South Africa’s HIV Treatment Gap: A Closer Look at the Numbers
In a surprising announcement, South Africa’s health minister revealed that over half a million previously diagnosed people with HIV have started treatment since the end of February. This significant jump has raised eyebrows, particularly given the country’s longstanding struggle to close the gap in HIV treatment. With a goal to reach 95% of people diagnosed with HIV, the minister’s claim has sparked both optimism and skepticism.
The health department aims to find 1.1 million people who know they have HIV but have either never started treatment or fallen out of treatment by the end of the year. If successful, South Africa would meet two of the three UN targets, known as the 95-95-95 goals, which aim to end AIDS as a public health threat by 2030. However, critics argue that the minister’s figures are "inconceivable," given the slow progress in recent years.
One of the challenges in tracking progress is the lack of a digitally centralized patient information system. Most clinics still use paper records, making it difficult to access and share information across facilities. This can lead to individuals being counted multiple times as they cycle in and out of treatment. According to Kate Rees, a public health specialist at the Anova Health Institute, "The health service expects people to be very rigid with their appointments, but life just is not like that." People may miss appointments due to work or relocation, and the longer the interruption, the more hesitant they are to return.
Despite the progress, the gap in HIV treatment remains significant. In 2021, South Africa was about 1.2 million people short of its 95% treatment goal, and by 2025, the shortfall is expected to be around 990,000. The number of people on HIV medication has increased, but the growth rate has slowed down over the years. In 2020, about 291,000 more people were on treatment than in 2019, but by 2021, the number had grown by only about 225,000.
Gesine Meyer-Rath, a health economist at the University of the Witwatersrand, emphasizes the importance of retaining people in treatment. "We can close the 1.1-million gap through improved retention alone," she says. However, with funding shortfalls and program closures, the challenge is becoming increasingly daunting. The US aid withdrawal is expected to result in the loss of about 40% of South Africa’s HIV data capturers by September, leaving a significant gap in the information needed to inform policy decisions.
As South Africa strives to meet its HIV treatment targets, it is essential to have accurate and detailed data. The "Close the Gap" campaign has good intentions, but without precise numbers, policymakers are "flying blind." The country’s progress towards ending AIDS as a public health threat depends on its ability to address the treatment gap and provide sustainable support to those affected by the disease.
