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S.African town surpasses UN targets to drive down HIV

November 30, 2019

Eshowe, a small town at the center of the world's AIDS epidemic in South Africa, is a beacon of hope in the bid to reduce the AIDS virus. It has beaten the 90-90-90 target deadline set by UNAIDS by a year.

People walk past a mobile testing unit from MSF on the outskirts of Eshowe
Image: Getty Images/G. Guerica

Eshowe is around 140 km (87 miles) north of Durban in KwaZulu-Natal province where one in four people is living with HIV. It has become beacon of hope in the fight against HIV in South Africa, the center of the world's AIDS epidemic.

The town has already surpassed the 90-90-90 HIV reduction goals set out by the United Nation's AIDS organization – showing that it's potentially possible for South Africa as a whole to reach the targets.

The UNAIDS targets aims for 90% of people living with HIV to know their HIV status, 90% of all people diagnosed with an HIV infection to receive antiretroviral therapy, and 90% of all people receiving antiretroviral therapy to achieve viral suppression by 2020.

Read more: UNAIDS report: HIV-related deaths down a third since 2010

Stunning results

When Medicines Sans Frontiers (MSF) recently evaluated the HIV project they run in Eshowe in conjunction with the KwaZulu-Natal Department of Health, they were amazed at the results.

Of 3,200 people surveyed in 2018, 90% of those infected knew their status, 94% of those who knew their status were on antiretroviral treatment and 95% of those on treatment had their viral load suppressed in 2018 - a result of 90-94-95.

"I'm happy we reached 90-94-95 in a small rural area of Eshowe," community member Zikhethelo Mthethwa told DW. "I'm very happy that our communities are getting better from their sicknesses and stigma has reduced in our community."

It's community members like Mthethwa that have made the project, which started in 2011 before UNAIDS introduced their targets in 2013, so successful.

Mthethwa is one of dozens of people from Eshowe who have been trained as health workers to encourage fellow residents to get tested, treated and stay on treatment.

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Multi-colored condoms wrapped in their plastic packets
Community health workers in Eshowe handed out 1.5 million free condoms a year between 2015 and 2018Image: Imago/Westend61

Some of their many tasks are distributing condoms, conducting door-to-door testing, encouraging people to seek treatment and raising awareness of HIV issues.

Reducing stigma, building trust

"The project was heavily invested in community interventions by peers, by community members talking to fellow community members and linking them to health facilities [as well as] health care workers following up back at home," explained Florence Anam, a HIV advocacy coordinator at MSF.

Traditional healers were also included.

"A community health worker would often come to the home of a traditional health practitioner to test someone that the health practitioner thought may be positive," said Ellie Ford Kamara, who coordinated the project on the ground for MSF.

Including people from Eshowe in the project not only brought HIV testing services to those who don't normally visit health centers, it also helped build trust, provide people with vital information and guide them towards treatment.

"This liaison and this close communication has really worked and this has been key to the success of the program," Ford Kamara told DW.

Nkosinathi Mpungose, one of campaigners on the ground, says it took hard work and perseverance to surpass the targest set by UNAIDS.

"The challenges were lack of education on HIV ... fear to test for HIV, stigma on HIV. I had to educate them to change their way of thinking," he said to DW.

A health worker tests someone for HIV inside their home
Home HIV testing by community health workers is integral to the Eshowe project Image: Getty Images/AFP/G. Guercia

Still a long way to go

However, in a press release, MSF warned against seeing the survey results as a declaration of victory in Eshowe.

The number of new infections among adolescent girls and young women is still high, and more than half of young men aged 15 to 29 years diagnosed with HIV as part of the survey are still not on treatment.

South Africa as a whole is home to 20% of the world's HIV cases, with 7.7 million people living with the virus in 2018. It has the largest antiretroviral program in the world, largely funded from its own resources, but is is still lagging on meeting the UNAIDS targets.

According to an updated model of South Africa's HIV epidemic released in June 2019, 90% of infected people in the country were aware of their HIV status, 68% of these were on treatment and 87% of these were virally suppressed by mid-2018  a result of 90-68-87.

This shows that South Africa has to change its business as usual approach, says Florence Anam from MSF.

"The days of sitting at the health center and waiting for sick people to come to you are over," she told DW.

"We need to understand that ... a patient could be a sick person, who will come very sick. But they could also be someone who is just going about their business but require medical care to be able to keep being healthy and go about their business.

We have to go to them."

December 1 is World AIDS Day.