When the world marks World Aids Day on December 1, South Africans don’t just remember history; we confront a present reality.
HIV and TB are not stories in textbooks. They are in our homes, our clinics, our workplaces and our cemeteries.
And in the Eastern Cape, they remain among the most powerful forces shaping the health and dignity of people.
More than 40 years into the epidemic, SA still carries 20% of the world’s HIV infections and 20% of all people living with HIV.
Despite making massive progress, we are not yet where we should be, and the Eastern Cape shows this most painfully.
The truth is simple: we are not losing this war, but we are not winning fast enough.
In June, our provincial cascade stood at 94–78–93 for adults — meaning 94% of people living with HIV know their status, only 78% of those are on treatment, and 93% of those on treatment are virally suppressed.
We are testing well and achieving strong viral suppression, but far too many people who know they are HIV positive are still not on treatment.
We know our biggest weakness: getting people onto treatment and keeping them there. Testing is not the problem. Treatment is. Treatment is about behaviour, stigma, access, confidence and trust, not just pills.
And that is why the Eastern Cape is struggling to close the gap.
How big is this gap? Huge.
To contribute to the national 1.1 Million Close the ART Gap campaign, we must find and re-engage 148,322 people who are living with HIV but are not on treatment.
These are not classified as “lost to follow-up” in the database. These are real human beings, mostly men, youths and children, falling out of the system and falling through the cracks.
Every one of them represents a preventable illness, a preventable hospitalisation, a preventable funeral.
If we do not close this gap, the epidemic will rise again. That is the warning.
To be clear: the situation is not hopeless. In fact, there are remarkable gains no-one talks about enough.
Our TB treatment success rate is at 78%, above the national 70% target. We have cut drug-resistant TB treatment from 7,200 pills and 180 injections down to 734 tablets using new BPaL-L regimens. That is real progress.
But we cannot celebrate progress while ignoring the cracks widening beneath our feet.
One of those cracks is men. Men test too late, start treatment too late and die too young.
Another is children: For children under 15, our treatment cascade stands at 88–75–77, meaning that 88% of children living with HIV are diagnosed, 75% of those who know their status are on antiretroviral treatment, and 77% of those on treatment are virally suppressed.
We are failing children who rely on us for survival.
This raises a painful but necessary question: who is supposed to find these people?
The government cannot do it alone.
Clinics cannot do it alone.
NGOs cannot do it alone.
This is why the 2025 World AIDS Day theme, “Let Communities Lead”, is not just a slogan. It is a strategy. It is an admission that the most powerful weapon we have now is community mobilisation.
Because if a man ignores his symptoms, it is not the clinic that knows — it is his neighbour.
If a child misses a follow-up visit, the grandmother knows. If a young woman stops ART, her friend knows.
Communities know first. Communities can act first. But communities can only lead if the government walks beside them, not behind or ahead.
This is why we launched two major campaigns in October: Close the Gap: 1.1 Million and End TB: 5 Million Tests.
These campaigns are not bureaucratic exercises. They are the largest door-to-door, street-to-street, village-to-village mobilisation efforts since the early ART rollout.
We are taking testing, treatment and screening out of clinics and into taxis, churches, farms, construction sites, schools and rural villages. We are bringing politicians into the build-up, not just to speak on the stage, but to knock on doors.
Because you cannot fight an epidemic behind a podium, ending an epidemic is no longer a scientific challenge; it is a leadership challenge, a social challenge, and a community challenge.
This World AIDS Day must be our turning point. Not because we are tired of the epidemic, but because the epidemic is not tired of us.
We have the medicine. We have the science. We have the tools. What we need now is the will.
Let communities lead. Let the government enable. Let us refuse to lose another generation. Because the Eastern Cape cannot afford another decade of preventable loss.
Not when we have the power to end this — decisively, permanently and together.
That is our task. That is our opportunity. And that is our responsibility.
Ntandokazi Capa, Eastern Cape health MEC
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