South Africa

Holy Disrupters: Interviews with religious leaders and advocates on HIV and compassion

Thabo Makgoba, Archbishop of Cape Town

UNAIDS speaks to the Archbishop of Cape Town, Thabo Makgoba about his work on HIV and his hopes for the future

What was your experience working on HIV in the early days?

I first started working on HIV in around 1998 when I was a rector in Johannesburg and it was a scary time, I remember the South African television adverts saying ‘AIDS kills’ with a coffin that banged—we were all terrified. Everyone was scared, there was a lot of stigma, parishioners were also dying from fear and lack of knowledge.

"There was an immense fear that life had come to an end…."

Through Archbishop Desmond Tutu and others we knocked on every door and established the Anglican Church of Southern Africa’s AIDS programme called ACSA. We hit the ground running but there was an immense fear that life had come to an end….

How has your work changed today?

Today our work has evolved—from fundraising, to incorporating HIV messages in the liturgy, in the prayers and in the readings. Today we make sure we don’t work in silos, we work with the mining companies, with the other churches and we work from an interfaith context—challenging our governments to do the right thing.

Much has happened in recent years and things have changed. There’s a sense of trust that has developed and partnerships now are much easier. As leaders, we have learned to work together, we’ve learned to work together on the ground, but we’ve also learned to work with our international partners. I’m hugely grateful to PEPFAR. Initially there was a degree of suspicion but once we realized, through UNAIDS, that PEPFAR is there to help us check our own resources and to strengthen our resolve to help people – a great deal of trust has been developed.

“There is nothing more pro-life than PEPFAR.”

I pray that PEPFAR will be reauthorized to ensure that the commitments that we have made are realized. There is nothing more pro-life than PEPFAR. Millions of mothers and children have been saved from dying because of PEPFAR.

UNAIDS has also been essential. UNAIDS has showed us how important numbers and record keeping are, how important data is. We have to be systematic, we have to be thorough in our interventions, understanding that evidence-based interventions are critical.

“UNAIDS has showed us how important numbers and record keeping are, how important data is.”

In faith communities you can drown in the tsunami of problems, you throw yourself into your work without really knowing whether the intervention is working. But through praying, partnering with others, looking at the numbers and seeing the impact on people whose viral load has been reduced has been a great experience—we have learned a lot through working with UNAIDS and PEPFAR.

What does the faith community bring to the response to HIV?

It’s the fact that we are there. We are in every corner, even where governments can’t reach with their 4x4’s we have a little church there, we have a mosque there, we see God’s people every Sunday at the very minimum. We marry we bury we baptize, and we do this work not because we want to be paid or we want constituencies, it is our vocation and our calling.

“We marry we bury we baptize….We are in every corner, even where governments can’t reach with their 4x4’s”

Whether you are a Christian, Muslim, a Jew or a non-believer, you are a child of God and you need healing. We don’t exist for ourselves, we exist in order to show the love and care of God in the communities.

“We smile at you so please smile at us, because together we have made this possible.”

We must ensure that no more children are born with HIV, we must work together to ensure that every child living with HIV has immediate access to treatment and we must ensure that those children will be alive and thrive. That way in 2025 they will come here saying “you have allowed us to live, and we smile at you so please smile at us, because together we have made this possible.”

Responding to the decision of South Africa's Cabinet to propose a Bill that will repeal criminalisation of sex work, UNAIDS Country Director Eva Kiwango said:

"The evidence is clear: Criminalisation has been proven to have increased the risks faced by South Africa's sex workers, hurt their health and safety, and obstructed South Africa's HIV response.

UNAIDS welcomes South Africa's Cabinet's proposal to repeal criminalisation and to protect sex workers against abuse and exploitation.

Criminalisation has impeded South African sex workers' access to vital health-care services, including effective HIV prevention, treatment, care and support services.

To end AIDS, we need to repeal the harmful punitive laws which are perpetuating the pandemic. To save lives, decriminalise."

