South Africa is currently fighting four epidemics at once: maternal, newborn and child health; HIV/AIDS and TB; non-communicable diseases such as cancer, cardiovascular disease and diabetes; and domestic violence and injury against women.

“We have one of the largest HIV/AIDS epidemics at a global level,” says Professor Glenda Gray, CEO and President of the South African Medical Research Council (SAMRC). “And with HIV/AIDS we have co-morbidity of TB. Reducing the burden of non-communicable diseases involves better lifestyle choices and increased medical research.”

 

South Africa must target vulnerable groups

 

There have, however, been some breakthroughs. South Africa has managed to increase life expectancy of HIV patients with one of the largest antiretroviral programmes in the world. It has also made strides in preventing mother-to-child infection, and implemented effective screening, antenatal care and treatment programmes. More work now needs to be done to target marginalised and vulnerable populations with HIV interventions, and particularly young women and girls.

“If we don't reach vulnerable populations, we're never going to be able to control HIV,” says Gray. “We must be sure that young women and adolescent girls can protect themselves and, if they become infected, are able to receive treatment and care. But we cannot simply focus on women. We need to find ways of involving men in this fight and empowering them to protect themselves and their partners, otherwise we will continue to perpetuate gender imbalance and the vulnerability of women.”

 

Partnership is crucial for health success

 

Joined up thinking is pivotal to the success of eliminating all four epidemics, says Gray, because it can provide better resources, increased funding and more cutting-edge innovation and logistical power.

“Public-private partnerships and philanthropic relationships, NGOs and pharmaceuticals are critical if we are to address some of the R&D challenges we face, particularly regarding TB,” she says. “Take drug discovery, which is expensive. We must work with industry and other international partners to get drugs through clinical research. We need to make sure we don't leave any diseases behind.”

 

The Nelson Mandela effect

 

Nelson Mandela has been credited with “changing the AIDS agenda in South Africa.” That's because he wasn't just a political visionary, says Professor Glenda Gray. He understood that social inequality was a driver of HIV and TB.

“Nelson Mandela saw the link between pathogens and poverty,” says Gray. “He was passionate about HIV because the disease was emerging in our country — and claiming the lives of huge numbers of women and babies — around the time he became our President. He also recognised the devastation wrought by TB, which was associated with populations such as mine-workers and migrants. He saw the injustice of these diseases and was determined to drive them up the political agenda.”

 

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