In a stark warning on World AIDS Day, the South African National AIDS Council (SANAC) revealed that condom usage in the country has plummeted to its lowest level ever, threatening to undermine decades of progress against the HIV epidemic.
The alert was issued by SANAC CEO, Dr. Thembisile Xulu, during an interview yesterday. The discussion centered on the latest data, which shows approximately 8 million people in South Africa are living with HIV, with about 6.2 million on antiretroviral treatment (ART).
“We are at quite a crossroads,” Dr. Xulu stated, linking the decline in prevention to a concerning funding landscape and a lack of recent, impactful public health campaigns. She noted that the last major successful social behavior change initiative was during the era of the iconic “Khomanani” campaign years ago.
“The young people of today have got no idea,” she said. “All they know is that treatment works and if I get HIV I’ll get treatment. So we need to push more on prevention, push more on effective prevention interventions like condoms. Condom utilization in South Africa has gone down to its lowest ever.”
The interview highlighted multiple pressures on the HIV response. While medical advances mean people are living longer with HIV, Dr. Xulu pointed to new challenges, including a higher burden of non-communicable diseases and specific health risks for women living with HIV.
A significant concern is the gap in treatment. While 8 million people are living with HIV, only 6.2 million are on ART. Dr. Xulu attributed this to a combination of factors, including funding cuts earlier this year that affected community outreach programs, ongoing stigma, and systemic complexities.
“We lost some staff members. Some community members that were funded to make sure that we bring people back onto care, back onto treatment were also not funded,” she explained.
Despite the challenges, Dr. Xulu outlined several strategic government-led efforts to regain momentum. These include the recent launch of six-month multi-month dispensing for stable ART patients to reduce clinic visits, and the “Close the Gap” campaign aiming to find and treat the estimated 1.8 million people not currently on medication.
She also highlighted the upcoming rollout of Lenacapavir, a new long-acting injectable for HIV prevention, scheduled to begin between February and April next year for key populations. Agreements are in place to pursue local generic production by 2027 to ensure sustainable access.
When asked about the greatest remaining obstacle to ending the epidemic by 2030, Dr. Xulu emphasized stigma and discrimination, citing a newly released stigma index report that shows internalized stigma remains a major barrier to care.
Her final message to South Africans was a call for renewed personal and collective action. “Let’s normalize the conversation around HIV… Test, be on treatment, live, love, be well, so that you don’t even transmit HIV to your loved ones.”
The warning underscores a critical juncture for South Africa’s HIV response, where sustaining funding, reinvigorating prevention, and combating stigma are deemed essential to protecting the 52 million HIV-negative South Africans and maintaining the hard-won gains of the past two decades.