Note: The statement by South Africa's Cabinet on their agreement to propose repeal of criminalisation is published at https://www.gov.za/speeches/statement-cabinet-meeting-30-november-2022-1-dec-2022-0000 under "Criminal Law (Sexual Offences and Related Matters) Amendment Bill of 2022". The Bill will now be published for public comment.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Following are the remarks made by UNAIDS Executive Director Winnie Byanyima during the graduation ceremony held at the Qwaqwa campus of the University of the Free State, South Africa

The acting Vice-Chancellor Professor Naidoo, Distinguished leaders of this great university, Ladies and gentlemen, Fellow graduands,

I would like to thank very much the University of the Free State Sciences for this honour to be conferred with an honorary doctorate from this great university. I know that through me, you are recognizing the work of all those around the world who advance social justice, particularly who advance the right to health for all. I stand before you humbly and I am proud to join the Kovsie community!

The hall we are in bears the name of a fearless and wise man. Madiba told us that, and I quote, “Education is the most powerful weapon which you can use to change the world”. I could not agree more. I was humbled to learn that this university bestowed an honorary doctorate on President Mandela in 2001.

Both my parents were teachers. One was a primary school teacher, the other a secondary school teacher. They were unconventional. They challenged and they encouraged us, their children. They taught us that what matters most in the world is being part of your community and standing up for justice.

For me, as for so many across the African continent, your struggle here for equality in South Africa—a struggle that we all can see is unfinished—is an inspiration. In the awful era of Apartheid even your province’s name, Free State, was itself a bitter irony. Today, whilst the long walk continues, the destination you are working to reach makes your name Free State as beautiful as those words deserve to be.

I wanted to share with you three reflections on freedom. These reflections are themselves inspired in large part by the insights of people from your country, including from the students’ movements of the past and today.

The first is that real freedom is so much more than the freedom to vote or, in the case of your country, the freedom not to be banned. Real freedom comes when every one of us is able to flourish. Central to that is education—which must be a right for all and not a privilege for a few. Every time I visit my home village in Uganda, Ruti, I meet friends of mine who did not have the opportunities I had, whose education was abruptly cut short because of an early marriage, because they had to tend to a sick family member or because they had to work for the family to survive, or they didn’t have school fees. All girls and all boys must be supported to complete a full schooling, and schools must be places of quality learning, of safety, and of empowerment—and, may I add, of joy, of enjoying oneself, one’s youth! The push that you students have made for tertiary education to open up, to reform, to reject the bad from the past, to include all, has been challenging for you, challenging for your institutions—but you have won many important steps forward and you should be congratulated for the progress that you have brought about. Congratulations! Yes, we’ve been following your movements, Rhodes must fall, fees must fall, and you inspired other students around the world to fight for inclusion and equality.

The second reflection is that none of us is free whilst anyone of us is not free. That is why the struggle for freedom needs always to be intersectional. Across the continent and across the world, South Africa has been a beacon for movements that are joined up, resisting racial inequality, embracing gender equality, and embracing equality for LGBTQ people. It is these inclusions that make a world free. So, continue to be that beacon—as a country and as a student and alumni community. Challenge stigmatization, challenge criminalization. Wherever you see anyone who’s put down because of their race, because they are a woman, because they are gay, or trans, stand up for them. Tolerance is not enough—be an ally to all who are marginalized, not only on their side but by their side.

The third reflection is that freedom is never given, it is only ever won. And it is never permanently or fully won in one moment—it must be won again and again and again. All progress has been won through collective movements, through the organising of extraordinary ordinary people. I’ve been part of the women’s movements in Africa, in the world. We’ve made a lot of progress through organizing, through holding hands, in all our diversity. The most important heroes are not those in history books or on podiums like myself, they are you—you working together, forming collectives.

Use the power that your education has given you. And use it to demand accountability and rights, for yourselves and for others. Education enabled me to go from that rural village of Ruti in Uganda, where we had no electricity, no running water, and it led me to serve in our national parliament.I was a member of parliament. It led me to lead an iconic global organisation, Oxfam International, and it led me now to lead the United Nation’s work globally to fight AIDS. From my little village.

But that power that education gave me cannot, never makes me proud in itself. It makes me responsible for what I must do to lift others, to make this world equal and just. My pride is in what I am able to do with others to make the world more just. The qualifications are mere tools to achieve a purpose.

Today is your day. You have achieved so much in getting to this day. I know you are going to celebrate as indeed you should. But let me challenge you. Let me challenge you as you leave this beautiful campus to go into the world to make a difference:

Go out there and work to build a society where every girl and boy gets the full and quality education they deserve.

