South Africa's Battle Against HIV
South Africa is home to 7.7 million HIV-positive people - the world's largest HIV-positive population.
66% drop in AIDS deaths since 2010 and 58% reduction in new infections.
With one in five adults living with HIV, South Africa shoulders nearly 10% of the global burden. Yet, it has achieved a 66% drop in AIDS deaths since 2010 and a 58% reduction in new infections—a testament to its massive treatment rollout. Today, 5.9 million South Africans receive life-saving antiretroviral therapy (ART), but 1.8 million remain untreated, driving ongoing transmission. Recent U.S. aid cuts have exposed the fragility of these gains, even as scientists unveil tools that could end the epidemic 1 4 5 .
Launched in February 2025 to add 1.1 million people to ART by end-2025—increasing coverage from 77% to over 90%.
Africa's first WHO-prequalified HIV drug—TLD (tenofovir/lamivudine/dolutegravir)—now being produced locally, marking a leap toward health sovereignty 9 .
Game ChangerDomestic funding covers 74% of the HIV response, but the loss of PEPFAR support (17% of the budget) threatens frontline health workers and clinics 1 5 .
The twice-yearly injectable lenacapavir has shown near-100% efficacy in preventing HIV. Approved in 2025 for prevention, it eliminates adherence barriers plaguing daily pills. In trials, 75% of users preferred it over oral PrEP. Gilead will supply it royalty-free to 120 high-burden countries—a potential "game changer" for young women, who face 570 new infections daily in South Africa 7 .
| Product | Dosing | Key Populations Tested | Efficacy/Advantage |
|---|---|---|---|
| Lenacapavir | Twice yearly | AGYW, pregnant women | ~100% efficacy |
| Cabotegravir (CAB-LA) | Every 2 months | AGYW in Zambia | 100% adherence in DREAMS program |
| MK-8527 (oral) | Monthly | Adults | Well-tolerated; Phase 3 upcoming |
A landmark Phase 1 trial for GRAdHIVNE1, a T-cell vaccine, launched in Zimbabwe and South Africa in July 2025. The vaccine uses a gorilla adenovirus vector to deliver networked HIV epitopes, stimulating CD8+ T cells to target HIV's structural weak spots. Enrolling 120 people (including those with HIV), it represents Africa's growing leadership in vaccine research 3 .
| Indicator | Decline | Consequence |
|---|---|---|
| Maternal viral load testing | 21.3% | ↑ Risk of mother-to-child transmission |
| Early infant diagnosis | 19.9% | Delayed treatment; ↑ mortality |
| Youth (15–24) testing | 17.2% | ↑ Undiagnosed infections; ↑ community spread |
"If nobody checks HIV patients who miss appointments, they're going to die"
15,000 PEPFAR-funded health workers lost salaries, forcing NGO clinic closures 4 5 .
This first African-led cure trial (Africa Health Research Institute, 2025) combined:
Of 20 women enrolled:
| Outcome | Participants | Duration Off ART |
|---|---|---|
| Initial viral suppression post-ATI | 6/20 (30%) | ~1 year |
| Sustained suppression (trial end) | 4/20 (20%) | 55+ weeks |
| Continued suppression (post-trial) | 4/20 (20%) | 1.5 years (average) |
"Studying how 20% controlled the virus unlocks clues for better cures"
| Reagent/Technology | Function | Example in HIV Research |
|---|---|---|
| Broadly Neutralizing Antibodies (bNAbs) | Target conserved HIV sites; block infection | Used with lenacapavir to boost immune control 7 |
| GRAd vector | Viral vector for vaccine delivery | Carries HIV epitopes in GRAdHIVNE1 vaccine 3 |
| Viral Load Assays | Quantify HIV RNA in blood | Track ART efficacy; detect treatment failure 4 |
| CD8+ T-cell Probes | Measure cytotoxic T-cell activity | Key for vaccine/cure trials (e.g., Durban study) 2 |
| AI Diagnostics | Rapid screening for HIV/TB co-infection | Mobile X-ray vans with AI in South Africa 7 |
South Africa's HIV response embodies both transformative potential and profound vulnerability. While innovations like lenacapavir, African-made drugs, and cure research offer hope, the funding crisis risks reversing decades of progress.
"In a time of crisis, the world must choose transformation over retreat."
With global solidarity, South Africa's science-led resilience could still end AIDS by 2030.