World Aids Day | HIV fight under strain as millions remain off treatment

Nelson Dlamini

On 1 December 2025, South Africa will join the global community in commemorating World AIDS Day, a powerful reminder that the HIV pandemic is far from over, with nearly 8 million people living with HIV in South Africa. It is also an opportunity to shine a spotlight on the persistent stigma that drives discrimination and creates barriers to testing and treatment.

The commemoration helps educate the younger generation, who may view HIV as a mere manageable chronic condition rather than the devastating crisis it once was. This reminder is crucial in emphasising the need to prevent new infections in order to eliminate the virus as a public health threat.

This year, South Africa will commemorate World AIDS Day under the theme “Renewed Efforts and Sustainable Commitments to End AIDS”.

The theme urges the reinvigoration of strategies to close gaps in prevention and treatment and emphasises the need for long-term domestic investment in the face of funding cuts and shifting global priorities. Recommendations in the theme rationale include increased domestic investment, large-scale decanting, and the urgent filling of vacancies to stabilise the public health system.

UNAIDS 95-95-95 Targets

In an effort to accelerate progress towards meeting the Sustainable Development Goals (SDG) targets for Agenda 2030, UNAIDS introduced the 90-90-90 targets in 2013, with a deadline of December 2020.

The aim was to ensure that 90% of all people living with HIV know their status, 90% of those diagnosed receive sustained antiretroviral therapy (ART), and 90% of those on treatment achieve viral suppression. After the December 2020 deadline, countries moved towards the 95-95-95 targets over the next five years, making 2025 the deadline year for these targets.

South Africa currently stands at 96-79-96, meaning the country is struggling with initiating and retaining people diagnosed with HIV on treatment. The challenge with the second 95 is not unique to South Africa; global progress stands at 95-85-92. Numerous factors affect treatment initiation and retention, ranging from structural issues (long queues and waiting times), economic barriers (transport costs and lost income from missed work), psychosocial challenges (stigma and discrimination), to gender and age-specific issues (men’s and adolescents’ negative perceptions of health facilities), to name a few.

In response, the Department of Health launched the Close the Gap campaign with the aim of finding 1.1 million people who are HIV-positive but not on treatment. The 1.1 million figure has been broken down by province, district, and even facility — everyone is working hard to close their portion of the gap. An update on progress is expected to be presented during the World AIDS Day commemoration.

Equal to the task

South Africa may be the global epicentre of HIV and TB, yet it is not taking the challenge lying down. Firstly, the government funds the majority of HIV and TB programmes, particularly the procurement of medicines — South Africa buys 90% of its own ARVs, with only 10% supported by the Global Fund. This financial autonomy enabled the Department of Health to introduce the Six-Multi-Month Dispensing (6MMD) strategy despite PEPFAR funding cuts. Under 6MMD, stable patients receive a six-month supply of ARVs in a single visit instead of attending the clinic every month. This improves treatment access and adherence by reducing clinic visits, travel time, and costs for patients while easing pressure on healthcare facilities.

In addition to running the largest publicly funded treatment programme in the world, the ARV regimens available at public facilities are among the best and most up-to-date on the market. Following WHO guidelines around 2019, the country swiftly transitioned from the three-in-one combination containing efavirenz — a drug with debilitating side effects and inferior efficacy — to a dolutegravir-based regimen, which has fewer side effects, achieves faster and more durable viral suppression, and is cheaper.

What sets South Africa apart from many other countries on the continent and beyond is its recognition of key and priority populations — including LGBTQI+ communities, sex workers, and people who use drugs — who all require tailored interventions to ensure no one is left behind, making the national response truly inclusive and comprehensive.

Young women most at risk

The greatest focus, however, must remain on men, children, adolescent girls and young women (AGYW) aged 15–24. Men and children have the largest treatment coverage gaps, while AGYW are the hardest hit by new infections — the country records around 1,100 new infections per week in this group. Apart from biological vulnerability, primary drivers include age-disparate relationships with older men (“blessers”) who have higher HIV prevalence, poorer treatment adherence, and multiple partners. Poverty and lack of employment often push girls into transactional sexual partnerships that expose them to HIV. Early sexual debut and gender-based violence also play significant roles.

Several interventions have been implemented, including the She Conquers Campaign, the #ZikhalaKanjani Youth HIV Prevention campaign, and Youth Zones which are dedicated youth-friendly service spaces in public health facilities. Although infections have gradually declined, much more needs to be done, particularly in improving access to prevention tools such as PrEP (pre-exposure prophylaxis) and the Dapivirine vaginal ring among others. 

We end 2025 with high hopes following the registration by South African Health Products Regulatory Authority (SAHPRA) of lenacapavir, the long-acting injectable HIV prevention drug administered once every six months. It promises to be a real game-changer in HIV prevention, with public rollout anticipated in the first quarter of 2026.

***Nelson Dlamini is the Executive Manager of Strategic Initiatives and Communications at GCIS 

*** The views expressed here do not necessarily represent those of IOL or Independent Media

IOL Opinion