Go out into the world to build a society that guarantees equality for everyone. That no one should ever again be discriminated for their gender, for their race, for their sexuality. Equality for everyone.

Go out to build collective power, I believe in the power of people. Change only happens through the power of people. Never wait for the right leaders to come and lead, you are the leader who must lead.

A more equal society will be better for everyone—for the rich, for the poor, for the able, for the less able. A more equal society is good for all—it is safer, it is more prosperous, it’s more sustainable, it’s healthier, it’s happier.

At heart I am an optimist. I want to tell you a story. This is my last challenge. You are shaped by the history of your country. The rest of us in Africa, particular of my generation, are shaped by the history of our continent including the history of your country. We watched, we followed what happened in this country and we waited for your independence, because it was going to be the independence of our entire continent. Let me tell you, when you were free, we all came rushing to see South Africa and South Africans, because for many, many years our passports had a stamp that said: “Valid for all countries except the Republic of South Africa”. We were not allowed to step here while there was still Apartheid. That was the resistance from the rest of Africa. So, when you were free we came rushing to see the remaining part of our continent come free. When my turn came and I arrived at the airport Johannesburg, it wasn’t even yet called O.R. Tambo airport, it had another name, when I arrived, I saw many young women at the immigration desk and I brought my passport to one of them. And she looked at me with a big smile and said “Welcome to South Africa” and I said “thank you”. Then she said “How is it out there in Africa?” I said “Africa?” “Yes, out there where you’re coming from, how is it in Africa?” It hit me that this young woman had not yet had consciousness that South Africa was part of Africa. And of course, I got into a discussion with her that this is Africa where you are. And she said “Ok, I know, but I mean there where you are.” So, this is my last challenge to you, my fellow graduands, you are coming from a history that cut you off from the rest of your continent. But what I leave with you is this—it’s a challenge and it’s a blessing: go out there and be proud Africans. Embrace your whole continent. Go out there knowing we have one history as a continent and we have one destiny as a continent. And serve your continent and make the most of it.

So, it’s not only an honour for me to receive this honorary degree and I thank you so much for it. It’s an honour for me to share this day with you, graduands, and to bless you as the future, or maybe let me say, the present of Africa.

I thank you.
 

Hundreds of people living with HIV are spreading the word in South Africa that effective treatment can prevent onward transmission of the virus. The Eastern Cape has become the first of nine provinces in South Africa to launch a public information campaign to raise awareness of U = U (undetectable = untransmittable) and to encourage people living with HIV to commence, maintain or resume treatment and achieve and maintain an undetectable viral load.

The innovative campaign celebrates the fact that people living with HIV who receive effective antiretroviral therapy and achieve and maintain an undetectable viral load cannot pass HIV to others via sexual activity.

The overall goal of the Eastern Cape U = U campaign is to reduce HIV transmission by promoting treatment adherence and decreasing loss to follow-up, increasing viral suppression and improving data management. The campaign is also promoting HIV prevention, including the use of condoms, and wider sexual and reproductive health.

Importantly, the campaign was designed to help the province to catch up and reach the HIV targets for 2020, under which 73% of all people living with HIV should have achieved viral suppression by 2020. Eastern Cape had reached 58% by 2020. The new global target for viral suppression is 86% by 2025.

The campaign was officially launched with pledges of support from Eastern Cape Premier Oscar Mabuyane, community members and other prominent stakeholders, including the Eastern Cape Provincial AIDS Council, the Department of Health, the South African National AIDS Council and UNAIDS.

Campaign leaders hope to inspire similar activities across the country and beyond. “We want this to be a bottom-up approach,” said nurse clinician and U = U pioneer Mandisa Dukashe, who first approached the Eastern Cape AIDS Council about the campaign. “We hope the success in Eastern Cape will inspire other provinces, at the national level and outside South Africa,” she said.

Four hundred people living with HIV have been trained as U = U peer educators across South Africa, including 70 in Eastern Cape, who formed the core of the new campaign. Campaigners are collaborating in a series of groups to ensure that awareness is raised, communities are mobilized and service providers are trained and ready.

The implications of U = U are that people living with HIV need access to treatment as soon as they are diagnosed and to maintain effective treatment to become virally suppressed. This means that people visiting health clinics and receiving a positive HIV test result need quality counselling, said Ms Dukashe, who is herself living with HIV. “There is not much time spent now with clients when initiating their treatment and they can get lost in the health system.”

