South Africa is expected to release its new national HIV strategy later this month. In a country that continues to battle the world's largest HIV epidemic, the document will guide the next six years in the fight against new infections.
The South African National Aids Council (Sanac), civil society groups and key government departments met to finalise the strategy late last week. The plan not only outlines the country's response to HIV but also guides its efforts against tuberculosis (TB) and sexually transmitted infections.
The latest draft of the national strategic plan, released on 10 March, is unlikely to be drastically different from the final version, which is expected be launched on 31 March in Bloemfontein.
The former head of policy at the HIV lobby group, the Treatment Action Campaign and current editor of the HIV and TB magazine Spotlight, Marcus Low, says although the strategy is ambitious and addresses difficult issues, gaps remain. He explains that the document is largely silent about how the country will hire enough community health workers, for example, to reach targets on HIV and TB treatment and care.
He explains: "To treat three million more people with HIV you're going to need people who will make that happen. The concern is that in that regard, the strategic plan is not connecting the dots enough."
Low argues that the strategy should have also included more aggressive targets on TB control and treatment in prisons, where transmission continues to be high.
So what will the future hold for the fight against HIV in South Africa? Here are three things you can expect – if the latest draft of the country's strategy is anything to go by.
After a decade of trying, decriminalisation of sex work is still on the table
South Africa's previous two national plans have called for the decriminalisation of sex work. Advocates are likely to continue pushing for the decriminalisation of the profession, with the latest strategic plan calling for"steps to be taken towards" this goal.
But the document does not outline what would need to happen make this a reality.
"Once we finalise this national strategic plan, it will have 10 years since decriminalisation has been put on the table," says Steve Letsike, Sanac deputy chairperson."If we are still calling for law reform on colonial laws, such as this one, then we are not fulfilling our mandate."
Sex workers are at a high risk of contracting HIV. Health department research published in 2015, conducted among 2 200 female sex workers in Cape Town, Durban and Johannesburg found that 40-70 percent were HIV positive.
A 2014 study published in The Lancet medical journal found that decriminalising sex work could prevent up to almost half of all new HIV infections globally in the next decade.
Decriminalising drug use? Not so much.
Decriminalising drug use – alongside sex work – was labelled as a "game changer" in the initial version of the plan released in September 2016.
But the call to decriminalise drug use has since been cut from the plan. Shaun Shelly is the head of policy, advocacy and human rights for people who use drugs, for the non-profit organisation TB/HIV Care Association.
He describes the sudden removal of the previous call for decriminalising drug use: "We battled with issues such as decriminalisation of drug use and the terms that are used to describe it, such as not using the words ‘substance abusers' and instead using ‘people who use drugs".
"All of a sudden none of that was in the latest draft of the NSP. It was like reading a totally new document. When we asked about it, nobody could tell us what happened and why it was like this now," he says.
Shelly says he believes that "political issues" may have made it difficult for policy makers to publicly endorse decriminalising drug use and that this may be to blame for the sudden change in the document.
He adds that the rehabilitation services mentioned in the strategy are not enough to address drug users' increased risk of HIV.
In 2001, Portugal decriminalised drug use in part as a response to rising rates of HIV infections among injecting drug users. People who use injecting drugs are more likely to contract the virus, partly because of needle sharing.
Research by the London School of Tropical Hygiene and Medicine found that new HIV infections among injecting drug users have fallen dramatically since Portugal decriminalised drug use.
Revamped sex education and condoms in schools
About a quarter of all new HIV infections occur in women between the ages of 15 and 24, according to the latest Human Sciences Research Council national HIV household survey. The 2012 study also found decreasing levels of condom use.
To help counter this, the department of basic education released a draft plan for better sexual education in schools. The policy proposed, for example, providing sexual and reproductive health services to secondary school learners, including HIV counselling and testing, and providing contraception.
What's behind the #AIDS2016 protest that almost left S. Africa's health minister speechless https://t.co/mg6muuLYyS pic.twitter.com/ZlDYMpQNC2— Bhekisisa M&G Health (@Bhekisisa_MG) July 20, 2016
What's behind the #AIDS2016 protest that almost left S. Africa's health minister speechless https://t.co/mg6muuLYyS pic.twitter.com/ZlDYMpQNC2
— Bhekisisa M&G Health (@Bhekisisa_MG) July 20, 2016
South Africa's new HIV policy says it will be pushing for these kinds of services in schools especially in districts with high levels of HIV infections. Providing contraception at school is likely to be a major change in many schools, as many school governing bodies have decided against allowing condoms in schools.
Schools aren't the only places condoms may be popping up in future. The plan also calls for government's new Max condoms to be distributed at spaza shops, hotels, hair salons and brothels.
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