Deputy President Cyril Ramaphosa: Seventh SA AIDS Conference

This conference is taking place at a critical moment in the struggle against HIV and AIDS and tuberculosis.

 

In many ways, we are at an inflection point.

 

Thanks to the progress we have made, thanks to partnerships we have forged, thanks to the resources we have mobilised, we now know that the fight against AIDS and TB can be won.

 

The question that we must answer at this conference is whether we have the means, the will, the knowledge and the courage to prevail.

 

Today, we reflect.

 

We reflect on the road we have travelled. And indeed we have travelled a long road, as Dr Nono Simelela was saying.

 

We reflect on lives lost, on children orphaned, on livelihoods diminished, as Siphokazi was saying today.

 

We reflect also on how prejudice has been challenged, treatment expanded, awareness raised and transmission prevented.

 

We reflect on the mistakes we have made and the lessons we have learnt.

 

Today, we refocus.

 

Drawing on our experiences and using the insights we have gained, we are better able to identify where to apply our efforts to achieve the greatest possible impact.

 

Today, we must also renew. 

 

We renew our commitment, we renew our determination, we renew what I would call our social compact, which has been forged over many years of shared struggle.

 

We renew our commitment to the achievement by 2030 of a generation of under-20s that is largely free of HIV.

 

At times, we have differed. Throughout, we have debated, discussed, conversed and we have communicated.

 

Ultimately, we have found agreement.

 

This conference is concerned with reflection, refocussing and renewal.

 

It should, as the previous South African AIDS Conference did, also address itself to responsibility.

 

We shall not overcome this epidemic unless all of us – collectively and individually working side by side – accept that we have a responsibility.

 

We have a responsibility as government and its employees, as every sector of civil society, as development agencies, as communities, as scientific fora, as leaders of institutions, as youth groups, and as researchers.

 

In our personal lives, in our own behaviour, we also have a responsibility. 

 

We have a responsibility as parents, spouses, partners, girlfriends and boyfriends, mentors and role models.

 

We have a responsibility to ourselves.

 

We have a responsibility to others.

 

Ladies and gentlemen, comrades and friends,

 

The government of the Republic of South Africa accepts – and is determined to fulfil – its own responsibility.

 

On World AIDS Day 2009, President Jacob Zuma declared our intent to confront the AIDS epidemic.

 

He said:

 

“We have no choice but to deploy every effort, mobilise every resource, and utilise every skill that our nation possesses, to ensure that we prevail in this struggle for the health and prosperity of our nation.”

 

Under the leadership of President Jacob Zuma, South Africa has turned the tide on HIV. That is an undeniable fact.

 

The advances we have made, have been made together.

 

Many emanate from public programmes, but still others have been made by grassroots activists. Many of whom are present in this room today.

 

South Africa is acknowledged by UNAIDS and others as global and continental leaders in the HIV response. 

 

We have the right policies in place and the political will to see them implemented.

 

South Africa has the biggest HIV treatment programme in the world, with more than 3 million people on life-saving antiretrovirals, moving on to 5 million, as Siphokazi said. 

 

In 2010, we launched a national HIV counselling and testing campaign  in which 20 million tests were conducted in a 20 month period.

 

We distributed more than 700 million male condoms last year and have conducted more than 1.6 million medical male circumcisions in public facilities since 2010.

 

The results have been significant. This achievement is significant. We have the biggest  HIV programme in the world.

 

People are living longer and fewer people are dying of AIDS and TB.

 

Life expectancy as attested by few speakers before me, increased from 53 years in 2006 to 62.2 years in 2013. This is a great achievement.

 

HIV associated deaths in pregnant women, infants and children under five have also declined.

 

We have also seen a decline in new HIV infections since its peak in 2004, especially among those less than 15 years of age. 

 

We have reduced mother-to-child transmission dramatically, to less than 2.6% in 2012. 

 

This means that we are on our way to eliminating mother-to-child transmission. This we should applaud.

 

These statistics are encouraging. 

 

But they do not fully capture the human impact of our interventions. 

 

They do not tell the story of the many thousands of people who can now manage HIV infection as they would any other chronic disease.

 

They do not tell the story of the many children of HIV-positive mothers who are born HIV negative and remain so.

 

They do not tell of the countless times that transmission is prevented by responsible sexual behaviour.

 

They do not tell the story of hope restored and confidence regained, as Dr Nono Simelela was saying.

 

These are stories to be shared and cherished and celebrated. Yes these are stories that we must celebrate. At times, as South Africans, we engage in a  spot called self-mutilation. We cut ourselves to shreds. We do not look at what we have achieved. We must celebrate these achievements. 

 

It does not mean that we do not have work ahead of us, as Khensani and Siphokazi were saying. I agree with them completely.

 

I accept what they are saying. The government does imternalise what they are saying. We have heard and we have heeded what they are saying, because they are telling the truth. These two sisters were saying that we have challenges. These are the challenges we have to face together until we have won the struggle against HIV. That's what we should be focussing on.

 

And yet, we still face many challenges. 

 

Our country has more than 6.4 million people living with HIV. That by any number is a huge number. That is where the challenge is.

 

More than 1 in 5 people with HIV in the world live in our country.

 

We have about 450,000 new HIV infections and 360,000 new TB infections each year. That is a challenge that lies ahead of all of us. Not only for the government, but for each one of us seated in this hall today because we are all implicated and we are all involved.

 

We are all part of this problem and this challenge. None of us ecapes this challenge. Together we must confront it.

 

A recent survey estimated that 2 million South Africans who are living with HIV do still not know their status.

 

We need to find the resources to expand further what is already the largest HIV treatment programme in the world and ensure better adherence to treatment.

 

Then we need to be able to sustain it for many years to come.