The concept of U = U arose from trials in South Africa and elsewhere that found that early antiretroviral treatment of HIV infection can prevent onward transmission. However, people can only know whether they are virally suppressed by taking a viral load test. Viral load levels should be monitored regularly to be sure that the HIV medicines are working, and this requires the active involvement of health-care professionals.

The campaign organizers want health-care providers to communicate this information to all people living with HIV. They particularly hope to inform couples’ counselling, especially those in serodiscordant relationships, where one partner is living with HIV and the other is HIV-negative. U = U cannot only prevent transmission of HIV to the negative partner, but can also prevent onward transmission to their child if the couple conceives.

Importantly, knowledge of U = U can help to reduce stigma about HIV infection and motivate people to start treatment in order to become virally suppressed and continue follow-up care. Globally, 66% of people living HIV were virally suppressed in 2020, with South Africa estimated to have achieved 61%, with 58% in Eastern Cape. This compares to the global targets of 73% of all people living with HIV achieving viral suppression by 2020, and 86% by 2025.

Over the next six months, Eastern Cape province will spread the U = U message across diverse audiences, through social media, radio and print media. Peer educators are working as HIV ambassadors and sharing their stories to inspire others. The campaign will also use billboards, rallies and community dialogues to reach as many people as possible.

“There is clear evidence that U = U messaging works and helps to bring people back to treatment and reduces stigma and discrimination,” said UNAIDS Country Director for South Africa, Eva Kiwango. “Treatment interruption is a persistent issue in South Africa and this campaign helps remind everybody that having an undetectable viral load when you are taking HIV treatment also stops transmission of HIV to others. This is critical for populations at higher risk of infection, such as adolescent girls and young women and key populations, including sex workers and gay men and other men who have sex with men.”

By Tabita Ntuli, UNAIDS Community Support Adviser, South Africa

If one word could define Leonora Nontokozo Mathe, AIDS activist and champion of key population rights, it is ubuntu—an African word with deep meaning that describes the character of people who recognize their shared humanity and humility. Born with HIV, Ms Mathe died this week after a long struggle with pneumonia.

Born and raised in Bulawayo, Zimbabwe, Ms Mathe was a phoenix who rose from the ashes after losing both of her parents at the tender age of 12 years. Ms Mathe was no ordinary person; she was an unforgettable icon who challenged HIV for the 31 years of her life. A quiet revolutionary, like still waters running deep, she was shy in her mannerisms, yet her advocacy spoke volumes. She knew how to listen attentively and was even better at speaking and expressing her mind in a way that advocated for the rights of people living with HIV.

Ms Mathe was a mother, sister and friend, a devoted advocate and champion of key population rights who was so softly spoken, loving and supportive. To know her personally meant you were exposed to her cheer and comical nature, for she was always cracking jokes and no one could hold back from laughing at some of the things she would say. She had the ability to make everything seem manageable, no matter how big or seemingly scary it was, and she spoke so candidly about her journey with HIV.

Ms Mathe travelled the world with her advocacy, visiting Namibia, Uganda, Rwanda, Morocco, Spain, the United Arab Emirates, Qatar, the Netherlands and Belgium, to name just a few of the countries she travelled to. A visionary and a leader who was starting her own organization, Hashtag InSolidarity, with the purpose of being more instrumental to key populations, she had partnered with a 14-year-old to help raise 100 000 crayons for needy kindergartens through a project called the Crayon Craze.

She wanted so much to empower women and girls through her organization and was in the implementation stages when her health became more challenging.

For the past three years, Ms Mathe was in and out of hospital, battling with pneumonia, yet she spoke which such lightness and understanding. She would say things like, “You know this body of mine has been through so many challenges due to being born with HIV, nothing shocks me any more about it, I just have to keep on fighting for my kids and my dreams to manifest before I die.”

Her dreams are as valid today as they were when she was alive. She experienced so many challenges with establishing her organization and trying to source funding and wanted to work with women living with HIV who are passionate about helping other women.

“Leonora Nontokozo Mathe was a tireless and passionate activist and leader who dedicated her life to championing the rights of people living with HIV and key populations and the empowerment of women and girls,” said Eva Kiwango, UNAIDS Country Director for South Africa. “We share in the sadness and offer condolences to her family and all who knew and loved her. She will be sadly missed.”

