available option.
 
We urge Traditional and Khoi-San Leaders, and communities to take the lead in fighting the second pandemic and the dual epidemics of HIV and TB. 
 
The success of the "Policy in Action" activities that were held yesterday in and around Mangaung, including interactions with workers focusing on the law and human rights of those living with HIV and AIDS in the workplace and interactions with those living with disabilities regarding their sexual rights, offers hope and inspiration.
 
In women-focused dialogues on the significance of accessibility and high-quality sexual and reproductive health rights, young women and adolescent girls took centre stage. Through sectoral activities, the important role that sports, the arts, and culture play in combating HIV among young people was also highlighted.
 
Ladies and Gentleman, 
 
For us to end the dual epidemics, communities must stop stigmatising and discriminating against those infected by HIV/AIDS and TB.
 
Former President Nelson Mandela said: "Many people suffering from AIDS who are not killed by the disease itself are killed by the stigma surrounding everybody who has HIV and AIDS."
 
Stigma and prejudice can be as traumatic as the illness itself, leading to partner or family rejection, social marginalisation, school expulsion, denial of medical services, and a lack of care and support.
 
The impact of this consequently discourages HIV testing, disclosure, prevention, and seeking treatment and care.
 
We urge all community leaders to mobilise members of their communities to alter society's attitudes and norms, some of which are the consequence of our upbringing and socialisation.
 
Furthermore, effective working relationships between community leaders and political leaders are required.
 
Political leadership and commitment from our premiers, mayors, and councillors are paramount to ensuring that AIDS councils are fully functional and adequately resourced.
 
As a Government, we are determined to work even harder to mobilise all sectors in order to strengthen our collective response to the dual epidemics of HIV/AIDS and tuberculosis.
 
Working together in unity, we will eliminate HIV as a public health threat.
 
Thank you.