Southern Africa: The silent HIV Crisis

For many decades in southern Africa, the region with the highest percentage of people living with HIV-AIDS, our biggest concern was treatment and care that remained outside the reach of the majority.

Now that antiretroviral therapy (ART) is more readily available, we face a new, albeit much more silent crisis: adherence to treatment routines.

The success of ART in suppressing viral loads, reducing transmission, and improving quality of life depends on consistent adherence. Southern African Development Community (SADC) countries have made significant progress in the fight against HIV-AIDS.

Yet, systemic, social and economic barriers, including stigma, poverty and limited access to healthcare, continue to undermine this life-saving treatment across the region. Addressing these challenges is crucial to sustaining progress in the fight against HIV-AIDS in SADC.

Non-adherence to HIV-AIDS treatment has significant costs. For individuals, it increases mortality, morbidity, and the risk of drug resistance, leading to more severe health complications. For health systems, it results in higher treatment costs, more hospitalisations, and greater demand for healthcare services. Economically, non-adherence reduces workforce productivity and perpetuates social inequality.

It also heightens the risk of HIV-AIDS transmission, making prevention efforts more costly. Overall, non-adherence places a heavy burden on individuals, health systems and society, underscoring the importance of consistent treatment adherence to reduce these long-term costs.

The expansion of ART in SADC has been remarkable. According to the 2024 SADC Voice and Choice Barometer: “The number of people on antiretroviral (ARV) therapy has expanded dramatically since 2010. The global target is for 34 million people to be on ART by 2025. There are now 14 441 960 people living with HIV, 83% of all those living with HIV-AIDS, who are on ART in SADC.

South Africa alone accounts for 19% of the global total of people living with HIV-AIDS who are on ART. The rate of increase of people on ART has been highest in Madagascar.”

This progress demonstrates the region’s commitment to combating HIV, but adherence issues threaten to undermine these gains.

The UNAIDS 95-95-95 targets aim is for 95% of people living with HIV-AIDS to know their status, 95% of those diagnosed to access ART, and 95% of those on ART to achieve viral suppression by 2025.

According to the Barometer: “There has been great progress between 2016 and 2023 for both women and men. However, women are still more likely to have been tested, accessed ARV therapy, and achieved viral suppression than men in most countries.”

Mauritius is an exception, where men are more likely to meet these targets due to a focus on key populations. Notably, Eswatini, Botswana, Zimbabwe, Zambia and Malawi have already achieved the 95-95-95 targets, while Lesotho and Namibia are on track to do so by 2025.

Among young people aged 15–24, a group particularly vulnerable to HIV-AIDS, infection rates have significantly declined. The Barometer notes that “SADC’s share of global new infections in young people has decreased from 49% in 2010 to 38% in 2023.”

Open discussions about sexuality and life challenges are critical during this phase. In my family, a young relative was diagnosed with HIV-AIDS at just 16 years old. Struggling to accept her status and battling suicidal thoughts, she often skipped treatment, expressing a desire to die.

However, with family support and counselling from a psychologist, she gradually embraced her journey and is now healthy and committed to her treatment.

People living with HIV-AIDS face numerous challenges, including stigma and discrimination, which often prevent them from seeking care or adhering to treatment. Limited access to healthcare, especially in rural areas, financial burdens and long distances to treatment centres also pose significant obstacles.

Additionally, mental health issues like depression and anxiety, alongside the fear of rejection, further complicate their ability to maintain treatment and lead fulfilling lives.

My relative even decided to stop using the nearby clinic because she was scared of being judged. These barriers hinder the effectiveness of HIV-AIDS care and contribute to ongoing health disparities.

The fight against HIV-AIDS in SADC countries has come too far to be undermined by these challenges now.

Each interrupted treatment represents not just a personal health crisis but a step backward in our collective battle against this epidemic. It’s time for policymakers, healthcare providers, and communities to come together and address these barriers head-on.

As a society, we must recognise that HIV-AIDS treatment adherence is not just a medical issue but a complex social challenge that requires a multifaceted approach. By addressing the root causes of non-adherence – from poverty to stigma – we can create a supportive environment where every HIV-AIDS-positive individual has the opportunity to live a healthy, dignified life.

The path forward is clear, though not easy. It requires commitment, resources and a fundamental shift in how we approach HIV-AIDS care. But with lives hanging in the balance, we have no choice but to act. The hidden crisis of HIV-AIDS treatment adherence in SADC countries demands our attention, our compassion and our resolve to find solutions.

The time to act is now – before more lives are needlessly lost to a manageable condition – and managing it demands consistent adherence to ARVs. The path forward is clear but requires urgent action. By addressing systemic challenges, fostering equity, and prioritising adherence, SADC can uphold its commitment to those living with HIV-AIDS.

Every life saved is a testament to the power of collective resolve and compassion in the face of adversity across the region. Achieving the 95-95-95 targets is possible. That must be our resolve on #WorldAidsDay2024.

• * Nokwe Mnomiya is a Woman of the South Speak Out or WOSSO fellow. For more information contact nokwemnomiya@gmail.com