The fable of the boiling frog is both among the more ominous and important ones for modern life. Despite the morbid conclusion, the boiled frog remains a good cautionary tale, warning the listener or reader against complacency, a lack of awareness, and the unwillingness to address one’s own impending doom.
For obvious thermal-based reasons, the boiling frog narrative has come to define the moral avolition of global governments in the face of ever-accelerating climate change and the consequences thereof. Sadly, South Africa can make a strong, albeit pyrrhic, claim to the boiling frog. Crime, economic stagnation, corruption and failing service delivery are all contributing to raising the temperature. But, above all else, it is our national health crisis which threatens to quietly boil us alive.
For some South Africans, the idea of a national health crisis may be surprising, as we forget about the very real and tragic HIV epidemic pillaging and burning communities and lives to the ground. As a nation, we have been living with rampant HIV for so long that we, depressingly, sometimes forget just how severe it remains for millions of our compatriots while life continues for the rest of us.
Globally, an estimated 40-million people were HIV positive in 2023. Of these cases, 65% were to be found among African populations, with a distressingly large one-fifth of all cases found in South Africa. In terms of new cases, the World Health Organization has estimated that for every 2,000 citizens free from the virus, one additional person will be infected .
In 2021, UN member states adopted the “95-95-95” targets. These objectives sought to give member states firm targets to aim for in dealing with the HIV crisis, requiring all nations to implement policies and programmes that will aim to reach the following outcomes by 2025: have at least 95% of people living with the virus be aware of their HIV status; have 95% of all people who are aware of their HIV status on treatment; and, finally, achieve a suppressed viral load among 95% of all those being treated.
The targets seemingly follow the logic of “aim high, miss high;” however, given that we’ve been faced with the epidemic for decades at this point, it should also be seen as the political equivalent of a growing impatient international crowd rightfully attempting to smother an existential threat among its midst. In essence, these targets — if reached — promise to curb the disease’s unchecked spread among all subpopulations, age groups, and geographic settings. This is particularly important given that the HIV epidemic largely devastates the most vulnerable among us, kicking off a vicious cycle of ill-health, hardships and suffering for multiple generations.
Given that 2025 is in touching distance, it’s about time we took a look at South Africa’s progress and took stock of our successes and failures — not to admonish ourselves, but to keep up the momentum behind curbing the spread of HIV and apathy alike.
So, just how far have we come? Luckily, numerous organisations — both local and international — have sought to keep track. Among these is the Human Sciences Research Council (HSRC) which, among a broad overview and survey of the HIV landscape in general, has also reviewed the progress made towards the 95-95-95 goals in particular. Its findings, released in October 2023, outlines some positive findings at the macro level.
For the first of the 95-95-95 targets, 89.6% of all people living with HIV (PLHIV) in South Africa were aware of their status at the time of survey, though some disparities between the sexes remain (the female PLHIV awareness rate is more than 600 basis points greater than that for men). In terms of the second and third 95-95-95 targets, 91% of all PLHIV were receiving antiretroviral treatment (ART), with 93% of all ART PLHIV patients displaying a suppressed viral load.
In general, then, it seems that progress is being made and even if South Africa were to miss the mark in 2025, it will not be by much. However, when it comes to human lives, small misses remain significant, thus compelling us to strive for perfection. To that end, despite the positive gains made, we can look to some of the underlying trends for guidance on where we can, and must, improve.
HIV responses succeed when they are anchored in strong political leadership, have adequate resources, follow the evidence, use inclusive and rights-based approaches, and pursue equity
— UN
One area of concern is the deceptive rate of PLHIV status between the sexes. At first glance, men are lagging behind — but, given the sad reality that South African women are twice as likely to be living with HIV, the disparity in awareness rates may mean that there are just as many female PLHIV patients who are unaware of their status as their male counterparts (about 17 out of 1,000 women are unaware that they have HIV, which mirrors the statistic for men).
Second, the distribution of PLHIV skews significantly in favour of some groups instead of others. The poorest remain the most vulnerable to infection which, worsened by historic disadvantages forced on different racial groups, has meant that black communities are disproportionately at risk.
Finally, since rural poverty is approximately double that of urban rates, we know that provinces and municipalities with larger rural populations are at greater risk. These observations correlate with the HSRC’s findings, who note the low rate of PLHIV awareness among provinces with larger rural and poor populations.
But, this we all knew already. Does that mean our interventions focusing on these communities are lacking? Not necessarily, but it does mean that if we are to reach the goal of zero new infections by 2030, we cannot slip, nor let up. The global HIV response aims to achieve “three zeros” by 2030: zero new infections, zero Aids-related deaths, and zero discrimination. Initially aspirational, this vision informed the 2030 Agenda for Sustainable Development, with measurable targets established in 2015.
The 2016 UN Political Declaration on Ending Aids outlined interim 2020 goals: reducing new HIV infections and Aids-related deaths to fewer than 500,000 each (a 75% reduction from 2010) and eliminating HIV-related stigma and discrimination, recognising that any case of discrimination is unacceptable.
Recent data highlights both progress and ongoing challenges. While efforts are increasingly targeted at identifying gaps and supporting underserved populations, insufficient action by many countries has hindered progress towards the 2020 milestones. This delay puts the global community off track to achieve the three zeros by 2030, emphasising the need for accelerated and inclusive responses to end the epidemic.
When it comes to this topic, the UN says it best: “HIV responses succeed when they are anchored in strong political leadership, have adequate resources, follow the evidence, use inclusive and rights-based approaches, and pursue equity.”
• Michael Mynhardt is CEO and co-founder at MMH & Partners Africa
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