When Capetonian Ben Brown (31) started to use an HIV prevention pill two years ago, it was because he wanted to "take charge" of his health.
"There's this misunderstanding that we have this ultimate control over our sex life," he says. "But really, there are so many factors outside our control that influence it and that sometimes result in us not using a condom. Or you use a condom and it breaks. I use this pill because I want that control back in my life."
The pill Brown takes is a two-in-one antiretroviral drug called Truvada. Studies have shown that its two ingredients, tenofovir and emtricitabine, can prevent HIV infection in up to 90% of cases if the pill is taken daily at more or less the same time. Some demonstration projects have shown even higher protection rates.
"I take it every night along with my multivitamin tablet. It's become a habit in my life; I don't even think about it," says Brown.
With more than 400 000 new HIV infections occurring in 2012, South Africa has the fastest-growing HIV epidemic in the world, according to the Human Sciences Research Council's 2012 household survey. The survey also found that more than half (52.9%) of the participants said they had never used condoms and that condom use had decreased from 85.2% among young men aged between 15 and 24 in 2008 to 67.5% in 2012.
"There are so many circumstances in people's lives that sometimes prevent them from using condoms — whether they're straight people, gay people, men or women," says Brown. "Maybe you're a lesbian who's been sexually assaulted, maybe you're a gay man who was taken advantage of, or maybe you're a young woman who has an older man — who knows?"
South Africa leads the waySouth Africa became the first African country, and the second in the world, to approve the use of Truvada as an HIV prevention pill in December. Using antiretroviral drugs as a form of HIV prevention is known as pre-exposure prophylaxis or PrEP. Antiretroviral medication is also used to treat HIV-infected people, but a combination of at least three different types of drugs is required.
The United States Food and Drug Administration approved Truvada as PrEP in July 2012 and Kenya, the only other African country to have done so, approved it for use as an HIV prevention measure about a month after South Africa did so.
Brown was tested for HIV over a period of two months before he started to use Truvada. During this period he had to ensure he wasn't exposed to HIV and could therefore not have unprotected sex. This is because there is a window period of between four and eight weeks in which the most common HIV test used in South Africa, known as an antibody test, might not detect the virus. The human body takes up to eight weeks to manufacture HIV antibodies.
"It was really important to ensure that I was HIV negative before taking PrEP. I still get tested once every three months, to monitor that I'm staying negative," says Brown.
Brown's doctor also assessed his risk of getting infected with HIV before prescribing Truvada. A month's supply of the medication costs him about R500, but this could be cut by 50% when a generic version of the drug is used.
Fears about risky behaviour may be unfoundedResearch has shown that medication containing tenofovir and emtricitabine has very few side effects, although kidney dysfunction is a concern. Brown says:
"I've never had any side effects. Most importantly, it makes me feel confident and reassured that I don't have to worry about becoming infected with HIV."
Some in the public health sector are concerned that PrEP might lead to risky sexual behaviour, such as users increasing their number of sexual partners or having more sex without condoms. But PrEP studies have shown that trial participants did not use condoms less than before they started with PrEP, because they were counselled on safer sex practices before taking the pill.
According to Kevin Rebe of the Anova Health Institute in Johannesburg, which is conducting a PrEP demonstration project in South Africa, doctors are expected to counsel their patients on the need for PrEP to be used in combination with other safer sex practices. This includes promoting condom use for protection against sexually transmitted infections other than HIV before prescribing the drug.
Brown says: "My behaviour certainly hasn't changed since before I started taking PrEP. Whether or not I use condoms was always a decision I made with my partner. I think, like everyone [else] in the world, I can't say I was always perfect [about] using condoms. But it's always been something I've done in partnership with the person I was seeing. And that hasn't changed."
Read more from our special AIDS 2016 report.
Taking the HIV prevention pill is about recognising your risk
Why contraception and the HIV prevention pill go hand in hand
PrEP: The dos and don'ts of using an HIV prevention pill safely and effectively
The next wave of HIV prevention progress
ARVs effective as an HIV prevention tool
More than 200 newly qualified doctors may be left with worthless degrees if provinces can't raise funds for internship positions
South Africa is one of just 23 countries globally that supports HIV self-testing. Find out how to take an HIV test at home.
Blood donations are scant in South Sudan as the process is frowned upon and treated with suspicion by locals.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.