A 'Prevention Revolution' Offers Hope in the World’s Largest HIV Epidemic
New forms of PrEP to prevent HIV, like injectable CAB-LA, are coming. Public health officials hope they’ll help South Africa’s young women, one of the most impacted groups in the world, avoid the...
Translate page with Google Home Stories STORY DECEMBER 1, 2022 A 'Prevention Revolution' Offers Hope in the World’s Largest HIV Epidemic Country: SOUTH AFRICA Author: Shane Burke 2021 POST-GRAD REPORTING FELLOW Share this page on Facebook Share this page on Twitter Email this page Print this page ENGLISH Project The Future of HIV/AIDS Prevention in South Africa READ MORE ABOUT THIS PROJECT - THE FUTURE OF HIV/AIDS PREVENTION IN SOUTH AFRICA A nurse holds a bottle of PrEP in a clinic in Cape Town, South Africa. Image by Shane Burke. South Africa, 2022. New forms of PrEP to prevent HIV, like injectable CAB-LA, are coming. Public health officials hope they’ll help South Africa’s young women, one of the most impacted groups in the world, avoid the virus. UMLAZI, SOUTH AFRICA—In South Africa’s Umlazi township, HIV is a part of life, even for those who don’t have it. Twenty-two-year-old Pamella Jili has seen its impact up close. She grew up in the township, a hot spot in the worst-hit province in South Africa, where more people live with HIV than anywhere else in the world. She has watched others struggle with the virus. When dating, she has always worried about her partner’s status. Despite living in the area experts have called the epicenter of the modern HIV epidemic, where two in three women will contract HIV by the age of 23, Jili has trouble taking a daily medication that nearly guarantees that she won’t contract it. Daily pre-exposure prophylaxis (PrEP) pills prevent HIV from replicating in the body, halting new cases when used correctly. And yet, prevention with this pill is easier said than done. “The problem is the pills,” Jili said. “People ask, ‘You’re so small, why are you taking pills?’ and they think they’re for HIV. We’re not even sick and we’re still taking pills.” Swallowing them makes her nauseous. Beyond that, Jili says cultural norms and stigma leave her feeling ashamed to take them. She’s not alone: Of 600 Umlazi women prescribed daily pre-exposure prophylaxis pills—known as PrEP—in 2018, just 18 were still taking them five months later. Jili wishes she could take PrEP as a shot that would last for a year, or at least several months. That way, she wouldn’t have to think about it every day. She’s used to injections—it’s how she takes birth control, like most South African women who use contraceptives. Soon, she might be able to do just that. Promising new forms of PrEP are coming that would offer protection for months on end, empowering people like Jili to decide what’s right for them. An injectable PrEP called long-acting cabotegravir (CAB-LA) now exists, touting the most successful prevention outcomes ever seen in trials. And it could be coming soon: South Africa is expected to “make a regulatory decision regarding CAB-LA within the next few days,” health authorities told South African health publication Bhekisisa yesterday. If approved and priced affordably, the health department could start a large-scale rollout by August. Other delivery methods like vaginal rings, implants, and long-acting pills are in the works, too. Although there will be battles to make these new medications accessible, they might stand a chance to break the cycle of transmission. A young woman receives a birth control injection in a mobile clinic in rural KwaZulu-Natal, South Africa. Image by Shane Burke. South Africa, 2022. As the city wakes up on a hot summer morning in February at Umlazi’s Mega City shopping mall, Jili and a class of other young women ages 18 to 23 settle into a computer lab, ready to practice their technical skills. Later, they’ll discuss their experiences with HIV prevention. They’re part of the Females Rising through Education, Support and Health (FRESH) program, an initiative run by Harvard, the Massachusetts Institute of Technology, and Massachusetts General Hospital’s Ragon Institute. FRESH aims to empower participants with nine months of career training and health education while performing clinical research. The participants are all HIV-negative but sexually active locals who aren’t employed or attending school. They’re also poor: a substantial risk factor for HIV. Some have children at home. Each is given PrEP, but most won’t take it long-term. Twice weekly before class, nurses will test students for HIV with a finger prick, aiming to catch new cases within the first few days of transmission. This allows clinicians to quickly provide treatment while learning more about the earliest stages of HIV, which might hold clues to developing vaccines and medications. “We wanted to recruit young women at high risk of HIV acquisition, but at the same time do an intervention that benefits them in terms of preventing new HIV infection and changing the socioeconomic factors that make them so vulnerable,” said Dr. Thumbi Ndung’u, a deputy director at Africa Health Research Institute (AHRI). Job opportunities in the region are sparse. South Africa’s youth unemployment rate soared to 67 percent earlier th...