Are 2 million HIV-positive people not receiving treatment in South Africa?
Antiretroviral medicines (ARVs) are used to treat human immunodeficiency virus (HIV). These drugs keep the amount of virus in the body low by stopping HIV from making copies of itself at different stages of the virus’s life cycle.
As a country with one of the highest HIV burdens, South Africa has an expansive ARV programme. It has proven to be effective in controlling the spread of the virus and is made available by the government through the implementation of initiatives such as free HIV testing, counselling, and treatment for exposed and unexposed people.
However, according to Simangazo Mokale, Assistant Director of the Communication Resource Centre at the Government Communication and Information System, of the nearly 8 million people living with HIV, only 5.7 million are on treatment, leaving a gap of over 2 million people who should be on treatment but are not.
Stigma and the fear of judgment were some of the reasons people resisted seeking treatment, she wrote in a February 2024 opinion piece.
Do the figures add up? We looked at the latest data as we approach World Aids Day on 1 December.
‘Confirmed as true’
Diego Iturralde, chief director of demography and population statistics at Statistics South Africa said that while the data agency does report on the number of estimated HIV-positive persons, it does not report on ARV treatment. He directed us to the Thembisa model, a robust estimate of HIV-related figures.
“Your estimates do seem to tie up to what he has reported. This claim should be confirmed as true,” he said.
The Thembisa model estimated that between 5.8 and 5.9 million people were receiving ARV treatment in 2023. In comparison, the model estimates that there are around 7.9 million people with HIV in South Africa. The difference is roughly 2 million, as Mokale claimed.
‘Psychological and social barriers’
Sanelisiwe Nondlazi, a doctor at Leratong Hospital in Johannesburg also affirmed the claim, emphasising the ongoing challenges in reaching all individuals in need of treatment. “These figures reflect the ongoing challenge we face. It is crucial that we reach those who are not on treatment to improve their health outcomes and reduce transmission.”
According to Nondlazi, gaps in the provision of ARV treatment can be attributed to various factors, including psychological and social barriers such as denial, stigma, diagnosis, and fear. These factors discourage people from seeking necessary treatment. Discrimination faced by men who have sex with men and sex workers is a particular challenge.
Logistical matters such as long queues, travelling to different health facilities, and unsupportive healthcare staff cause further predicaments. Nondlazi said that in order to close the gap, initiatives such as the PIMART programme should be extended and practised nationwide as it allows people to receive ARV treatment from places like pharmacies without a doctor’s note. “This initiative makes it easy for people to access the treatment without feeling exposed.”
Establishing tailored programs that increase HIV awareness to inform and support vulnerable populations is also an essential element in closing the gap.
Conclusion
Publicly available data supports the claim that 2 million HIV-positive people are not receiving ARV treatment. Several barriers prevent people from seeking help, including stigma and fear of discrimination. This report was written by Lesedi Jonga, a journalism honours student at North-West University, as part of a mentorship programme by Africa Check, the continent’s first independent fact-checking organisation. The programme, funded by the United Nations Democracy Fund (UNDEF), aims to foster the practice of fact-checking across the continent.