Eight of the 10 sites where between 3 000 and 5 000 HIV-negative sex workers will get an antiretroviral pill that prevents HIV infection will be ready to do so in June, according to the health department's deputy director general of HIV, Yogan Pillay.
The 2013-2014 South African Health Monitoring Survey with Female Sex Workers, which was conducted among about 2 000 sex workers in Johannesburg, Cape Town and Durban, found that about 72% of women surveyed were HIV infected.
Research has shown that an HIV prevention pill, which contains two antiretroviral drugs, tenofovir and emtricitabine, can prevent HIV infection about 90% of the time if taken daily. This intervention is called pre-exposure prophylaxis, or PrEP.
Pillay says the three population groups — sex workers, men who have sex with men, and young women — with the highest HIV infection rates in South Africa are being prioritised to be provided with the pill.
The Medicines Control Council approved a branded drug, Truvada, for this purpose in December, but the health department plans to use a generic version of the drug which will soon be available.
PrEP demonstration projectsAccording to Pillay, men who have sex with men will be the next group that receives an HIV prevention pill at selected sites in the public health sector. A demonstration project, run by the Anova Health Institute, is currently providing PrEP to about 150 men who have sex with men in Cape Town and will scale up to a further 150 in Johannesburg soon.
The Human Science Research Council's 2014 household survey found that young women between the ages of 15 and 24 are four times more likely than men in the same age group to be infected with HIV. This group also accounts for a quarter of new infections in the country.
Pillay says demonstration projects among young women will be completed in two to three years and health workers at state clinics will receive special training to be sensitive to, and not judgmental about, young women who request the pill.
According to Rebe young women are the largest group who could benefit from PrEP, but it will be the hardest one to reach. "If we market PrEP as, 'if you are high risk, promiscuous, not using condoms and having dirty sex, then PrEP's for you', then no young woman is going to want to take this up because it will associate them with very negative behaviour," Rebe says.
"What we have to do is frame this intervention as something that responsible people will do. These are people who are able to say, 'right, you know what, I am sexually active, I'm smart about it. I recognise my risk'."
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