Join the Western Cape in taking the Equal Rights, Equal Care path to ending AIDS

The Western Cape Department of Health and Wellness prioritises the needs of individuals living with HIV, at risk of contracting, or affected by HIV in the province. HIV currently accounts for the fourth highest number of deaths (5.7%) in the province, and mostly affects individuals between the ages of 15 - 44 years. World AIDS Day 2024, celebrated on 1 December, is a reminder that universal health coverage is not just a goal, it is a human right. 

This year’s theme, Equal Rights, Equal Care, highlights the urgency of bridging gaps in healthcare access to achieve the United Nation’s AIDS 95-95-95 targets, which aim for 95% of people living with HIV knowing their status, ensuring that 95% of those diagnosed are on treatment, and 95% of those on treatment are virally suppressed. The theme also aligns with the country’s commitment to universal health coverage and commemorates milestones such as 20 years of free antiretroviral therapy (ART) and 30 years of freedom in 2024.  

While people diagnosed with HIV have access to free and effective treatment and care in the province, HIV remains a significant health challenge in the Western Cape. At the end of September 2024, it was estimated that approximately 497 687 people in the province were living with HIV. Meaning, the Western Cape has achieved the first of the three targets. Of those who know their HIV status, approximately 365 362 (73,4%) are currently receiving ART, falling short of the second 95% treatment target. Among adults, only 30.9% of males and 69.1% of females are on ART. 

Of the third target, 89% of those receiving ART is virally suppressed meaning that the amount of HIV in a person’s blood is so low that it cannot be detected by a standard lab test and the person can’t sexually transmit HIV to others.  
 

Taking ART is the best way to control HIV and stay healthy

Despite gains on the province’s 95-95-95 targets, far too many persons living with HIV are not currently on treatment. The benefits of adhering to ART help ensure individuals achieve Undetectable = Untransmittable (U=U). To achieve the targets, the Department and its partners are working to ensure an additional 107 441 persons living with HIV are placed on treatment. If diagnosed early and with the right treatment, these individuals can expect to live a normal life. 

“Despite concentrated efforts to combat HIV/AIDS in the Western Cape and throughout South Africa, the virus remains a significant public health challenge. While the expanded rollout of antiretroviral therapy over the years has dramatically improved the prognosis for those living with HIV, it is crucial to continually educate the public about HIV prevention, improve access to HIV testing and treatment, and address the persistent stigma associated with the virus. These measures are essential for effectively managing and reducing the ongoing epidemic,” said Dr Keith Cloete, Head of Department, Western Cape Government Health and Wellness.

“Patients are being inadvertently lost, particularly when they relocate. Most facilities require patients to return to their original facility, which creates unintended barriers. We need to eliminate these obstacles and ensure seamless continuity of care. We urge all patients initiated on treatment to adhere to their treatment plans. Furthermore, the uptake of pre-exposure prophylaxis (PrEP) remains low. PrEP is a safe and easy to take medication which protects you from contracting the virus,” said Amelia Mfiki, Chairperson of the Western Cape Civil Society Forum, Provincial Council on AIDS and TB.

In line with the Provincial Implementation Plan (PIP) for the National Strategic Plan (NSP) for HIV, Tuberculosis and Sexually Transmitted Infections 2023–2028, several measures are being implemented by the Department to improve ART retention. Providing ART treatment at clinics is now being delivered as part of a broader package of primary healthcare HIV services, including prevention services such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), condom distribution, voluntary medical male circumcision (VMMC), and testing services including self-screening. Some of these services are provided by various non-profit organisations (NPOs) and other partners.

As part of community oriented primary care (COPC), the Department is making strides towards scaling up services in communities, reducing the burden on facilities, as well as improving adherence support. Wellness Hubs within certain districts in the province continue to offer HIV testing services, linkage to social services, and medication collection. 

The roll out of e-lockers at selected Community Health Centres in the Metro district, assisting clients with after-hour medication collection is also progressing well. Additionally, the Department’s Chronic Dispensing Unit (CDU) packages over 70 000 packets of ART medication for clients with two-month prescription, reducing the number facility visits that they are required to make. 

Many clinics across the province run ART adherence clubs supporting treatment retention for clients. As of September 2024, 187 ART chronic clubs were running across five districts, with 137 230 clients attending. Dedicated services to key populations including adolescent and youth friendly services at selected sites, a men’s clinic based at Karl Bremmer Hospital as well as services to key populations via 180 funded high transmission area sites implemented by NPOs make services accessible to clients. 

The Department has also developed key enabling policy documents to support the provision of ART services for providers, as well as support the treatment journey for care users. These include MECC (make every contact count), a framework for differentiated models of care (DMOC), as well as the strategy for the expansion of psychosocial rehabilitation and support services (PSR). 

As part of continuous quality improvement measures, the provincial Department participated in the National 100 facilities project. In March 2023, the National Department of Health identified 100 high-burden sites across the country with high ART loss to follow up (LTFU), of which 27 were in the Western Cape. Districts and partners led and implemented quality improvement strategies to improve the number of clients remaining on ART. We are proud that, by March 2024, 26 of the 27 facilities demonstrated growth in their retention, with 20 of the 27 sites performing above the provincial performance for clients remaining on ART.

While challenges like stigma, treatment gaps, and healthcare disparities persist, the Western Cape continues to lead with a comprehensive and accessible HIV treatment programme, serving as a beacon of progress. With human rights at the centre, and the support and involvement of communities and our multisectoral partners, the province can end AIDS as a public health threat by 2030.

Premier Alan Winde has urged residents to make optimal use of these healthcare services, “It is better to know your HIV status as early as possible. This is vital to improving your quality of life. While this is difficult, it is the first step towards preparing yourself for treatment, both medically and psychologically. We have come a long way in our efforts to prevent the transmission of HIV and in treating this condition. We have learned hard lessons and must continue improving our health services in this regard.”

Western Cape Minister of Health and Wellness, Mireille Wenger, shared, “Starting and staying on ART is essential for anyone living with HIV. It not only protects your health but also stops the virus from being passed on to others. If you haven’t been tested yet, don’t wait—knowing your status is the first step. And if you already know your status, our dedicated teams at healthcare facilities are here to support you every step of the way. Together, anyone living with HIV can lead a happy, healthy life. I want to express my heartfelt gratitude to the NPOs, partners, and healthcare workers who tirelessly contribute to the fight against HIV in our province.”

For testing and access to ART, we encourage residents to visit one of our primary healthcare facilities and talk to a trained healthcare worker about the best options for them. HIV tests are fast and easy, and they are also free at our facilities.