Towards an HIV-free generation: A South African Journey
The past decade has seen historic public health milestones in South Africa’s response to the HIV epidemic, namely, the success of the Prevention of Mother-to-Child Transmission of HIV program (PMTCT), thereby moving the country closer to the goal of an HIV-free generation. The Durban 2016 International AIDS conference is an opportunity to reflect on the achievements during this journey.
The impressive scale-up of PMTCT services integrated in the maternal and child health care services and primary care resulted in almost universal HIV-testing among pregnant women in 2009, compared to slightly less than 50% of pregnant women in 2005. HIV prevalence among children aged 2–14 fell from 5.6% in 2002 to 2.4% in 2012 and the number of new infections among children declined by 79% from an estimated 78,000 infections in 2004 to 16,000 infections in 2013 due to the rapid expansion of services to prevent MTCT. The rate of mother to child transmission of HIV fell from 8% in 2008 to 2.6% in 2012 to 1.5% as per programme data in 2015.
So, what made this possible?
Several factors have contributed including high levels of political commitment, leadership at all levels among Government and key stakeholders, strong technical assistance partnerships, research, implementation, monitoring, and funding, thus bringing together a whole range of resources needed for a response of this magnitude. Most importantly, the partnerships on the ground, engaging women and children, adolescents and young people, families and communities, local leaders and role models, media and the private sector all contributed towards building a momentum for the response to the epidemic.
The highlights include enabling and evidence-based policies and strategies, decentralized use of data to inform program action linked to results as well as linking 52 districts and nine provinces towards one national action framework, namely the “No child born with HIV in South Africa” facilitating the PMTCT response in 2011. The programme was assisted by a supportive environment to design and roll out innovative solutions using digital and mobile technology. A notable example is the MomConnect initiative, piloted by UNICEF with the KZN Department of Health and other partners in 2011. Lessons learned informed the national scale-up of the program in 2014. Today, over 700,000 pregnant women are connected through their mobile phones and receive SMS alerts throughout their pregnancy until one year after the child’s birth. South Africa’s MomConnect program is one of the largest mobile technology public health programmes in the world. Policy makers, programme managers and researchers have all documented the success of the PMTCT program and its positive impact on South Africa and globally.
UNICEF continues to work closely with Government, as the lead strategic and technical partner for PMTCT and paediatric HIV care and treatment. From policy to services, work has been done to understand gaps and challenges from policy to programme to practice levels. This work, combined with appropriate and innovative responses has shown results.
We still, however, need to step up our efforts to reach every woman and child. Equity in coverage, in access, in quality of care and in every aspect of policy implementation and program monitoring is the focus for the coming years. The next five years are crucial to implement the plan towards eliminating mother-to-child transmission of HIV to guarantee that no child is born with HIV in South Africa. This will mean reducing new HIV infections among adolescents and young women, supporting planned pregnancies, fast-tracking early access to antenatal care, and following up care and support to mothers in the post-natal period.
Today, as we collectively define ways to implement the Sustainable Development Goals, the equity focus and the spotlight on addressing social factors, reaching the unreached and supporting governments towards a comprehensive, evidence-based HIV response, are critical areas of work.
Let us together finish the unfinished.
 Barron et al. 2013. Eliminating mother to child HIV transmission in South Africa. Bulletin of the World Health Organization; 91:70–4
 Simbayi, L., Shisana, O., Rehle, T. et al. 2014. South Africa National HIV Prevalence, Incidence and Behaviour Survey 2012. Human Sciences Research Council.