The Impact & Urgency

In 2018 South Africa contained 21% of the worlds population of people living with HIV, and 14% of new infections (UNAIDS, 2019). South Africa is noted to be one of the first of Africa's countries to gain a policy that allows for universal access to antiretroviral therapy (ART) after WHO recommended and the policy has been in effect since September 2016 (National Department of Health, 2016). While implementing this policy has proven to be successful, it requires the amount of people on ART to go from an estimated 4.7 million to an approximate 8 million, almost doubling the amount of ART necessary (Statistics South Africa, 2019; UNAIDS, 2019). It has taken South Africa over 15 years to get where they are when it comes to treatment. They have had to go through "intense domestic and international financial investments, massive social mobilization and commitment from all levels of government and civil society. "(Myburgh et al., 2021) . Despite their best efforts they are falling behind on their UNAIDS 90-90-90 targets (UNAIDS, 2019). The UNAIDS 90-90-90 target was put into places to ensure that 90% of people with HIV are aware of their disease, 90% of people diagnosed with HIV are receiving treatment, and 90% of people who are on ART achieve viral suppression (UNAIDS, 2014; UNAIDS, 2015).

The challenges in South Africa that are causing negative results are likely to continue to intensify, at least for a short term. This is due to the increase of ART for a successful adaptation of 'universal' access to ART. "For treatment to be available requires it to be physically reachable, economically affordable and socio-culturally acceptable; coverage is defined by the ‘proportion of a population needing an intervention who receive it’ and impact is measured by the efficacy and effectiveness of the intervention to reduce infection and mortality rates. " (Myburgh et al., 2021) . While we have seen great improvement in the efficacy and efficiency of ART, the other requirements South Africa is struggling to meet.