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HIV/AIDS in South Africa
One target goal for SDG 3 is to help treat and minimize the effects of diseases such as HIV. In the early 2000’s South Africa had been the area most affected by the outbreak of HIV. Only 1/1000 people living with HIV had access to treatment and the average cost for treatment was 10,000-15,000 USD a year (Moutafis & Surprenant, 2020) . A joint effort was required to create a change. The global political agenda had to add a goal of access of treatment for AIDS. Also, healthcare providers had to be able to show the treatment was safe and effective, and could be done easily in Africa, which lacked resources. Lastly, the pricing needed to become more affordable for their people (Hoen et al., 2011) .
After those three tasks listed above were completed and put into action, funding for antiretroviral drugs (ARVs) was increased and they started investing in the healthcare system to deliver treatment and help those both HIV positive and HIV negative. This is thanks to the civil society and the leaders who took the risk (Hoen et al., 2011) .
While great progress has been made, there still is room for growth. After the movement to allow for better access to HIVs was put into effect we have seen how ARV treatment can reduce HIV/AIDS illnesses and deaths in developing countries. However, there is more work to be done. ARVs are still not used enough for those in need, and are getting to people too late. WHO recommends that resource poor areas start people with their HIV treatment when their CD4 cell counts are above 350 cells/mm3 opposed to 200 (World Health Organization, 2009). For wealthy countries it is recommended that the treatment starts earlier at a CD4 cell count of 500 cells/mm3 or more (Thompson et al., 2010) . With these numbers it means that we are moving in the right direction however this means that 14 million people are now in urgent need of the treatment with 9 million not being able to afford the medication. In order to find a solution for this issue this means that ARVs still need to become more affordable, meet the current medical standard, and be able to be developed and adapted for the location they are needed. The medication should be adapted for locations that don't have access to refrigeration, health workers are in short supply, or where minimal or no monitoring is available (Hoen et al., 2011).
This graph represents the people living with HIV who are not on ART (15 years of age and older). (UNAIDS, 2020)
Effect of Gender and Race with HIV/AIDS
Racial inequalities and gender play a large part in the epidemic of HIV. In 2012 a survey was conducted and showed that an estimated 6.4 million people, which was about 12.2% of their population, were living with HIV. This epidemic is known to affect women more than men, especially Black African American women (Rehle et al., 2015) . This gender inequality can be traced back all the way to 2002 where we see a higher infection rate in females (17.7%) than males (12.8%) (Richardson et al., 2014). This trend continues throughout future surveys. In a future survey constructed in 2005 it is noticed that infection rates have decreased but are still more prevalent in females opposed to men with females at 13.3% and males at 8.2% (Simbayi & Shisana, 2005). Lastly, in 2018, we see a slight increase in infection rates with rates of 14.4% in females and 9.9% in males (Rehle et al., 2015). In all of those surveys conducted Black African Women had the highest prevalence compared to other race groups. A big factor for why we see this is poverty. A humans science researcher stated, "Poverty is an overarching factor that increases the disparity associated with HIV prevalence between genders and among race groups created by historical and current unequal cultural, social and economic status in South Africa ."(Mabaso et al., 2019). Since women in South Africa have low social and economic statuses, it reinforces "unequal gender power dynamics". This dynamic forces women into relationships that are not safe for them and creates a higher chance for them to be exposed to HIV infection by a man. This typically happens when they have transactional and intergenerational sex (Awoleye & Thron, 2015; Sia et al., 2014) . Even in the other parts of Africa, the women are most affected by the epidemic of HIV. This is mainly due to women's inequality when it comes to their social, cultural, and economic statuses in these various societies (Mabaso et al., 2019).
Tuberculosis In South Africa
An estimated 360,000 people in South Africa developed tuberculosis in 2019 with 58% of those people being HIV positive and 17% of those people died. (World Health Organization, 2013). Tuberculosis remains to be the leading cause of death in South Africa and is most prevalent with people who have HIV (Ford et al., 2016). They would diagnose TB by using smear microscopy, culture and line probe assay until 2011. They then started to introduce GeneXpert MTB/RIF assay for use in testing TB (Ford et al., 2016). It is known that people who have successfully; completed TB treatment are four times more likely to die compared to the general population (Osman et al., 2021).
This image shows the steps of how to use the Xpert MTB/RIF testing kit (Theron, 2012)
People co-infected with TB and HIV
“In 2019, an estimated 58,000 people died from TB, of whom 36,000 (62%) were coinfected with HIV.” (Gengiah et al., 2021). South Africa has a goal to reduce the deaths caused by TB by 95%, and they want to reach this by 2035. In order to keep reducing the mortality rate, we have to look specifically at the HIV-TB coinfected patients (Naidoo et al., 2017). A key strategy to be able to reduce deaths caused by TB among people with HIV is to integrate TB and HIV services (Sculier & Hāylayasus Gétāhun, 2012). “HIV-TB services refers to screening, diagnosis, and treatment services provided for both diseases at the same clinic, by the same clinic team, on the same visit day.”(Gengiah et al., 2021). In order to operate and deliver high-quality HIV-TB services there are going to be some challenges due to how complex it is. This is especially hard when you are in an environment that lacks resources because there is a need for simple, low-cost, and sustainable solutions to “enhance service delivery” (Clark, 2017).
This picture represents the leading causes of death in South Africa in 2018 before COVID-19 (Statistics South Africa, 2021)
References
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Clark, J. (2017, August 17). IHI PARTNERS WITH SOUTH AFRICA NATIONAL DEPARTMENT OF HEALTH ON INITIATIVE TO IMPROVE TUBERCULOSIS CARE AND OUTCOMES. Institute for Healthcare Improvement. Retrieved June 17, 2022, from http://www.ihi.org/about/news/Documents/IHIPressRelease_Gates-Foundation-Funds-TB-Work-in-South-Africa_Aug17.pdf
Ford, N., Matteelli, A., & Shubber, Z. (2016, January 12). TB as a cause of hospitalization and in-hospital mortality among people living with HIV worldwide: a systematic review and meta-analysis. NCBI. Retrieved June 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712323/
Gengiah, S., Naidoo, K., & Mlobeli, R. (2021, September 30). A Quality Improvement Intervention to Inform Scale-Up of Integrated HIV-TB Services: Lessons Learned From KwaZulu-Natal, South Africa. NCBI. Retrieved June 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514040/
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Sia, D., Onadja, Y., & Nandi, A. (2014, October). What lies behind gender inequalities in HIV/AIDS in sub-Saharan African countries: evidence from Kenya, Lesotho and Tanzania. PubMed. Retrieved June 19, 2022, from https://pubmed.ncbi.nlm.nih.gov/24345343/
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Statistics South Africa. (2021, June 15). TB tops leading causes of death in SA in 2018. Retrieved June 19, 2022, from https://www.statssa.gov.za/?p=14435
Theron, G. (2012, November). Figure 1: Xpert MTB/RIF assay overview. Panel (a) shows the single-use,... ResearchGate. Retrieved June 19, 2022, from https://www.researchgate.net/figure/Xpert-MTB-RIF-assay-overview-Panel-a-shows-the-single-use-disposable-assay-cartridge_fig6_233797152
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