South Africa’s National Strategic Plan for HIV, TB and STIs (2023‑2028) was launched on Friday at Tlhabane Stadium in Rustenburg, North West, coinciding with World TB Day. The event, held under a fully stocked marquee, was attended by Deputy President Paul Mashatile, government ministers including Dr Joe Phaahla, the CEO of the South African National AIDS Council, Thembisile Xulu, activists, residents and representatives of various civil‑society organisations. In a statement released before the launch, the Presidency described the new plan—also called the People’s NSP—as “by far the most critical” because it will be the last NSP before the 2030 agenda, in which the global community pledged to end AIDS by that year. This is South Africa’s fifth NSP and is presented as a blueprint and roadmap for a multi‑sectoral, people‑centred approach to eliminate HIV, TB and STIs as public‑health threats by 2030.
The plan sets out four strategic goals: (1) breaking down barriers to achieving solutions for HIV, TB and STIs; (2) maximising equitable access to services and solutions; (3) building resilient, integrated systems for health, social protection and pandemic response; and (4) fully resourcing and sustaining an efficient NSP led by revitalised, inclusive and accountable institutions.
In his keynote address, Deputy President Mashatile—who also chairs the South African National AIDS Council (SANAC)—emphasised that the NSP is about preserving lives. “This should be the last NSP in our lifetime,” he said, urging South Africans to collectively combat the social isolation linked to TB and to maintain well‑coordinated, multi‑sectoral interventions against stigma and discrimination. He called it unacceptable that stigma remains a problem in 2023.
A notable feature of the new NSP is its heightened focus on mental‑health support for people living with HIV/AIDS and those undergoing TB treatment. One key objective is to “integrate and standardise delivery and access to mental‑health services.” Vuyo Masebotsana, a peer educator from Access Chapter 2, an LGBTQI+ advocacy organisation, welcomed the inclusion, noting that transgender people often face discrimination when seeking care. The NSP cites a prevalence of mental‑health conditions—depression and anxiety—in 40 % to 70 % of people with TB, and highlights the two‑way link between HIV, TB, gender‑based violence, human‑rights violations, inequality and mental health. The plan calls for intensified screening, psycho‑social support and the rollout of guidelines that enable healthcare workers to recognise, manage or refer mental‑health cases within HIV and TB programmes.
Michel’le Donnelly, Project Leader for Advocacy and Awareness at the South African Federation for Mental Health (SAFMH), explained that integrating mental health with HIV and TB programmes could reduce global HIV and TB infections by up to 17 % and 20 % respectively. She stressed that services must be delivered at all levels of care by well‑trained, culturally and gender‑sensitive staff who are fairly compensated and equipped to address comorbidities. Adequate budgeting, she added, is essential. While the NSP emphasises mental health, the Department of Health’s National Policy Framework for Mental Health—still being drafted—remains the key policy document in this area. The previous framework expired in 2020 and was criticised for insufficient funding. Although the 228‑page NSP contains more than 150 references to mental health, it does not cite the Department of Health’s new or old mental‑health policy, leaving the relationship between the two documents unclear.
Regarding TB, the NSP aims to strengthen diagnosis and support for people with TB, acknowledging that the 2021 National TB Prevalence Survey found many cases remain undiagnosed and asymptomatic. Professor Willem Hanekom, Director of the Africa Health Research Institute, highlighted that South Africa records about 300 000 new TB cases and 56 000 deaths annually—a number that could fill a stadium in Durban. He praised the NSP’s focus on implementation: improving diagnosis, initiating treatment and ensuring treatment completion. Hanekom stressed that while current tools must be optimally used, developing new diagnostics, treatments and especially vaccines is crucial, as modelling shows that existing tools alone cannot control the epidemic. He also noted that the six‑month TB regimen remains a burden and urged the adoption of newer four‑month regimens, which are already available.
Ingrid Schoeman of TB Proof, a South African advocacy group, echoed the NSP’s emphasis on strengthening TB diagnosis. She advocated for targeted universal testing in high‑risk groups—people living with HIV, household contacts, and those with previous TB—using digital chest X‑rays and urine LAM, offered on weekends and evenings to improve access. Schoeman called for quality, family‑centred counselling for every diagnosed individual to address stigma and depression. She also welcomed the updated TB infection guidelines, which recommend short‑course preventive therapy for high‑risk groups after a negative test, and urged an immediate scale‑up of this therapy nationwide.
The NSP retains the 95‑95‑95 HIV targets: 95 % of people living with HIV should know their status, 95 % of those diagnosed should be on treatment, and 95 % of those on treatment should achieve viral suppression. It places particular emphasis on key and priority populations and on mental‑health access. Proven prevention methods—condoms, voluntary medical male circumcision and pre‑exposure prophylaxis (PrEP)—are endorsed. Professor Linda‑Gail Bekker of the Desmond Tutu Health Foundation warned that the dual HIV‑TB epidemic must remain a focus, noting ongoing challenges such as breakthrough vertical transmission. She highlighted the need to reach the remaining two million people who are not yet on antiretroviral therapy, maintain treatment adherence, achieve viral suppression and thereby benefit from U = U (undetectable = untransmittable).
Accountability is a central theme. Schoeman argued that ending TB requires political leaders to close implementation gaps through partnerships with local community representatives. She praised the health department’s broad, inclusive consultations with TB survivors and civil‑society organisations, which secured buy‑in from local leaders, district managers and provincial TB managers for the next five years. Sihle Mahonga‑Ndawonde, a project officer at the TB Accountability Consortium (TBAC), said the consortium is establishing an accountability forum to monitor the National TB Recovery Plan (launched in 2021) and the new NSP. A recent TBAC report highlighted gaps in provincial implementation data, suggesting either poor execution or a lack of documentation. Mahonga‑Ndawonde noted that TBAC will convene accountability meetings with provinces to continually track progress on TB plans, including the new NSP.
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