© Stefan Heunis

South Africa

Roughly seven million people are living with HIV in South Africa

South Africa, home to over 55 million people, has one of the continent's biggest and most developed economies.

Until 1994 it was ruled by a white minority which enforced a separation of races with its policy of apartheid.

The apartheid government eventually negotiated itself out of power after decades of international isolation, armed opposition and mass protests.

The democratically-elected leadership encouraged reconciliation and set about redressing social imbalances.

Médecins Sans Frontières/Doctors Without Borders (MSF) has worked in South Africa since 1999, caring for tuberculosis (TB) and HIV/AIDS patients.

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paTient story: sinthemba

Sinethemba Kuse, 17, from Khayelitsha, was one of the first TB patients initiated on delamanid in South Africa. 

“Just imagine being told that you have multidrug-resistant tuberculosis (MDR-TB) just before Christmas. The same day the doctor gave me tablets and I also got an injection. The injections were painful. I was scared of the needle because I had to be injected every day. Sometimes I would bleed and I even got lumps. I swallowed a lot of tablets, so I would vomit or be dizzy.

"Later, we were told about a new medication that is available in Khayelitsha that not a lot of people are lucky enough to have. Dr Jenny [Hughes] of MSF explained more about this new drug called delamanid. In February 2015, I started taking it. All I can say is that there is hope. I trusted it with my life and it worked. My gran and everybody started noticing the difference – even my gran’s church friends saw the change.”

MSF's work in South Africa: 2016

South Africa has the largest HIV patient cohort in the world and is helping to lead the way in terms of gaining access to new treatments for multidrug-resistant tuberculosis (MDR-TB).

2016 was a year of political upheaval in South Africa. 

The leading political party lost control of several major cities, following municipal elections in August. South Africans continued to make strident and often violent demands for better public services and accountable leaders.

KwaZulu-Natal Province

The MSF HIV/tuberculosis (TB) project in uThungulu district (population 114,000), is aiming to be the first site in South Africa to meet the ambitious UNAIDS 90-90-90 targets.

In 2016, we:

  • Tested 56,029 individuals for HIV/TB.
  • Performed 2,370 male circumcisions.
  • Distributed 1,573,756 condoms.

Read the report below to see how we are aiming to influence the South African government's future strategy for meeting 90-90-90 treatment targets nationally:

download REPORT: bending the curves of the hiv/tb epidemic in kwazulu-natal >


The Khayelitsha project near Cape Town continues to develop and implement treatment regimens for multidrug-resistant tuberculosis (MDR-TB), and innovative models of care for patients living with HIV and TB.

In 2016, we:

  • Focused on developing models of care to support specific at-risk groups - e.g. pregnant women and their infants, adolescents and men.
  • Established 13 postnatal 'Moms and Tots' clubs (in partnership with the city of Cape Town and mothers2mothers) - enabling women to access one-stop services for HIV and other health issues (thereby improving adherence to treatment).
  • Supported the Western Cape Department of Health, offering 'strengthened treatment' regimens to DR-TB patients.

Throughout 2016, we fought for access to new TB drugs, both in Khayelitsha and nationally. South Africa now has national access to the new TB drug - bedaquiline.

In Khayelitsha, we have the largest national cohort on another promising new medication - delamanid - with 61 new patients initiated on treatment in 2016.


We continued to support the Department of Health in North West province, expanding access to care for victims of sexual violence in Rustenburg (located in South Africa's platinum mining belt).

download report: untreated violence >

The above report publishes the results of our survey of 800 Rustenburg women between 18 and 49. 

We discovered that:

  • One in four women in Bojanala district have been raped in their lifetime.
  • Half have experienced some form of sexual or intimate partner violence.
  • 95 percent of women had never told a health facility about their assault.

We support three Kgomotso care centres. These are primary healthcare facilities that provide an essential package of medical, legal and psychosocial care to victims of sexual violence - with the aim of preventing illness and reducing suffering associated with rape.

The package includes:

  • Forensic examination.
  • Post-exposure prophylaxis (PEP) to prevent HIV and other sexually transmitted infections.
  • Psychosocial support and counselling.

In 2016:

  • 290 victims of sexual violence were treated.
  • 100 percent of those eligible received essential medication and/or psychological care.

In addition to working with provincial health authorities in Rustenburg, we continued to advocate nationally for increased access to services at healthcare facilities for vicitms of sexual violence.

Fix the Patent Laws

The Fix the Patent Law coalition consists of 32 patient groups and organisations, launched in 2011 with MSF as a founding member. It campaigns for reform of intellectual property laws - addressing obstracles to national access to affordable medicines.

Following years of pressue, the South African Department of Trade and Industry released a new intellectual policy consultative framework in July 2016.

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In September 2016, the coalition published a report - comprehensivelt making the case for patent law reform in the country. You can read it below:

download report: patient barriers to medicine access in south africa >

The coalition continues to exert pressure on the government to expedite legislative reform.

Stop Stockouts

The Stop Stockouts Project is a civil society consortium supported by MSF and five other organisations. It monitors the availability of essential drugs in clinics across the country, and pushes for the rapid resolution of stockouts and shortages.

Communities are trained on how to report stockouts, while national authorities are encouraged (and if needed, pressurised) to advocate the reform of supply chains.

In 2016, the project:

  • Received 605 reports of stockouts through its national hotline.
  • Trained 3,454 patients and community activists.
  • Secured a three-year grant from the European Union to continue its current operations.

Find out more in our International Activity Report

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