As we stand at the threshold of a new year, it is crucial to reflect on the persistent challenges but also the progress made in the realm of public health in South Africa, particularly in the context of HIV and tuberculosis (TB).

Over the years, South Africa has made significant progress in the fight against HIV.  The government’s commitment to widespread antiretroviral therapy (ART) programmes, coupled with increased awareness and destigmatization efforts, has played a pivotal role in stemming the tide of new infections. However, the journey towards an HIV-free generation is far from complete. It is heartening to witness the continued expansion of HIV testing and treatment programmes and the decentralization of healthcare services, especially in rural areas, has improved accessibility and reduced barriers to HIV care. Nevertheless, challenges persist, such as the need for sustained funding and access, combating persistent stigma, and addressing the root social determinants that contribute to the epidemic.

Pre-Exposure Prophylaxis (PrEP) has become a cornerstone in HIV prevention efforts. In 2023, advancements in PrEP research have led to the development of novel formulations and delivery methods, expanding accessibility and effectiveness. Longer-lasting PrEP options, such as implants and injectables, are on the horizon, offering additional choices to those at risk of HIV infection. However, it remains critical to advocate for approval of new products, which can only be scaled up if feasible costing agreements can be agreed upon guaranteeing sustainable and continuous access for patients.

In January 2022, the WHO endorsed the Undetectable equals Untransmittable (U=U) concept. The evidence-based U=U message conveys that individuals living HIV who have achieved and maintained an undetectable viral load through effective antiretroviral therapy (ART) cannot transmit the virus through sexual contact. Antiretroviral therapy, thus, is not only managing HIV in terms of patient health but also in preventing its transmission. The #sayzero initiative aims to encourage Healthcare professionals engaged in HIV care to state clearly at each visit that zero risk of transmitting HIV is attainable through persisting with appropriate HIV treatment.

While strides against HIV have been substantial, TB remains a formidable foe, often overshadowed but equally critical in the public health narrative. The intersection of HIV and TB poses unique challenges, given the heightened vulnerability of individuals with compromised immune systems. South Africa’s efforts to integrate TB screening and treatment within HIV programmes are commendable, but the battle against TB requires intensified focus. Addressing TB necessitates not only improved diagnostics and treatments but also a holistic approach that tackles socioeconomic factors contributing to its persistence.

Looking ahead, the key to sustained progress lies in holistic solutions that address the interconnected nature of health challenges in South Africa. Strengthening primary healthcare infrastructure, investing in health education and community engagement, and fostering international collaborations for research and development are paramount.

As we embark on this journey into 2024, it is imperative to recognize that the battle against HIV, TB, and other infectious diseases is not one that can be won overnight. It requires unwavering commitment, innovative strategies, and a collective effort from governments, healthcare professionals, communities, and international partners. By acknowledging the challenges, celebrating achievements, and fostering a united front, South Africa can continue to make strides towards a healthier and more resilient future.

As we absorb the knowledge and experience gained in 2023, it is evident that the fight against HIV is evolving into a more nuanced and sophisticated endeavor. However, although we are edging closer to the treatment cascade targets set by UNAIDS does not signify victory over the HIV epidemic in South Africa. HIV incidence continuous to be significantly influenced by the diversity of risk factors and the extent of ART and viral suppression coverage among people living with HIV. To effectively move towards AIDS elimination, it is imperative to enhance the implementation of additional HIV prevention strategies, requiring the synergy of scientific innovation, community engagement, and policy advocacy. While challenges persist, the collective momentum of advancements instills optimism in us as we continue to step towards attaining our vision as we transition into 2024: To lessen the impact of the HIV epidemic on individuals, families and communities through innovation and our passion for humanity.