Ms Mathe was exceptional, phenomenal, wonderful, gifted and talented. A fiery soul whose light burned so brightly, particularly on key population matters, on which she unapologetically spoke about issues that needed urgent attention and addressing.

A light that burned so beautifully shall never be forgotten—her legacy lives on.

UNAIDS is deeply saddened at the passing of Archbishop Emeritus Desmond Tutu

GENEVA, 26 December 2021—UNAIDS is deeply saddened at the passing of Archbishop Desmond Tutu who fought against apartheid in South Africa and combated racism and injustice worldwide. He was a powerful voice in the fight against AIDS, combating denial, demanding access to treatment for all, calling out against discrimination of people living with HIV, and championing the human rights of lesbian, gay, bisexual and transgender people, women, and children. His work on HIV and tuberculosis prevention and treatment changed global paradigms and saved many lives.

“A giant has fallen. Archbishop Tutu was a freedom fighter, a holy man, a great hero who played a history-shaping role in the liberation of Africa,” said Winnie Byanyima, Executive Director of UNAIDS. “He was a leading light who brought global attention to injustice in a way few others could and a champion for the rights of all people living with and affected by AIDS. Millions are alive and free today because of the path he charted and the hope he brought to this world.”

Archbishop Tutu was outspoken in calling for an end to AIDS denialism in South Africa.  He fought for access to lifesaving medicines. "People, not profits, must be at the centre of patent law for medicines," he said while calling on pharmaceutical companies to make AIDS medicines accessible. He was also a champion of rights of gay people. He likened laws that criminalize forms of human love as apartheid laws—”so obviously wrong”.

Archbishop Desmond Tutu was an advocate for preventing HIV infection in adolescents and young people. He co-chaired the UNAIDS commission on HIV prevention in 2011 that led to setting bold global targets for HIV prevention. He extolled on young people to take on the leadership on AIDS. “Bold and honest actions are needed, and we look to the next generation of leaders to bring about positive change in attitudes and actions,” said Archbishop Tutu while speaking with young leaders in Robben Island on HIV prevention.

“UNAIDS has lost a friend, guide and mentor,” said Ms Byanyima. “Our thoughts are with his family, the people of South Africa, and many around the world whose lives he touched and changed for the better.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Data from South Africa highlight the challenge faced by many treatment programmes when it comes to successfully retaining people in HIV care.

The HIV treatment programme in South Africa reaches more people living with HIV than any other in the world, with more than 5 million adults (aged 15 years and older) receiving antiretroviral therapy in 2020. Among the 2.5 million adults living with HIV in South Africa who are not on treatment, a steadily increasing percentage are people who had started treatment but are no longer receiving it.

Efforts to support people on treatment to maintain treatment and achieve durable viral suppression are critical to improving health outcomes, maximizing the preventive benefits of treatment and preventing the emergence of drug-resistant strains of HIV. The World Health Organization recently updated its HIV treatment guidelines with a new recommendation to trace people who have disengaged from care and provide support for re-engagement.

By Mbulawa Mugabe, UNAIDS Country Director for South Africa

It is with great sadness that I received the news that the Executive Mayor of Johannesburg, Geoffrey Makhubo, passed away on 9 July 2021.

Having served in various senior positions in the Johannesburg Council and as the Member of the Mayoral Committee for Finance, Mr Makhubo was appointed Johannesburg Executive Mayor in December 2019, a position that he served with commitment and dedication.

Mr Makhubo was a strong advocate in the response to HIV, and on World AIDS Day 2020 he urged communities to work together to end HIV-related stigma. UNAIDS is grateful for his leadership and commitment to public health and to the HIV response, and for his unwavering support for the Fast-Track cities initiative. Given his commitment to the urban health agenda, Mr Makhubo addressed the global Fast-Track cities conference in 2020 and was a panellist at the United Nations High-Level Meeting on AIDS Fast-Track cities side event in June 2021.

His death is a deep loss for the HIV community and the citizens of Johannesburg.

Mr Makhubo died from COVID-19 complications, following a positive test result in late June.

We extend our sincere condolences to Mr Makhubo’s colleagues, family and friends, and to the city of Johannesburg.