Are young South Africans ignoring Aids message? By Karen Allen

BBC News, Johannesburg Published duration 17 July 2016

image copyright AFP image caption Aids drugs are now widely available in South Africa

It is a frostily cold morning in the outskirts of Johannesburg. Children aged between six and 17 are queuing up for their "morning meds", shivering their greetings to the nurse assigned to supervise them. It's now part of their daily routine before they skip off into the yard and get bussed off to school.

These youngsters are a walking, breathing, living testimony to South Africa's shameful past.

When a minority in the leadership allowed politics to overshadow science and refused to accept the potent reality of HIV/Aids, it delayed the rollout of preventative treatment and exposed tens of thousands of newborns to disease.

Most of the youngsters popping their pills were infected in the womb.

When the rest of the world was rolling out a drug called Nevirapine to reduce the chances of mothers transmitting the virus to their offspring, elements within the South African leadership famously advised patients to use lemon and garlic instead, to protect themselves.

Aids in South Africa:

image copyright AFP image caption Aids remains the biggest cause of death among young people in Africa

340,000 new infections in 2014 (931 a day)

2,700 young people infected every week - 74% girls

More than half a million infected in the past year

140,000 recorded Aids deaths every year

Many Aids deaths go unreported, so it is estimated there are more than 400 aids deaths each day

Source: UNAids, 2014

But times have changed. Dramatically.

South Africa reviewed its position in the face of international criticism.

"At least now the children have treatment, and more importantly they have life," says a sanguine Gail Johnson, the founder of a refuge for HIV-positive children created in the memory of the little boy she fostered, called Nkosi Johnson.

Her 11-year-old son's impassioned plea during the last big Aids conference here 16 years ago, to stop stigmatising people with HIV, moved the world to tears.

It marked a line in the sand and South Africa now has the most extensive anti-retroviral treatment programme in the world.

image caption Sanele has told his girlfriend he is HIV-positive

Youngsters like Sanele - a slightly built 20-year-old from Soweto who grew up in Nkosi's Haven orphanage and lost most of his family to Aids - are now far less likely to be infected at birth.

"I never asked to be infected with this disease... at times I rebelled, I said: 'Why me?'" he says.

But he is now reconciled to his fate, is well controlled on his medication and wants to be a role model to other young people like Nkosi who died shortly after his famous speech, deprived of Aids drugs.

Sanele is now completing his higher school certificate and dreams of becoming a computer engineer.

'Sugar daddy' syndrome

Rates of mother to child transmission have fallen by more than 50% since 2009 thanks to an aggressive programme of testing and treatment which has been rolled out across South Africa.

But the country faces a new threat - the staggering number of young people here under the age of 24 becoming newly infected with HIV.

image copyright AFP image caption The government is warning against sugar daddies

In any one week, 2,700 young men and women aged 15-24 become infected with HIV, according to figures released by UNAids.

Young South African women are particularly at risk and are getting infected in higher numbers due to a complex range of factors including economic and gender inequality, family breakdown and the practice of younger women having sex with older men.

This is the so-called "sugar daddy" syndrome or what the experts call "inter-generational sex".

It explains why in some places, young women are three times more likely to be infected with HIV than young men.

A new word which captures this arrangement is a "blesser" - used to describe an older man who will offers gifts to a younger woman for sex.

South Africa's Health Minister Aaron Motsoaledi recently embraced the term when he unveiled a new programme seeing to tackle the alarming number of adolescent infections.

As well as addressing problems with gender violence, he said the programme aims "to keep girls at school for as long as possible and create job opportunities for them so they reduce their dependence upon men".

'It is not spoken about'

HIV/Aids has exposed the complex social dynamics in South Africa and treatment alone is clearly not the answer for reaching the holy grail of an Aids-free generation.

One of the challenges that young people face is stigma.

image copyright EPA image caption South Africa is running one of the world's largest HIV programmes in the world

Sanele is one of the few courageous young South Africans to have declared his HIV status to his friend and his girlfriend.

"When I told her, she didn't believe me, she thought I was messing around but eventually she talked to my family and realised it was true and she got used to it. We are still together today".

But he admits that when you are out on the street "it is not spoken about".

Stigma and ignorance about HIV persists in South Africa despite concerted efforts at public information campaigns.

Sanele looks like any ordinary young man, enjoys his football and is clearly not dying.

Yet an estimated 400 people die in South Africa every single day of HIV-related illnesses, either because they don't seek help early on or default on their treatment. That message - that you can still die from the Aids virus - is somehow getting lost, he believes.

South Africa is not alone. More than two million adolescents around the world are living with HIV, according to Unicef.

Most of them are in sub-Saharan Africa and Asia.

It still remains the biggest cause of death among young people in Africa and the number of lives lost in this group has tripled in the past 16 years.

Little wonder then that the issue is likely to dominate debate when Aids experts reconvene in Durban, to assess the progress since the last conference.