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World AIDS Day 2020 marks a distinct juncture in the management of HIV in South Africa over the past ten years.

This is because, along with the new threat of the Covid-19 pandemic, we are also faced with an additional threat to an old pandemic.

Hon. Speaker, according to the Lancet publication, early modelling data showed that a six-month disruption in antiretroviral therapy delivery for HIV could result in up to half a million additional deaths; double mother-to-child transmission in sub-Saharan Africa over one year; and an increase in mortality by up to 40% over the next five years.

In South Africa, based on official figures, which we concede may be under reported, Covid-19 has not yet been as devastating as initially thought and the most dire forecasts for HIV-positive patients have yet to be realised. Instead, however, the greater threat to HIV-positive patients is not the Coronavirus itself, but rather the impact that the pandemic has and is having on HIV prevention, care and treatment.

During the hard lockdown from April until June, we saw the following reductions:
- The total number of HIV positive patients remaining on anti-retroviral treatment declined by 6 000, from 76 700 to 70 700;
- Medical Male Circumcision, which can reduce a man’s risk of contracting HIV by up to 60%, declined from 10 000 to 9 000;
- The availability of male condoms declined from 18 million to 13 million; and
- Only 46 700 HIV tests were conducted against a target of 76 700.
These worrying outcomes are as a result of shifting focus to combat Covid-19, at the expense of HIV prevention, care and treatment.

In effect, we saw things like district condom officers being redeployed to do Covid-19 work, we saw a call for the suspension of medical and traditional male circumcision, and we saw HIV positive clients falling through the cracks.

Hon. Speaker, in previous years, we have celebrated strides made in South Africa in tackling the HIV epidemic. This was particularly seen in South Africa’s commitment to enrol all HIV positive people onto treatment immediately after diagnosis, regardless of their CD4 count; the launching of Universal Testing and Treatment; and the fact that South Africa has the world’s largest ART programme.

It will indeed be a tragedy for the gains made in the war against HIV and AIDs over the past decade, to be undone.

Yet the World Health Organisation has warned that a broad disruption in HIV treatment in sub-Saharan Africa as a result of Covid-19, could, and I quote: “effectively set the clock on AIDs deaths back to 2008, when more than 950 000 Aids-related deaths were observed in the region”.

Hon. Speaker, restrictions of movement due to lockdown, coupled with shortages of essential medicine and closure of health facilities due to Covid-19 positive cases, resulted in disruptions to HIV treatment and services, with far reaching effects.

This is particularly worrying given that there is a growing number of HIV positive people, who have been previously diagnosed, but are not on ART. This includes those who had started ART and defaulted, as well as those who were never initiated. This number has increased during COVID-19 pandemic.

In this regard, the Northern Cape needs to reboot and regain its focus on the initiation of patients onto treatment, as well as retaining patients in care.

Hon. Speaker, this also shines the spotlight on the health system’s failure to implement an effective contact tracing programme. This has and continues to be dismally lacking in the country’s Covid-19 response, despite it being the key component in containing a pandemic.

Government has no choice but to find a way to get this right.

If contact tracing of Covid-19 positive cases succeeds, then at least there will be a lasting positive legacy to come out of the pandemic that can be used in the ongoing fight against HIV and TB.

In much the same way, the current situation presents an opportunity for much needed systemic change within the health care system. In fact, Covid-19 specific interventions could eventually enhance HIV and even TB services, like screening services for Covid-19 that could be repurposed for HIV and TB.

The now more regularised wearing of masks could possibly also serve as a means by which to decrease the spread of TB.

Hon. Speaker, there is no doubt that Covid-19 will have a lasting negative impact on HIV. More, however, must be done to minimise this impact.

There can thus be no doubt that this places greater responsibility on government, together with all stakeholders, to work harder to mitigate the harm that is being done. As the theme for World AIDS Day 2020 states, “We’re in this together”.

Ending AIDS thus requires communities to be engaged in identifying and helping to address their specific needs, specifically the most marginalised and vulnerable members. It also requires authorities to be accountable for the quality and delivery of the services required to address those needs.

In closing, Hon Speaker, as our candles glow strongly in memory of those lost to Covid-19, AIDs and TB over the past year, we need to channel this sadness into finding a better way to integrate health care to equally protect and save people from all illnesses, not just those dominating global headlines.

This said, Covid-19 must be stopped, but so too must HIV and so too must TB.

Let’s embrace the World Aids 2020 theme and objectives. Resilience and impact. Resilience has brought us accolades in the past but is being tested again. We need to come together with other health issues while holding on to key successful attributes. The impact should be felt by everyone! Our health care workers need protection as all illnesses deserve to be treated. All patients deserve a fighting chance with decent roadworthy ambulances. And no specific diagnosis or price tag on treatment should be the determining factor as to whether anyone lives or dies.

Issued by DA