 

South Africa is unique on the African continent in that we fund more than 80% of our HIV and TB response with funds from the fiscus. These are our own generated funds from all of us as South Africans.

 

We are grateful to our donors and development partners, such as PEPFAR. Thank you very much Ambassador for the United States to fund many of our AIDS programmes. We thank you and we are saying please remain committed. Do not disengage. You have been a patner in this struggle; we want to see you contunuing being our partner.

 

The Global Fund, is also our partner and continues to stand with us by financing a part of the national response. 

 

We have set ourselves ambitious goals.

 

As part of the global 90/90/90 targets, we want to have at least 90% of South Africans that are HIV positive on treatment.

 

We want 90% of those on treatment to be virally suppressed.

 

Such ambition requires a far greater commitment of resources than ever before.

 

Yet, the cost of putting so many more people on treatment is insignificant compared to the human cost of not doing so. 

 

Simply put, as a country we cannot afford not to invest in HIV prevention, treatment and care.

 

As government – as a country – we have difficult decisions to make.

 

As we step up our AIDS response, we need to find the resources to educate our children, to house our people, to build infrastructure and to provide social support to those most in need.

 

We are confident that the recently concluded South African Investment Case for HIV and TB will provide guidance on how to spend our money to achieve even better results.

 

Yet, however much we are able to expand this programme, putting more and more people on lifelong treatment is ultimately not sustainable. 

 

The tap of new infections has to be turned off. We need to stop new infections.

 

Behaviour change interventions are proving much harder to implement than clinical interventions. 

 

The transmission of HIV has to do with sex and sex has to do with complex human behaviour. 

 

And human behaviour has to do with a myriad social, economic and cultural factors.

 

We need a massive HIV prevention campaign that begins with the promotion of condom use and the reduction of multiple concurrent partnerships, but that also addresses sexual coercion, transactional sex, intergenerational sex, risky sex linked to the use of alcohol and drugs, lack of access to work for young women, ignorance, powerlessness and poverty. 

 

We need to dramatically reduce the rate of HIV transmission among the youth.

 

The results of the HSRC’s 2012 National HIV Prevalence, Incidence and Behaviour Survey raised a deep concern about the rate of new HIV infections in South Africa. 

 

A quarter of new HIV infections in the world occur in South Africa, sadly.

 

The HSRC survey also showed that one in four of these new infections occurs among young women and girls between the ages of 15 and 24.

 

These young women are the future of our country.

 

They are the scientists, the engineers, the doctors, the teachers, the public servants, the workers and the mothers of tomorrow.

 

If we fail them, as a nation we fail.

 

We must develop new and innovative responses that address the specific needs of young women. 

 

I hope that new information from this conference, the innovative ideas, will assist us to strengthen our interventions that target young women.

 

We must confront the reality that the astonishingly high infection rates among young South African women has much to do with the behaviour of men.

 

It has much to do with how men of that age – and older – relate to women.

 

It has much to do with the forms that social interaction takes and how sexual relations are conducted.

 

It calls for greater awareness, greater respect and greater responsibility.

 

But beyond this population group, we need to focus prevention strategies on other areas where they will have the greatest impact.

 

We have started the work on a national HIV prevention programme among sex workers.

 

We have suspected for a long time that HIV prevalence in this sector is much higher than the general population. 

 

New research has found very high HIV prevalence among sex workers – of between 40 and 70 percent – in Cape Town, Durban and Johannesburg. 

 

While we have a few programmes that targets this sector, we must rapidly scale up access to prevention, treatment and care, and support for sex workers.

 

There is much more to be done to focus our efforts on other areas where HIV is concentrated, such as our major cities, and among other populations who are at a higher risk of HIV infection than the general population.

 

Ladies and gentlemen,

 

As we reflect on what we have achieved, it is only fitting that we extend our deepest gratitude to the millions of South Africans who have made this possible.

 

We must thank those who must take time off work and pay for transport to collect their antiretrovals and who diligently take their drugs.

 

We must thanks those who have come forward to be tested for HIV and screened for TB.

 

We must thank those who use condoms as a matter of course and a matter of principle.

 

We must thank those who take responsibility for themselves and responsibility for others. By taking responsibility they are saving the nation.

 

Next year, in 2016, South Africa will be hosting the 21st International AIDS Conference. 

 

When the International AIDS Conference was last held in South Africa, in 2000, there was still insufficient attention paid to the impact of the epidemic in Africa. 

 

The AIDS 2000 Conference in Durban helped to change that and put the focus on the continent where the epidemic has taken its greatest toll.

 

AIDS 2016 can be another watershed conference.

 

It is an opportunity to turn conviction into action, goals into outcomes, and hope into reality.

 

It is an opportunity to demonstrate what we have achieved as a nation, to share what we have learnt, and to learn from others.

 

As our experience in South Africa shows, HIV, AIDS and TB will not be overcome without a sustained collective effort.

 

We cannot afford to let up. 

 

As I interact with my colleagues of the South African National Aids Council (SANAC) as we debate issues and as we continue to realise that the only way we can confront  this challenge is to work together, I see in their eyes a great determination.

 

A few days ago we had a lekgotla as SANAC  where me and my deputy were leading the process of getting SANAC to begin to refocus, to renew its committment, I could see in the eyes of everyone who participated that there is a renewed energy. Renewed energy to meet this challenge.

 

This is what we need as a nation. A renewed  energy so that we can refocus. 

 

So that Khensani's pictures should be a thing of the past. So that the tales and stories that Siphokazi was talking about, about her own sister, should be something relegated to the past. This is the task that we all have collectively as a nation, particularly ourselves as government, ourselves as activists, as medica professionals, as researchers, all of us sitting here.

 

Let this conference re-ignite our enthusiasm. Let it re-ignite our energy.

 

Thank you very much.