In recent years South Africa has made great strides towards providing support to those infected, and affected, with HIV. We are also firmly committed towards meeting the UNAIDS global target to ensure that by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV will receive antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
As part of this commitment, the South African government and its partners, is implementing the largest HIV treatment programme in the world, which includes an estimated 4.2 million people. However with an estimated 7.1 million people who are infected with HIV , it is clear that much more remains to be done. With the guidance and leadership of South African National AIDS Council the HIV, TB and STI’s response is right underway implementing the National Strategic Plan 2017-2022.
We intend testing and treating at least 6.2 million people with HIV by 2020 and we have also committed to reducing new infections of HIV by 60% from 270,000 in 2016 to less than 100,000 by 2022.
These targets are included in the South African Strategic Plan on HIV, STIs and TB) 2017 – 2022 and through the monitoring approach we will be able to recalibrate the targets to ensure a more efficient approach and based on the new evidence, serve the targeted population so that no one is left behind. Thus, this has called for a thorough investment in South Africa’s prevention agenda, and to ensure that interventions will be community led.
While South Africa’s goals are far reaching, the country’s response to HIV is remarkable for one other reason.
Many of us may not know that South Africa is one of very few countries around the world which has included the needs of the LGBTI community in its national response to HIV. The national LGBTI HIV Plan was launched during the 2017 8th National AIDS Conference hosted in Durban.
The LGBTI HIV plan makes it incumbent upon stakeholders to reach all key and vulnerable populations with customised and targeted interventions. We know that the stigma and discrimination faced by members of the LGBTI community makes it difficult for people to test for HIV and for those infected, to seek treatment. Experience has shown us that excluding such communities from the opportunities to be tested and seek treatment, to receive competent services, only creates the conditions that is not enabled for a better health seeking behaviour and it defeats the vision of an HIV free generation further into the distance.
Indeed, global statistics show that transgender women are nearly 49 times more likely to be infected with HIV than other adults of reproductive age.
Despite this, there is currently very little information in South Africa about the specific HIV vulnerabilities of transgender women. In addition, HIV prevalence amongst transgender women also remains undocumented and as a result, transgender women remain underserved.
It is against this background that we must welcome the first South African study looking at HIV prevalence in transgender women which was launched earlier this month.
This study is led by the Human Sciences Research Council (HSRC) and supported by the United States Centres for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR). This study is also supported by various local and international academic and civil society partners and will be conducted in Cape Town metropolitan area in Western Cape, the Johannesburg metropolitan area in Gauteng and in East London located in the Eastern Cape province.
Civil society partners who will, amongst others, be crucial in helping to recruit participants will include: Social, Health, Empowerment (S.H.E.) Feminist Collective in East London, Sex Workers’ Advocacy and Education Taskforce (SWEAT), Gender Dynamix and Access Chapter 2 (AC2). The University of California, San Francisco will provide technical assistance.
The study is named BotsheloBaTrans which celebrates the spirit of transgender women who are strong and brave in the face of constant discrimination from society. Botshelo (from Setswana) means Life. This name was chosen because this study is about transgender women’s lives – and the focus on embracing dignity and integrity of transgender women, and the journey towards happiness and self-love. This study, in many ways will be the first step in that process because it will give members of the transgender community a voice, a face and through this, their dignity.
Importantly, this study goes beyond just looking at HIV prevalence amongst transgender women. It brings our Constitution to life in that the insights from this study can be used to develop and implement awareness campaigns targeted at the transgender community and at society at large. This study is the first step in a journey where eventually, members of the transgender community will not suffer discrimination, exclusion and marginalisation.
It is equally part of South Africa’s commitment to looking at the real issues which impact on the LGBTI community in general, and the transgender community in particular. This includes the psycho-social elements of discrimination and exclusion in the socio-economic life. This survey will yield insights and awareness which will ensure that everyone can be reached in the fight against HIV, regardless of gender identity, expression or even sexual orientation, it is about putting people first.
This study will intensify the fight towards other communicable diseases as well as HIV, participants in the study will also have access to HIV Counselling and Testing (HCT); we will test for HIV prevalence, antiretroviral testing, HIV viral load testing (to test the level of HIV in the body), TB and for other sexually transmitted infections (STIs).
The evidence based results from the study will influence South Africa’s understanding and therefore, responses, to the public health needs of transgender women in South Africa. This study will also become part of the global body of knowledge on the public health needs of transgender women. By making public health and communication programmes more focused, we will begin to see a greater return on investment on the significant resources invested in fighting HIV.
South Africa’s late statesman, President Nelson Mandela said “AIDS is no longer just a disease, it is a human rights issue.” With the launch of the BotsheloBaTrans study, South Africa has taken a significant step towards protecting the human rights of a deeply marginalised community. Members of the transgender community will have the freedom, and the opportunity, to be tested and become part of a treatment programme if necessary. More importantly however, the transgender community will no longer be faceless and nameless in the fight against HIV, and to better ensure that services are competent. South Africa has taken one more step towards fighting this disease towards an HIV free generation but equally upholding its reputation as a champion for and defender of human rights.
Steve Letsike is the Deputy Chairperson of SANAC.