Deputy Speaker, in 2007 South Africa represented 0,7% of the world's population, but accounted for 17% of the global number of HIV infections. This translated into 5,6 million people.
In 2000 the leading cause of morbidity was HIV at 31%, and the leading risk factors were unprotected sex at 32%. Trends in death notifications increased sharply, doubling over a decade to 700 000 deaths in 2008, with tuberculosis having a six-fold increase in the same period.
The statistics I have just read out are from the recently released National Development Plan. So, why is it that we seem unable to break the back of the HIV/Aids pandemic? How can we achieve zero infections? Why is it that HIV is still the single biggest killer of women of reproductive age, despite having the biggest treatment campaign in the world?
In her book, The Invisible Cure, on the HIV pandemic in Southern Africa, Dr Helen Epstein addresses this issue, and I quote:
The root cause of our Aids crisis is the entrenched culture of multiple concurrent sexual partners, aggravated by intergenerational sex.
She describes this as the "Aids superhighway". She concludes that the only countries in Africa that have turned the Aids pandemic around are those that have focused on partner reduction. Of particular interest is Uganda's "zero grazing", the name given to the policy to promote sexual fidelity.
She says further:
If the network of concurrent relationships serves as a superhighway for HIV, then partner reduction would be a sledgehammer, breaking up the highway into smaller networks and destroying the on-ramps - the casual relationships that let HIV onto the superhighway in the first place. In theory, condoms could have created "road blocks" on the superhighway if only people used them consistently. But most condom use in Africa is inconsistent, especially in the longer-term relationships in which so much HIV transmission takes place.
Epstein notes that the HIV rate in Zimbabwe and Kenya began to decline in the late 1990s once multiple partnerships began to decline; this, after the rate of condom use had been increasing throughout the decade. During the same period, HIV rates rose in Botswana, South Africa and Lesotho, where no partner reduction occurred and where condoms were emphasised as the main method of prevention. In all three countries, condoms were used more frequently than in Uganda where the HIV rate was falling.
South Africa and particularly men remain in deep denial about the core problem: that multiple concurrent sexual partners, aggravated by unprotected intergenerational sex, is spreading HIV.
While we have focused on condom distribution and free treatment, which are crucial components in the fight against HIV, we have ignored individual responsibility. Often, anyone promoting the "be faithful" component of the ABC prevention trilogy - abstain, be faithful and condomise - has been shot down.
Why is it that Uganda has had a reduction? And it seems to be the following conclusion: they have managed to remove the stigma against people living with HIV while stigmatising the behaviour that spreads HIV. This distinction is very important.
People living with HIV must be able to lead full, stigma-free lives and get the treatment they need to do so. At the same time, it is fair to require everyone to know their status and to avoid situations that involve infecting others. While this precaution applies to everybody, people that are HIV-positive have a particular duty to disclose their status in situations in which others could be at risk.
We must begin by challenging the premodern notion that unprotected sex with multiple intergenerational concurrent sexual partners is a cultural right. It simply is not. In a modern urban context, it wreaks social devastation. It drives up the teenage pregnancy rate, entrenches poverty, spreads disease, destroys families and produces unwanted and neglected children. It is the key reason why our health system is so overburdened. It must stop. It is not merely a moral issue. It is a developmental issue.
Let me say this so there would not be a misunderstanding. The DA in the Western Cape, which was the first province to roll out ARVs to HIV-positive people, will continue to provide the most advanced free treatment to everyone who tests positive for HIV. But it is fair to require everyone to take regular, free HIV tests and counselling and accept responsibility for preventing risk to others.
Only through a multidisciplined approach will we ever defeat the scourge of HIV. We have to break the cycle of infecting the next generation and we have to strive towards zero infections. We have to address head-on that having unprotected sex with multiple concurrent sexual partners, aggravated by intergenerational sex, is spreading HIV. I thank you all. [Applause.]