The fight against AIDS needs communities empowered by science

Just 40 years ago, the world learnt of the first reported case of Aids. In June 1981, the US Centers for Disease Control and Prevention CDC reported cases of a rare lung infection in young gay men. Since then, it is estimated that more than 80million people have been infected with HIV the virus that causes Aids of whom 40.4million have died from Aidsrelated illnesses. Last year, 39million people were living with HIV globally, and 630,000 died of Aids.

During the first two decades of this pandemic, Aids was a death sentence in poor countries, where most patients with the disease lived. This changed in 2000, when thousands gathered at the XIII International Aids Conference in Durban and demanded before the world equal access to Aids treatment for all who needed it. The conference was a clarion call for ending unequal access to treatment. It soon led to the creation of organisations such as the Global Fund to Fight Aids, Tuberculosis and Malaria and the US President's Emergency Plan for Aids Relief, which have made lifesaving treatments available to the inhabitants of even the most remote villages in Africa.

In 2016, the world came together at the UN in New York to embrace a global goal of ending Aids as a public health threat by 2030, the key objective of the UN's political declaration on ending Aids. To realise this aim, UNAids and the World Health Organisation set a global "909090" target for 2020. The target was for 90% of people living with HIV knowing their status, 90% of them being on treatment, and 90% of treated patients having suppressed the virus so effectively that it was not detectable in their blood. This requires reaching individuals who rarely interact with the healthcare system, conducting tests, proactively providing treatment, retaining treated patients in care, and supporting them with taking their medication.

Is South Africa on track to reach the 2030 goal, by meeting the 909090 target? Despite our having made good progress in providing those who need it with HIV treatment, the evidence says we have not reached the target. Last year, South Africa had 7.6million people living with HIV, and we had reached 947569 of the target. This means 94% of HIVpositive individuals knew their status, but only 75% were on antiretroviral therapy, and just 69% had suppressed viral loads. Last year there were 160,000 new HIV infections and 45,000 Aids deaths. South Africa witnessed more deaths from HIV than Covid19 last year.

Clearly, our country has much work to do to get our Aids response back on track, and we cannot do so without active community engagement and leadership. In SubSaharan Africa, adolescent girls and young women accounted for more than 77% of new infections among people aged 1524 last year. In South Africa, we need to make this group our priority. The challenge of Aids today requires us to do better with the scientific tools at our disposal. But the high rates of HIV in adolescent girls and young women in our country and many parts of Africa continue to highlight the importance of developing new technologies that will enable women to protect themselves against HIV. More active involvement and leadership by this group is critical in achieving greater progress in the Aids response in South Africa.

There are no shortcuts. The journey to 2030 requires greater communitydriven initiatives to bring about behavioural change. With growing misinformation and conspiracy theories, pandemic responses need trusted voices. Community leaders are well placed to counter misinformation with scientifically accurate education on the ground. Indeed, community leadership is central to all HIV response strategies in treatment and prevention. For communities to play their full part, they need to be empowered with factual information based on science. Science is needed not only to generate new technologies for HIV prevention and care, but also to find ways to maximise the impact of existing technologies. Science is needed to understand the human behaviours that lead to HIV transmission and determine the effectiveness of interventions.

As Sir Francis Bacon said: "Knowledge itself is power." Knowledge is essential to counter efforts to deliberately mislead people. Overcoming misconceptions and barriers to healthcare services requires ongoing community empowerment through dialogues that bridge the gap between science and scientists on the one hand and the communities they serve on the other. As South Africa tries to improve its Aids response, it needs support from partners across the globe. Its success will depend on the extent to which we can achieve active community leadership informed by science.

* Karim is the director, Devnarain a research associate, and Mdletshe the head of community engagement at the Centre for the Aids Programme of Research in South Africa