New treatments offer new hope to South Africans

With South Africa’s HIV prevalence currently estimated at 12.7%, major strides continue to be made to tackle the epidemic. Significant developments in treatment, preventive measures, and public education have been instrumental in supporting the 8.45 million people living with HIV and preventing transmission.

While the rollout of highly active antiretroviral therapy (HAART) has transformed HIV from a fatal illness into a largely manageable condition, Dr Fulufhelo Tshivhula, Obstetrician and Gynaecologist at Mediclinic Limpopo, notes that challenges remain – particularly for expectant mothers. “With access to free antiretroviral therapy for anyone testing positive, millions of South Africans can now lead healthier lives. However, HIV remains our leading cause of maternal mortality.”

For pregnant women, early detection and HAART are critical in managing HIV, reducing maternal death rates, and preventing mother-to-child transmission. “Ensuring that HIV-positive mothers receive HAART from the outset. Although progress has been made, we still face barriers that prevent many women from accessing these services early on.”

These barriers include late presentation to healthcare, limited resources, and in some cases, fear of stigma, which discourages disclosure of their HIV status. “Many individuals still fear being labelled as promiscuous if they disclose their status, which has serious implications for their access to healthcare and psychological well-being,” says Dr Tshivhula. “Education is crucial. We need to embed comprehensive HIV education in all platforms, from schools to community programmes, to shift these perceptions and encourage an informed, supportive approach.”

Progress in preventive measures
A groundbreaking development in HIV prevention is the introduction of a six-monthly injection, lenacapavir, which is currently undergoing review by the South African Health Products Regulatory Authority (SAHPRA) for potential approval. Lenacapavir, a long-acting injectable, has demonstrated high efficacy in recent trials, with a 100% protection rate for HIV-negative women between the ages of 16 and 25.

The bi-annual schedule addresses the challenges associated with daily oral pre-exposure prophylaxis (PrEP), making prevention more accessible to high-risk groups, including young women who often face barriers to consistent medication adherence​

“An injection twice a year could revolutionise HIV prevention,” Dr Tshivhula notes. “For individuals unable to commit to daily pills, lenacapavir offers an alternative that could help reduce infection rates significantly. If approved, it will be an essential addition to South Africa’s HIV prevention toolkit, particularly for those who are most vulnerable to infection.”

In addition to treatments like HAART and the promising lenacapavir injectable, research into a comprehensive HIV vaccine continues to advance. While vaccines are in early stages, Dr Tshivhula says that their development represents a proactive global approach to eradicating HIV/AIDS. “The progress in vaccine research offers hope that we may one day eliminate HIV transmission entirely. But until then, we continue to rely on treatments and preventive measures that have transformed the health landscape for millions.”

Reflecting on whether enough is being done to educate South Africans about HIV and other sexually transmitted diseases, Dr Tshivhula concludes: “It will never be enough until we reach a stage of zero rate extension. As South Africa observes World AIDS Day in the coming weeks, it is both a celebration of progress and a reminder of the commitment needed to end the epidemic once and for all.”