HIV prevention must be linked to GBV interventions

by Yogan Pillay, Department of Preventative Medicine, University of Pretoria and Foster Mohale, National Department of Health.

South Africa’s annual 16 Days of Activism Against Gender-Based Violence was launched on 25 November and runs to 10 December. This year’s theme is “Time to act is Now”.  On 1 December, the global community will come together, as has been done annually since 1988, to commemorate World AIDS Day. Led by UNAIDS, this year’s theme is “Take the Rights Path: My health, My right”. 

Why link sexual and gender-based violence with HIV? Data shows that women are more likely to acquire HIV than men, especially in the younger age groups. Adolescent girls and young women aged 15-24, are more likely to be HIV positive, than adolescent boys and young men. This difference points to young girls and women being infected by older men. It has also been long known that many women who are living with HIV were infected through non-consensual sexual acts, often accompanied by physical and emotional violence; linked to the imbalance in power between women and men. In 2023 the South African Police Service reported over 53 000 sexual offences of which almost 43 000 were raped, which is very likely an underestimate, as many instances of sexual violence against women go unreported for a variety of reasons. Ending sexual and gender-based violence now will also lead to a reduction in HIV rates. 

As we approach the 36^th World AIDS Day on 1 December 2024, what can we report as progress and what more should be done to decrease new HIV infections and ensure that more people with HIV are tested, on treatment and are virally suppressed? Currently, there are about 150 000 new HIV infections in South Africa annually. This adds to the estimated more than 7 million people living with HIV of whom around 5.5 million are on life-saving antiretroviral therapy.

While people we loved died around us over the past 30 years, especially during the period between 1985 and 1995, there was much communication and awareness about HIV. Mortality decreased significantly as we rolled out antiretroviral drugs and fewer people we knew and loved died which has resulted in a false sense that we have already overcome one of the greatest epidemics to face humanity. 

Therefore, the work is not yet done – globally 1.3 million people acquired HIV in 2023, of which 760 000 were in Africa and 150 000 were in South Africa. Additionally, globally about 23% of people living with HIV do not have access to treatment. Regrettably, this is similar in South Africa; with about 1 in 4 people living with HIV, NOT on treatment and which contributes to the 50 000 people who die every year. Many of these deaths can be avoided, if people who are vulnerable to HIV get tested and are initiated on ARVs early and stay on treatment so that they are virally suppressed. In addition, with more than 50% of people with HIV also infected with Tuberculosis (TB), we must also ensure that people with HIV are tested and treated for TB, because many of the deaths of people with HIV are the result of TB infection and we know that while HIV can be treated, TB can be cured!

What should we do?

First, we should all be aware of HIV and its cousin TB and the fact that we can all be infected but equally, we can act, individually and collectively, to prevent these infections. Let’s spread the prevention messages that we know well but seem to have forgotten. Government, the private sector as well as civil society has the responsibility to improve and expand communication around HIV, TB and GBV. Most people regularly use social media; we can also use these channels to effectively communicate health messages.

Secondly, we can prevent HIV and TB. For HIV, the use of condoms during every sexual act not only prevents HIV transmission, but also other sexually transmitted infections as well as unwanted pregnancies. Syphilis and teen pregnancies have skyrocketed in recent years. Public clinics provide pre- and post-exposure prevention medication (PEP and PrEP) that are also free. We hope that long-acting injectables for HIV prevention (injections every 2 or 6 months) will also be available soon. At the current rate at which we are reducing new HIV infections, we will still have more than 60 000 new infections per year in 2044.

Thirdly, we should encourage all those that are vulnerable to HIV and TB to get tested regularly. HIV self-testing kits are available for anyone to test themselves, with privacy and confidentiality or can be tested in public health clinics for free and be initiated on treatment. Similarly, TB tests in public clinics are free, as is treatment.

To get as many people on treatment for HIV as possible, we need to be more ambitious. One ambitious goal should be to add at least 1.1 million more people on HIV treatment and keep them virally suppressed. This will prevent new infections, as they will not transmit to others, thereby reducing new HIV infections and also prevent them from serious illness and death. 

Together with this ambition, we should test and treat many more people with TB, including those without symptoms. As with COVID-19, we have people with symptoms and those without. TB is the same, with about 50% of people with TB having no symptoms. This means that people with previous TB, people with HIV and contacts of people with active TB, should also be tested, in addition to those with TB symptoms (coughing for longer than 2 weeks, weight loss, night sweats, chest pains).

Fourthly, those that test positive for HIV and TB must be treated and stay on treatment as prescribed. It is life-long for HIV and for at least 6 months for TB. This means that health professionals, community health workers, family members and friends should support people with HIV, to stay on these chronic medicines, as we should do for other chronic conditions like diabetes and hypertension as well.

This World AIDS Day let’s commit to being a healthier nation by taking charge of our own health, that of our family members as well as our communities – we can do this. A healthy nation is a productive nation.

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The views and opinions expressed in this opinion piece are those of the authors, who are not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.