South Africa can be proud of the progress it has made in treating HIV and reducing Aids-related deaths. But its continued failure to prevent new HIV infections among young people is threatening to reverse strides achieved in the past few years, warns a report by the Joint UN Programme on HIV and Aids, known as UNAIDS. It serves as the leading advocate for global action against the epidemic.
News24 reports that experts attending the eighth SA AIDS Conference, held in Durban last week, said South Africa needed more than just treatment if it hoped to achieve its goal of having an HIV-free generation. It also needed to sustain its commitment to preventing, treating and possibly curing HIV.
New infections were said to be persisting, despite increased efforts to treat HIV infections with the hope of reducing new ones and, in so doing, preventing Aids-related deaths, the report said.
Last year, a UNAIDS report estimated that 270,000 South Africans were newly infected with HIV last year. Most of those infected were young people – the same generation that government was banking on to help it achieve an HIV-free generation.
Linda-Gail Bekker, a professor of medicine and deputy director of the Desmond Tutu HIV Centre at the University of Cape Town, said in the report that South Africans should not be choosing between prevention and treatment because of the magnitude of the country’s epidemic. Currently, 7m South Africans are living with HIV, while slightly more than 900 people are being infected a day.
The report says the state provides antiretroviral (ARV) drugs to more than 3.7 million people at a cost of R130 a month per person. With the adoption of the test and treat policy – where a person is put on treatment immediately after testing positive, irrespective of their CD4 count – the number of people on ARVs is expected to multiply.
“In South Africa, we have to focus on treatment and prevention. If we focus on our pre-exposure prophylaxis (PrEP) to prevent infection in key populations, including young women, we could have a greater effect [on HIV prevention],” said Bekker. “We must increase our focus on prevention in young women because of their ability to transmit to others.”
The report says that last year the Centre for the Aids Programme of Research in SA released a study showing how HIV moves from an older woman to an older man, who then infects a young girl. The girl grows up, becomes a young woman and then starts dating men her age, whom she then infects. Bekker was referring to this cycle when she said young women’s ability to transmit to others was concerning, the report says.
“Oral PrEP is part of the prevention option today … and is ready for deployment. The benefit of PrEP lies in avoiding 260,000 infections among young South Africans. This outweighs the risks,” Bekker said.
South Africa approved the use of PrEP last year in certain high-risk populations, including among sex workers and men who have sex with men. Currently, 1,300 people are taking PrEP in 17 pilot sites countrywide, the report says.
Scientists and policymakers said that, while PrEP offered an effective way of preventing HIV infection in South Africa, it was not a magic bullet.
The report says that several vaccine trials are taking place worldwide and South Africa is one of the countries at the forefront of this research. Currently, two trials – the vaccine efficacy trial known as HVTN 702 and the AMP study – are under way.
Professor Penny Moore, the research chair of virus-host dynamics at the University of the Witwatersrand and the National Institute for Communicable Diseases, said the AMP study – which seeks to find out if cloning broadly neutralising antibodies can prevent HIV infection – was currently enrolling volunteers.
And, the report says, scientists working on the AMP study plan to recruit 4,200 people, of whom 1,500 will be women living in sub-Saharan Africa at high risk of acquiring HIV.
Professor Thumbi Ndung’u, research group leader at the Africa Health Research Institute, said South Africa, like the rest of the world, needed a cure for HIV, but finding one would not be easy. According to the report, he cited the evolving nature of the HI virus and its ability to hide as the biggest obstacles to flushing HIV out of the human system.
He mentioned several methods tried over the years, without success. These included stem cell transplants, done to eliminate HIV from patients’ immune systems. The so-called functional cure was also tried on HIV-positive people – this refers to stopping HIV treatment and allowing the body to naturally control the virus.
Ndung’u said even the stem cell transplant, which had worked for Timothy Brown – the first person to be cured of HIV – was not viable “because it was expensive and could not be introduced on a large scale”. In 2006, Brown found out he had leukaemia. He received two stem cell transplants to treat his cancer and rebuild his immune system – in the process, killing off his HIV.
Specialists at the conference voiced their concern about the spiking rates of infections among young women, a trend reflected throughout the continent, reports VOA News. “What does it tell you about the lack of knowledge about HIV, 20, 30 years into the HIV epidemic?” said Mark Heywood, the director of the Section 27 social justice movement.
“We have seen, shockingly, a decline in knowledge of HIV amongst young people. It is like we have taken our foot off the accelerator, in certain respects.”
Heywood says more than 200 young women, ages 15 to 24, are infected with HIV each day in South Africa. In 2015, that demographic accounted for the largest segment of new HIV infections in South Africa and a disproportionate number of new cases in the region. Adolescent and young women made up a quarter of the new cases in sub-Saharan Africa, according to UNAIDS most recent global report.
UNAIDS says adolescent and young women in Africa are at “particularly high risk” for a variety of reasons, such as poverty, lack of education and violence.
The report says many poor young women in South Africa have “transactional” sexual relationships with older men who have jobs and money. The men buy them food, clothes and gifts. Health care workers in South Africa say transactional sex is a key driver of the new infections among young women in the country.
The report says Heywood is at the forefront of protests to demand the government make a new weapon against HIV infection available to young women. That weapon is a combination of antiretroviral drugs called “pre-exposure prophylaxis,” or PrEP. Taken correctly, the pill can prevent people from getting HIV.
Heywood says the state could afford to give the drugs to young women for free. “If you have literally tens of billions of rand being stolen every year out of different government departments, that is money that could be generating programs that reduce the vulnerability of young women,” he is quoted in the report as saying. “But there has to be a (political) will.”
South Africa’s Health Minister, Aaron Motsoaledi, says he plans to provide PrEP to young women in about two to three years, after educating them about the pill. It must be taken at about the same time every day, and ideally is used with condoms. However, Heywood says in the report that Motsoaledi’s “innovative” policies to prevent new HIV infections are likely to stall, as Motsoaledi has been politically isolated after publicly opposing President Jacob Zuma over Zuma’s alleged corruption.