Eighteen months since Sars-Cov-2 first penetrated our shores, South Africa finds itself on the receiving end of a storm warning.
With Covid-19 becoming the most onerous and expensive public health undertaking in modern history, our public health system is wedged beneath the crippling impact of a triple pandemic collision – Covid-19, HIV and tuberculosis (TB).
In the race to stem the Covid-19 tidal wave, the silence in the conversation around HIV has been deafening. The free-fall drop of over 50% in HIV and TB testing and monitoring since the advent of Covid-19 is a devastating setback. For those who have been on the front lines of the HIV/Aids pandemic over the last 40 years, this is alarming cause for concern. History is repeating itself.
Despite the devastating Covid death toll (69 775 as at July 26, 2021), TB and HIV/Aids remain the leading causes of death in South Africa. Figures from the South African National Aids Council (SANAC) reveal that 72 000 people died of Aids-related causes in 2019, and 200 000 new HIV infections were recorded during the same period.
Figures from the WHO Global Tuberculosis Report 2020 reveal 58 000 people died of TB in South Africa over the same period, while in 2020 new TB infections soared to over 300 000. With national budgets being reprioritised to marshal resources to fight the Covid pandemic, TB and HIV infections are inevitably on the increase – untested and unmonitored.
South Africa’s faltering and floundering response at the start of the Covid vaccination procurement process is reminiscent of the fatal missteps taken at the onset of the HIV pandemic. When HIV ceased to be a death sentence in the Western world in 1996 with the introduction of triple-cocktail therapy, the HIV/Aids death toll only peaked in SA over a decade later in 2008.
Although the reduction in HIV deaths of over 50% since 2010 is a positive development, the annual death toll from Aids-related causes over the last 13 years has never been less than 70 000 deaths per annum. This is the root of the persistent, lingering and wholly unnecessary public health crisis.
At the risk of stating the obvious – we weren’t supposed to be here. The singular advantage TB and HIV have over the current pandemic is worth mentioning. Tuberculosis is a curable disease; HIV is a manageable chronic condition and death is avoidable.
The current HIV and TB setbacks were entirely preventable had South Africa had better preparedness in pursuit of the Sustainable Development Goals. The dire conundrum is that in the context of Covid, with South Africa being home to the largest population living with HIV (7.7 million in 2019), more not less effort and investment is required to ensure vulnerable communities don’t continue to fall through the cracks.
As at July 25, 2021, 6 million people in South Africa had received Covid-19 vaccinations; 10% of the population. Covid data gathered to date reveals a predictable pattern. Our first wave peaked during winter 2020, the second during the December festive season, and the third wave has resurged in winter, exactly a year after the first. Given the inevitability that South Africa will not attain herd immunity by December 2021, it is therefore not a moment too soon to formulate a plan of action for the looming year-end fourth wave. The data is clear – science fails where poor service delivery prevails.
The response to these pandemics is marked by gross inequality. Systemic exclusion has persistently left all marginalised communities exposed and unprotected against global health threats like HIV, and now Covid-19, for decades.
Accountability, and not the resilience of our nation’s citizens, is by far our most required strategic weapon. The recent unrest in certain parts of the country is a clarion call. The shifting of goalposts and the constant moving of targets only serve to fuel the vicious cycle of infection, illness and crisis. Any delay in getting the right treatment at the right price to the right people is simply unacceptable.
The writing is on the wall. The ongoing disruptions to essential services will lead to more HIV and TB deaths, and the milestones and gains achieved in the HIV response irrevocably reversed.
With eight years ahead of us, it is absolutely possible to still meet the Sustainable Development Goals target to end Aids by 2030. In the Covid era, an agile, forward-looking response must be the fulcrum of any pandemic cessation strategy. In the noisy confusion of policy development, strategic planning and implementation, the time is nigh to get back to basics. Batho pele, the Sotho/Tswana term for “people first” is the principle to guide people-centred responses that place the communities’ needs, concerns and desired outcomes at the centre of every campaign. All people, in all communities, from all walks of life, must reap the benefits of science. Our people are suffering. Our people are dying. When we name our problems, solutions become easy to find.
We have work to do. We must finish what we started. When victory is won, the spoils will be ours.
Judi Nwokedi is chairperson of the Aids Consortium in South Africa, a human rights organisation aimed at promoting a non-discriminatory response to the HIV/Aids epidemic.