Women remain disproportionately affected by HIV in South Africa, with adolescent girls and young women facing persistent gaps in prevention and treatment.
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Despite significant progress in combating the HIV epidemic in South Africa, women continue to bear a disproportionate burden of the virus. Recent data reveals that of the 7.8 million people living with HIV in the country, more than half are women. While national strategies are making strides in treatment and viral suppression, experts warn that critical gaps remain.
These insights were shared during the National Health Laboratory Service (NHLS) public webinar under the theme “Women’s Health: Our Challenges. Our Science. Our Future”, yesterday.
Last week, Treasury presented figures at a meeting of the special parliamentary committee overseeing the budget. It revealed that in KwaZulu-Natal, which has the highest number of people taking antiretroviral drugs, the number has decreased by almost 100 000. The Department of Health had planned to provide treatment to 1.67 million people, but only 1.57 million people received the treatment. In Gauteng, the Department of Health planned to provide treatment to 1.49 million people, but only 1.29 million people collected the drugs.
National Institute for Communicable Diseases (NICD) Centre for HIV and STIs head Dr Leigh Berrie said that current statistics for South Africa show that 7.8 million people are living with HIV, a 12.3% prevalence. Of those, more than half, 5.1 million, are women who are living with HIV, a prevalence of 15.7%.
“The latest statistics show that in the past year there have been 139 521 new infections in the total population in South Africa. And of those, again, more than half were new infections in women, 85 958. There is a great burden imposed on women in South Africa in terms of HIV,” Berrie said.
“For people living with HIV who are on antiretroviral treatment in South Africa, there are a total of 6.1 million, and of those 4.2 million are women living with HIV.”
The UNAIDS 2030 95-95-95 strategy aims to end the HIV epidemic by 2030 through three targets: 95% of people living with HIV know their status, 95% of those diagnosed are on antiretroviral treatment, and 95% of those on treatment achieve viral suppression at less than 1 000 copies per ml.
Berrie explained that in South Africa, the cascade is 96% of people living with HIV know their status, 82% of those are on treatment, and 97% of those have reached viral suppression.
“The cascade follows a similar pattern: 97% know their status, 84% are on treatment, and 97% are virally suppressed,” Berrie said about women.
However, she said a challenge exists in younger age groups, specifically adolescent girls and young women.
“All in all, there is a heavy burden imposed by the epidemic on adolescent girls and young women, and they are considered to be at substantial risk of HIV infection,” Berrie said.
She explained that there is still a large amount of stigma associated with HIV. There is also a lack of awareness, education and counselling. There is also a low uptake of prevention services to prevent transmission of HIV. Specifically for pregnant women, there is low attendance at antenatal care clinics. Then, for pregnant and breastfeeding women, a low uptake of viral load testing in women living with HIV to maintain viral suppression.
Dr Nokukhanya Msomi, Department of Virology head, NHLS/University of KwaZulu-Natal, said that for women living with HIV, the burden of human papillomavirus (HPV) infection is amplified. Evidence shows that women living with HIV have a sixfold higher risk of cervical cancer than in the case where there is no HIV.
“The gaps that we have in finding women early enough to provide care are that traditionally there has been low coverage of women getting routine screening through what is commonly known as the pap smear. We have seen this has been a bigger problem in rural areas,” Msomi said.
“We also have missed our opportunities in leveraging our good HIV treatment programmes or care programmes by not actively screening women with HPV at the point of HIV diagnosis. This has resulted in women with HIV and HPV not being linked to care early enough and also resulting in poor follow-up. This is a problem that we are actively correcting.”
