South Africa faces two intersecting public health crises, experts warn

The Interim Chief Executive Officer of the Gender Based Violence and Femicide Response Fund (the Fund), Ms. Zanele Ngwepe, is raising the alarm with a forewarning  that South Africa’s fight against Gender Based Violence (GBV) and Human Immunodeficiency Virus (HIV) can no longer be separated, saying the two epidemics are deeply intertwined.

Ngwepe was speaking in Johannesburg on Wednesday, February 26 at a Multistakeholder engagement attended by multi-sectoral organisations including Human Sciences Research Council (HSRC), South African Aids Council (SANAC), Networking HIV and AIDS Community of Southern Africa (NACOSA), Bridging the Gap South Africa, Gugu Dlamini Foundation, Teddy Bear Clinic, and the University of Pretoria. 

“The GBVF and HIV crises are not separate struggles but deeply entangled, fuelled by the same structural inequities, cultural norms, and systematic failures that continue to erode the developmental potential of our communities,” the Fund’s CEO highlighted.

President Cyril Ramaphosa launched the private-sector led Fund in February 2021 to support the implementation of government’s National Strategic Plan (NSP) for Gender-Based Violence and Femicide to bring to halt the scourge of GBV. This is after President Ramaphosa declared GBV a second pandemic after Covid-19.

Four years later, Ngwepe asserts it is clear that that the twin epidemics have negatively shaped the lived realities of many in the country, especially women, adolescents and young people. This, she insists requires mobilisation of resources to ensure a unified, strategic response to the epidemics. 

“The intersection of these crises demands a combined approach, one that is proactive, integrated, and rooted in collaboration across government, the private sector, civil society, non-governmental organisations (NGOs) and global development partners. We must acknowledge that the same vulnerabilities that expose women and girls to HIV also make them susceptible to violence. Therefore, addressing one without the other is simply insufficient.” she stated.  

Supporting Ngwepe’s sentiments, HSRC’s Dr Nompumelelo Zungu told the engagement that research data unveiled an unambiguous intersection between HIV and GBV.  HSRC is the largest dedicated research institute in Africa focusing on the social sciences and humanities.

Dr. Zungu added that women who have experienced GBV are 1.5 times more likely to acquire HIV emanating from the association between Intimate Partner Violence (IPV) and HIV infection.

She further explained that 30 percent of women living with HIV globally have experienced some form of GBV in their lifetime. 

“The experience of sexual violence places women at higher risk of contracting HIV due to unequal power in sexual relations, which often lead to forced or unprotected sex with the abusive partner,” she explains.

Dr. Zungu revealed a survey conducted to adult women indicated 58 percent prevalence of childhood history of physical abuse before the age of 15 while the prevalence of childhood history of sexual abuse for the same age group stood at four percent.

“The prevalence of childhood abuse among men before the age of 18 is 74.6% for physical abuse and 15.7% for sexual abuse. This highlights that sexual abuse is a significant issue affecting children in South Africa,” she said.

In terms of the study that focuses on the lifetime physical violence, Dr Zungu said, research revealed 35,5 percent prevalence, translating to 7.8 million women who have experienced physical or sexual violence.

That’s a huge number, she said, adding that the rate of sexual violence in South Africa within a period of 12 months affects about two percent of women.

“One might say two percent is very low but if you translate that at community level or population level, then you can see that you are talking about over 400 000 women who experience sexual violence in a period of 12 months, and if that keeps carrying over in the subsequent 12 months, it’s a crisis.

Dr. Zungu further outlined that the HSRC investigated the prevalence of a controlling behaviour with regards to condom usage by male partners towards their spouses as a contributing factor to the intersection of the two epidemics.  

“We found that 26 percent of women indicated that their partners got angry and refused to use a condom, leaving them vulnerable to HIV. We also found that 44.4 percent of men admitted that they did not expect to be denied intimacy by their partners, and 21.1 percent of men would be upset if their partners insist on condom usage,” she said. 

Moreover, 6.4 percent of men believe that payment of lobola (dowry) takes away a women’s right to say no to sex. 

Acknowledging the crime stats, the Fund’s interim CEO argues that the GBVF National Strategic Plan outlines key pillars that directly align with the HIV National Strategic Plan, which calls for the elimination of violence as a structural driver of HIV. 

“If you look at Pillar Two, which focuses on prevention and shifting harmful social norms, and Pillar Four, which emphasises survivor-centred support, you realise an urgent need for creating synergy between GBVF and HIV response frameworks. To truly combat both crises, we must break down artificial barriers between these strategies and create a holistic, survivor-centred, and rights-based approach,” she said. 

In addition, Ngwepe said, the approach ought to translate to one stop-shop solutions for victims of gender-based violence through integration of health services and criminal justice system.

“If a survivor of gender-based violence seeks assistance at a facility, they should receive comprehensive support in a seamless and integrated manner. This includes access to essential health services, psychosocial support, and immediate engagement with the criminal justice system, all within a single process, to prevent secondary victimisation.”,” she stressed.   

According to Ngwepe, South Africa has made significant strides in tackling both GBVF and HIV through the development of comprehensive national strategies, yet working in silos will reverse the gains.

SANAC’s CEO, Dr. Thembisile Xulu echoes the sentiments on the intersectional expression of the two epidemics.

These figures, she noted, are not coincidental but rather confirm what is already known in terms of the scourge of GBVF, that it has reached epidemic levels in the country and this is a common trend for countries that have a high burden of HIV. 

“South Africa continues to carry the largest burden of HIV endemic in the world with a total of 7.8 million people living with the virus. We are also grappling with unacceptable high rates of Gender-Based Violence and Femicide. These dual epidemics disproportionately affect women, men, young girls, and other priority and vulnerable populations,” she said. 

Dr. Xulu pointed out that the previous and current National Strategic Plans for HIV, Tuberculosis (TB) and Sexually Transmitted Infections (STIs) identify GBV as one of the social and structural drivers of HIV/AIDS. Survivors of GBV are at high-risk of contracting HIV and people living with HIV are more likely to experience GBV. 

“Given the complexities of these intertwined challenges, there is no single organisation, government entity or sector that can effectively address them on their own. It is imperative that we adopt a collective, integrated and sustained response. Breaking the cycle of HIV and GBV require a collaborative, multi-stakeholder approach that delivers comprehensive and effective interventions,” she said. 

Dr. Xulu affirms that evidence shows that attending to these epidemics in isolation is ineffective. 

“But working together is not enough, the key is accountability.  It’s about communities being able to hold themselves accountable, it’s also about us having an accountability framework and to hold one another accountable on what we have agreed to do, ” she said. 

Meanwhile, in the light of a shifting geo-political landscape and the withdrawal of Pepfar, the U.S.  President’s Emergency Plan for Aids by the Trump Administration, Dr. Xulu closed the conference by calling on government and local donors to increase domestic funding and to become less reliant on international donors. 

Pepfar was initiated in 2003 to help fight HIV/Aids in countries with high HIV infection rates such as South Africa.