Fighting HIV by using preventive pills 

South Africa’s health department has HIV prevention programmes but young women are still vulnerable to infection and HIV organisations have called for an emphasis on other prevention measures.

After conducting a national survey that revealed that young women between the ages of 15 and 24 account for the highest rate of new HIV infections, the Human Sciences Research Council (HSRC) highlighted the need for making prevention mechanisms such as pre-exposure prophylaxis (PrEP) available and easy to access.  

PrEP is a two-in-one protection tablet, made up of two amalgamated antiretroviral drugs. It is taken by anyone who thinks they might be at risk of HIV infection.  

The HSRC-led research consortium produced a report titled South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. It says that although new HIV infections in the country had decreased to 270 000 in 2016 from 360 000 in 2012, women aged 15 to 24 accounted for 100 000 new HIV infections. 

Tusani Kunene, the national HIV prevention manager for the AIDS Healthcare Foundation in South Africa, said that PrEP, along with other HIV prevention measures, can reduce infection. Kunene said that for South Africa to reach its goal of zero new infections by 2030, it will have to use multipronged strategies, particularly those that empower women. 

“This is especially the case for women who are, most of the time, dependent on their male counterparts to use the condom as protection whenever they have sex. Therefore, the availability of a preventative pill that can be used independently in preventing the acquisition of HIV is a welcome discovery,” he said.

Additional measures

PrEP was rolled out to selected clinics in South Africa in 2016. It was highly recommended to sex workers, the transgender population and men who have sex with men (MSM) as these groups were said to be at a higher risk of HIV infection.  

Sindi van Zyl, a general medical practitioner, said PrEP works by preventing HIV from inserting itself into the DNA in our CD4 cells, which are deemed the most important cells in the system.  

Both Van Zyl and Kunene emphasised that although PrEP prevents one from getting HIV, the use of condoms remains essential as this prevents sexually transmitted diseases (STDs) and unwanted pregnancies as well. 

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The availability of this drug remains a challenge. Kunene explained that access to PrEP was modelled around rights and needs, and given to groups that were deemed to be high risk, but added that the recent data on new HIV infections among the youth calls for easy access to the drug. “It is therefore important that Department of Health makes PrEP available to young women, just like it offers ARVs to those who are infected,” he said.

Van Zyl said PrEP is available at some universities and is provided free of charge for students. “It is available free of charge for sex workers and MSM, and available through most medical aids. You can also get it from a private doctor as a cash patient,” she said.

Post-exposure option

In cases where people suspect they may have been exposed to HIV, post-exposure prophylaxis (PEP) is recommended. PEP is a combination of antiretroviral drugs, taken to prevent becoming infected. 

Wits Reproductive Health and HIV Institute deputy executive director Francois Venter said PEP is taken after many forms of exposure. Medical practitioners use it after needle sticks. “You can get splashed in the eye, you might cut yourself with a knife, you might be playing rugby [and get injured], you might be having unsafe sexual exposure,” he said.

Venter said the pills should start being taken within 72 hours of potential exposure. “The situation we often see is in post-sexual assault, someone is being raped, they make their way to a facility to take PEP. After 72 hours there is probably no benefit, but before 72 hours there is a massive benefit. The quicker the better. If you take the drug for the full 28 days, once a day, the chance of you getting HIV is almost zero.” 

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He explained that the reason for the 28-day regime is because efficacy is low when the drug is taken for only a week. “People often forget to take the pill. To my mind, that’s probably the biggest challenge, is to make people finish it.” He added that PEP is safe for pregnant women.

To get the tablet, one has to take an HIV test. “You can get resistance to this if you are HIV positive. We often have people who find out that they are HIV positive at the time of exposure,” he said. 

The side effects of PEP vary between regimes, said Venter. “I’ve been on PEP and I felt a little bit off and slightly lost my appetite. That was about it.

“You will feel nauseous and often vomiting, and have ultra dreams.” But he added that the current PEP medication has few side effects and people shouldn’t be worried.

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