This compared to 7.2 million in 2017. “There has been progress in the number of AIDS-related deaths since 2010, with a 50% decrease, from 140 000 deaths to 71 000 deaths,” UNAIDS reported. “The number of new HIV infections fell from 390 000 to 240 000 in the same period.”
Although the numbers are encouraging, SA still has the biggest HIV epidemic in the world. This begs the question – is enough being done to treat and prevent HIV/Aids in SA? In April the Center for Strategic & International Studies (CSIS) expressed concern that the HIV epidemic in SA is not being treated like a crisis.
“In February, we travelled to SA, to understand what is happening in these areas with ‘hyperendemic’ HIV epidemics, where prevalence rates exceed 15% among adults,” said Sara Allinder (CSIS – executive director and senior fellow, Global Health Policy Center). “We were alarmed by the complacency toward the rate of new infections at all levels and the absence of an emergency response, especially for young people.”
PRE- (PREP) AND POST-EXPOSURE PROPHYLAXIS (PEP)
In December 2015, SA became the first country in sub-Saharan Africa to fully approve pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs to protect HIV-negative people from infection. However, the CSIS said PrEP rollout in SA has been slow and inadequate since it was approved in national guidelines in 2016. “PrEP offers a tool to help break the transmission cycle,” said Allinder.
“In areas where there is so much HIV circulating, every sexual encounter is high risk, and widespread PrEP could be a prevention lynchpin.” Southern African HIV Clinicians Society (SAHCS) CEO, Lauren Jankelowitz, agreed. “PrEP works 100% if used correctly.” According to AVAC (Global Advocacy for HIV Prevention) as of July 2019 there were 23-24 thousand current PrEP enrolees.
“These numbers are concerning,” she said. “We are still far from the era of no new HIV transmissions, and as such, need to ensure all people who are sexually active have access to PrEP to prevent HIV. Anyone engaging in risky (or risk unknown) sex should have access to PrEP to prevent contracting HIV, said Jankelowitz. “We believe, for everyone else, post-exposure prophylaxis (PEP) should be available for preventing HIV (after the potential exposure).”
The SAHCS stressed concerns that the National Department of Health (NDoH) is not doing enough to educate healthcare professionals and the public on the existence, benefits, and availability of PrEP and PEP. “The majority of people in the public sector do not know about PrEP especially as it is only available in demo projects to sex workers and MSM (men who have sex with men). This creates stigma about PEP and PrEP and many patients/prospective PrEP/PEP users perceive they will be judged,” said Jankelowitz.
“The NDoH rolled out a hugely successful campaign for breastfeeding and HIV (including for example national billboards) and we believe the same should be done for PrEP and PEP, especially as we move towards it becoming available in pharmacies. PrEP and PEP should be as accessible as asking a pharmacist for emergency contraception.
THE FUTURE OF HIV IN SA
“Healthcare workers attitudes are slowly shifting,” said Jankelowitz. “Many NDoH employees (nurses, doctors) aware of PEP use it for their own needle stick injuries.
Healthcare professionals should be educating themselves about the new drug options and delivery methods available. They should be educating their patients about knowing their status, and their HIV negative patients about the benefits of PrEP” According to Avert (charity focusing on HIV and sexual health worldwide), “SA has made great strides in tackling its HIV epidemic in recent years and now has the biggest HIV treatment programme in the world. Moreover, these efforts are now largely funded from SA’s own resources.
However, while the short-term financing of SA’s HIV epidemic is secure, in the longer term, the government needs to explore other strategies in order to sustain and expand its progress.” “This is no time for business as usual from South Africa or its partners,” warned Allinder. “The epidemic is exacerbated by its concentration in 15-49-year-olds, those of reproductive and working age who are the backbone of SA.
Without aggressive action to reduce the rate of new infections in young people, HIV will continue to take a tremendous toll on the country for years and generations to come. Collective action is needed to push beyond the complacency and internal barriers to implement policies and interventions that directly target HIV prevention and treatment for young people.