PrEP for the holidays, says HIV expert

Staying healthy and living an active life means taking your medication daily to manage chronic conditions. Picture: pexels/Miguel Á. Padriñán

Staying healthy and living an active life means taking your medication daily to manage chronic conditions. Picture: pexels/Miguel Á. Padriñán

Published Nov 30, 2023


Ahead of World AIDS Day on 1 December and the upcoming holiday season, South Africans are encouraged to keep their HIV and other chronic medications up to date.

Dhirisha Naidoo, Chief of Party for the PEPFAR funded USAID HIV treatment and care programme, APACE, in partnership with the Department of Health, is urging the public on note the importance of staying on life-saving treatment during the festive season.

Naidoo stated: “The holidays can be a fun and exciting time of year for many. As we plan for and look forward to the break, we urge all South Africans to protect and maintain their health during this period.

“We see many people often run out of chronic medications over the holidays and don’t get refills until they are back home, but this impacts the stability of their medical condition.”

She added: “Staying healthy and living an active life means taking your medication daily to manage chronic conditions. This is especially important for people living with HIV to ensure their viral load remains undetectable so they cannot transmit the virus.

“We encourage people to stock up on multi-scripted medications or enrol in the Central Chronic Medicines Dispensing and Distribution programme to ensure they have sufficient medications.”

Health minister Dr Joe Phaahla expressed concern regarding HIV treatment in the The 5th National Strategic Plan on HIV, TB and STIs 2023-2028, stating, "Although considerable strides have been made in certain areas, such as HIV-testing, we are still lagging behind on initiating and retaining infected people on antiretroviral therapy.

“Among the nearly 8 million people living with HIV, about 5.7 million of them are on treatment, leaving us with a gap of over 2 million people who should be on treatment but are not.

“It is also concerning that the percentage and levels of viral suppression are not enough to reap the full benefits of treatment as prevention.”

Globally, the concept of Undetectable = Untransmittable (U=U) is gaining recognition as a message of hope for people living with HIV, said Naidoo.

Achieving viral suppression through adherence to HIV medications allows individuals to live longer, healthier lives. Viral suppression means having an undetectable viral load, making HIV untransmittable.

Naidoo explained: “People living with HIV can live freely, without the fear of transmitting HIV to others.”

However, the latest UNAIDS statistics reveal the ongoing challenges in the fight against HIV. In 2022, approximately 39 million people worldwide were living with HIV. 1.3 million individuals became newly infected that year.

Moreover, 9.2 million people living with HIV did not have access to antiretroviral treatment.

As the holiday season approaches, a concerning trend emerges within the HIV community - an increase in individuals defaulting on their treatment regimens.

People living with HIV face disruptions in daily routines during the holiday season, according to a study published in the Journal of Acquired Immune Deficiency Syndromes.

Getting caught up in festivities, travelling, or social commitments can make it hard to stick to a medication schedule.

Plus the holiday season often involves gatherings with friends, family, and acquaintances, triggering concerns related to HIV disclosure and stigma. Holiday drinking and substance use negatively impact HIV treatment adherence.

All these factors including fear of judgement, rejection, or discrimination can discourage people from adhering to their treatment regimens during this time.

Preventative measures, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), play a crucial role in addressing HIV risks.

Teenage girls and young women in South Africa face a particularly high risk due to socio-economic circumstances. They accounted for 77% of new infections among young people (15-24 years) in sub-Saharan Africa in 2022, said Naidoo.

“The importance of preventative HIV medications for young women and girls cannot be overstated.

“Girls are at greater HIV risk if they engage in sex at a very young age; when they don’t have the power to negotiate condom-use; when they have multiple sexual partners; if they are repressed by patriarchal culture and gender-based violence; and if they have transactional relationships with sexual partners as a result of the difficult economic environment,” Naidoo warned.

Preventative medications include pre-exposure prophylaxis (or PrEP) - a highly effective oral medication taken to prevent HIV infection, and post-exposure prophylaxis (PEP) for cases where young women may have been exposed to HIV through unprotected sex or rape.

PEP should be taken within 72 hours of HIV exposure. Multi-scripts are also available for these preventative medications.

In South Africa, adult men make up about 37% of those living with HIV. Injecting drug users, transgender individuals and their sexual partners, men who have sex with men, sex workers and their clients, and others are important groups that need men to continue taking their HIV meds.

According to UNAIDS, together they are responsible for 70% of HIV infections worldwide and 51% of new infections in sub-Saharan Africa.

The Global Health Alliance’s children’s charter released in 2023 also encourages pregnant women or women who are planning for pregnancy to test for HIV and other transmittable infections.

If HIV negative, they should consider taking PrEP (preventative HIV medication) throughout their pregnancy and breastfeeding period, or if their child was exposed to HIV, to bring the child into their local clinic to be tested advised Naidoo.

“Reaching the goal of ending new HIV infections by 2030 is possible. To do this, we must protect our most vulnerable from contracting HIV and ensure those who are HIV+ have access to the necessary treatments to enable them to live long, healthy lives,” she said.