Oral pre-exposure prophylaxis (PrEP), taken as a once-daily pill, has been hailed the world over as one of the major HIV prevention interventions in the fight against AIDS. Yet, apart form sex workers, very few South Africans are using PrEP or even know it exists.
The latest Department of Health (DoH) figures show just 3011 young people (between 15 and 24) in the country are using PrEP. This is despite the fact that, if taken as prescribed, PrEP can reduce one’s risk of contracting HIV through sex by over 90 percent.
“Three thousand is a woefully low figure. It is not clear why something that clearly works is not being rolled out aggressively, particularly for young women,” said Professor Francois Venter from the Wits Reproductive Health and HIV Institute.
The HIV prevalence among young women in South Africa is over three times higher than young men. According to the Human Sciences Research Council the disparity in HIV prevalence is “most pronounced” among young adults aged between 20 and 24; 15.6 percent of women in this group are HIV infected compared to 4.8 percent of men.
Up until last year, PrEP was targeted at other high-risk groups such as sex workers and men who have sex with men. But after the decision to extend access to young people, especially women, uptake has been slow and the DoH has been criticised for failing to prioritise PrEP – or young women.
They were unable to provide Health-e News with the disaggregated PrEP data for this key population.
But the DoH’s Dr Yogan Pillay estimates that “around two thirds are adolescent girls and young women”.
Although this intervention is important for young women, especially those in violent relationships, PrEP has not received the national attention of other interventions such as the government’s voluntary medical male circumcision campaign to prevent HIV which, Venter said, “is one of the most successful in the world”.
Violence and HIV
Nomalanga Ngwenya, from Agisanang Domestic Abuse Prevention and Training in Alexandra township, said she can attest to the vulnerability to violence and HIV experienced by young women. Of the estimated 70 weekly cases her organisation encounters, most (40 percent) are due to abuse followed by rape (30 percent).
“Women in abusive relationships normally are afraid to negotiate for condom use, so any intervention to help would be most welcome,” she said.
However, Venter said that PrEP is a “more complicated programme” than one for medical male circumcision and that uptake might increase with time.
“We’ve seen it with the sex worker programme for PrEP where uptake was initially quite blunted but once people got used to it, it turned into an incredible success,” he said.
This is another reason why “more advocacy should be done to make it more widely-available”, according to Ntando Yola, from the Desmond Tutu HIV Foundation. He said there is just “too little knowledge” about PrEP among South Africa’s general public.
As a young woman in the early 2000s Penny Segoto, a mother of three from Midrand, contracted HIV from her unfaithful husband.
She told Health-e News she wished PrEP was available back then so she could have protected herself.
“It can help a lot of women with their dishonest partners,” she said.
While Segoto has learnt about PrEP in HIV circles, the majority of South Africans have not.
Said Venter: “Young girls are incredibly vulnerable to HIV and we should be throwing absolutely everything we have at them – especially PrEP.” – Health-e News
Additional reporting by Ramatamo Sehoai
An edited version of this story was published in the Saturday Star, the Weekend Argus and the Sunday Tribune