By: Gareth Lowndes

Two high-profile South African court cases are making news locally and internationally and nobody wishes to trivialise or sensationalise the personal tragedies and grief surrounding those murder trials. But two other reports in recent weeks are likely to have far broader, more serious long-term implications for our country than matters involving Oscar Pistorius and Shrien Dewani.

The first is the new Human Sciences Research Council report on South Africa’s HIV rate, which found that the number of our people infected with the virus has increased. Assuming the report reflects a true picture, there were 470 000 new HIV infections in South Africa in 2012. South Africa may now have the world’s highest rate of new infections. Providing anti- retrovirals (ARVs) for these people will cost about R400-million a year.

The National HIV Prevalence, Incidence and Behaviour Survey for 2012 found that South Africa has more than 3.13-million children who have lost parents to Aids. It is roughly the same as the number of people living in Ekurhuleni. Clearly, each child needs care and support, but again it would be far preferable if the number of orphans as well as the number of people with HIV declined each year.

The second report of interest is the ascendancy of Nigeria as Africa’s biggest economy in terms of gross domestic product. There is little doubt that HIV places a massive financial burden on sub-Saharan Africa economies. Might that have been a factor in South Africa being overtaken by Nigeria as the leading economy on the continent?

Equally worrying are the reported shifts in attitude and behaviour. The study indicates that condom use and the level of knowledge about HIV have declined. This is alarming, as is the anecdotal evidence of an emerging attitude among some young people, who opt to not use condoms and say they will simply go onto ARV treatment if they are infected with HIV.

We cannot afford to be complacent about HIV in South Africa. We cannot resign ourselves to millions of our people living with HIV, and, in the long term, millions being spent to fund ever-growing ARV programmes – we can move beyond that. We have made great strides in fighting this disease and we have in our grasp the prospect of an Aids-free generation within 20 years, as long as we pursue all the options available to us. To achieve this, effective HIV prevention is paramount.

Key to this is the relatively new drive for medical male circumcision (MMC), a safe, quick procedure that reduces a man’s chances of being infected with HIV during heterosexual sex. Combined with other measures, including consistent condom use, regular testing, delaying sexual debut and a reduction in the number of sexual partners, MMC greatly reduces HIV risk among men.

So, MMC offers lifetime benefits to men and their partners but, from a more general perspective, widespread uptake of the procedure will, within a few years, begin to deliver benefits at a broader population level. We estimate that, for every five MMCs, one HIV infection is averted – so, as the number of men afforded HIV protection though MMC increases, so the number of people infected should decline.

Apart from the potent humanitarian benefits of helping reduce the risk of HIV/Aids, an effective combination prevention strategy that includes MMC would save South Africa R50-billion over the next ten years. A number of organisations are facilitating MMC, but it requires large-scale cross-sectoral participation.
It is enormously encouraging that the HSRC report points to a significant increase in MMC, from 1.5-million in 2002 to 3.3-million in 2012. It is also heartening that nearly 40% of male respondents over 15 indicate that they would like to be circumcised. We must facilitate that. By ‘we’ I specifically challenge large-scale employers to do so because they can activate MMC campaigns quickly and cost-effectively, but also civil society and government. Churches, sports clubs, soccer supporters clubs and stokvels all have a role to play and so, of course, do labour and business, especially if they work together.

South Africa’s successes in addressing HIV must be lauded and Health Minister Aaron Motsoaledi should take credit for the roll-out of ARVs and prevention of mother-to-child transmission, and for promoting MMC. But the success of MMC requires more than Ministerial endorsement – it requires, for example, each employer in labour-intensive industries to promote the procedure within the workplace. Each employer who does so will move us closer to a future of declining, not climbing, HIV infections. ARVs are necessary and save lives, but we need to find a future where their use is in decline and HIV is in retreat.

The context of South Africa falling behind Nigeria has nothing to do – or should have nothing to do – with ‘beating’ another economy. It is not about one-upmanship or some testosterone-fuelled game of my-economy’s-bigger-than-yours. It is about ensuring that South Africa has a competitive advantage and that its people have dignity, health and a livelihood. It’s about freeing our people from the misery of a terrible disease, and freeing massive economic and human capital for socioeconomic development through better HIV prevention.

Aids denialism delayed the roll-out of ARVs in South Africa. It was an expensive mistake – both in terms of lives lost and the cost to the economy. Thereafter, the denialists turned on and challenged the efficacy of ARVs, also costing many lives. We cannot allow ‘circumcision denialism’ to do the same.

The epidemiological impact of MMC on HIV infections is scientifically proven, and we must use every tool at our disposal to beat this epidemic. Certainly, MMC is only a part of the wider Combination Prevention approach – but it is an important part. For the first time, we have a relatively simple and low-cost one-off intervention that can help turn the tide on new HIV infections.

Lowndes is Prevention Programmes director for CareWorks.