Private sector – a key strategic partner in getting our HIV targets back on track

Of all the effects that Covid-19 has had on South Africa, one of the most insidious has been its impact on our fight against the HIV pandemic. While we saw a 57% reduction in new infections between 2010 and 2019, infection rates have started rising again as we channelled our energies and resources into fighting the coronavirus – e now need to refocus if we’re to regain control of this disease.

According to StatsSA, around 13,7% of the South African population (PDF) – or 8,2 million people – were living with HIV in 2021. Shockingly, one in every five (19,5%) adults aged between 15 and 49 are HIV positive. Men’s HIV coaching initiative Coach Mpilo estimates there are around two million men living with HIV who are not on treatment. This doesn’t just put immense strain on our health system: it’s wreaking havoc on our most vulnerable communities, including young girls and adolescents.

Preventing HIV goes way beyond trying to limit the spread of disease. The pandemic is an accumulation of numerous structural and societal factors and behaviours that include child-headed households, gender-based violence GBV, power dynamics and socio-economic challenges. In many communities, this is exacerbated by migration, transient workforces who engage in risky sexual behaviours with multiple partners, and vulnerable young women who see the need for relatively affluent partners who have jobs.

This type of unbalanced power relationship only results in vulnerabilities being further exploited, and it all comes together in a melting pot of negative outcomes, including early school dropouts, unplanned pregnancies and a range of sexual and reproductive rights issues. These social challenges place a further burden on an already stretched healthcare system.

The bottom line is that the private sector has a massive role to play if we’re to get anywhere near the global goal of eradicating HIV/AIDS by 2030. And, thanks to numerous industry alliances and partnerships, including the Business Alliance to End AIDS and the SANAC Private Sector Forum, we’re making a real difference.

Anglo American created the largest private sector anti-retroviral (ARV) treatment programme in the world in 2002. In 2016, the company aligned its HIV/AIDS targets to UNAIDS 90/90/90 strategy: 90% of people living with HIV know their status; 90% of those living with HIV are on sustained ARV therapy; and 90% of those receiving ARV therapy have undetectable viral loads.

Notwithstanding our well-established HIV counselling and testing programmes, we continue to report a high number of new cases of HIV. To reduce the incidence of HIV, we plan to work with other partners to strengthen existing initiatives and introduce innovative interventions aimed at HIV prevention.  

Because HIV transmission is so strongly influenced by the ecosystem, we’re going to have to work more closely with communities than ever. We’re going to have to galvanise the private sector as a whole to help meet our crucial targets – and that includes addressing the broader social factors we’ve referred to, helping people overcome the stigma of living with the disease, and advocating for game-changing innovations in the HIV space.

One of the key areas where we’re already working to make a difference is by providing support to adolescent girls and young women. Here, it’s critical to provide adolescent-friendly care under WHO guidelines that include everything from HIV and pregnancy testing to GBV prevention and education around gender transformative principles to strengthen family cohesion and prevent violence.

Another focus area is to deliver programmes for men who are vulnerable to HIV. When it comes to issues like GBV and HIV, we have looked at the social and structural factors that contribute to HIV transmission and acquisition. We understand that we can only achieve sustained reduction in HIV incidence if we collaborate with other local partners and support our National Strategic Plan on HIV, TB and STIs. Our existing and new programmes have to be integrated in a manner that addresses the risk of HIV, the elimination of GBV and related anti-social behaviour.

A peer-to-peer approach helps break down stigma and focusses on breaking down stigma and harmful gender stereotypes. A prime example of this approach is our partnership with Coach Mpilo, which works in communities to support HIV-positive men in getting control of HIV and regaining a healthy, safe and productive life. The coaches help the men they work with reach a point where they can live openly and confidently with HIV, without any of the fear and shame that they might have felt initially.

Removing stigma, building an environment in which men can come forward to get tested, and creating a supportive space for treatment have all contributed to men enjoying improved health and well-being, despite their HIV status.

A multi-faceted approach is needed, which demands the involvement of the private sector, government and all social partners. If we get it right, we’ll be well on the way to ending HIV by 2030. Our country, and our people, deserve no less.

By Dr Charles Mbekeni and Dr Alexandra Plowright

Dr Charles Mbekeni is the health lead at Anglo American South Africa and Dr Alexandra Plowright is the global health lead for community health at Anglo American