On December 1, people around the world unite to show support for those living with HIV, and also to remember those who have lost their lives due to Aids-related illnesses.
The red ribbon has become the universal symbol of HIV awareness, support for and solidarity with people living with HIV. World Aids Day was the first global health day, and the iconic red ribbon led the way for other coloured ribbon awareness campaigns, such as the pink ribbon for breast cancer.
Each World Aids Day has a specific theme, with this year’s being Global solidarity, shared responsibility.
As it has to many other public health issues, the Covid-19 coronavirus pandemic has brought additional challenges to the HIV/Aids programme. Disruption of service delivery at primary healthcare level – including HIV prevention, testing, treatment and care – will undoubtedly haunt us for years to come.
The call to solidarity is made to re-focus efforts to reach the goal of ending the HIV/Aids epidemic by 2030. In the short term, this means restoring and maintaining essential HIV services that were disrupted during the Covid-19 pandemic.
In the medium term, it means intensified efforts to prevent new infections, while awaiting a breakthrough in the development of a vaccine.
Having an HIV-free generation is an attainable goal. It has been proven that when an HIV-infected person’s viral load is undetectable, they cannot transmit the virus via unprotected sex. HIV viral load refers to the amount of HIV in the blood. Antiretroviral treatment suppresses viral replication and, if taken regularly, results in the amount of virus in the blood being undetectable.
The message that undetectable equals untransmittable, or U=U, has given people living with HIV new hope.
Prevent new infections in women
Women living with an undetectable HIV viral load, who fall pregnant, can now be almost certain of not transmitting the illness to their unborn child.
One of the great success stories of the HIV/Aids programme in South Africa is the prevention of mother to child transmission programme. Vertical transmission (meaning from mother to child) of HIV can happen during pregnancy, during labour or after birth via breast-feeding. In 2010, the rate of vertical transmissions was 16%. This decreased to 3% in 2019, but renewed efforts are now being made to eliminate it.
The current South African consolidated antiretroviral treatment guidelines allow access to treatment for all HIV-infected people.
The latest UNAids data revealed that 97% of pregnant HIV-positive women were accessing HIV treatment.
To eliminate vertical transmission, we need to ensure these women attain and maintain full virological suppression, but, more importantly, we need to prevent new infections.
National prevention strategies include public health-education programmes, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and voluntary male medical circumcision.
Education on prevention of HIV includes HIV risk reduction counselling and the correct use of condoms and lubricants.
Despite all these measures, there were 200 000 new infections recorded in South Africa in 2019. With complacency setting in, demonstrated by this rise in new HIV infections, it is critical to continue education and awareness programmes.
PEP is offered to individuals after a high-risk exposure with the potential transmission of HIV, such as after rape or healthcare workers sustaining an injury on duty. Effectiveness of PEP is reliant on early presentation and good adherence. Due to the advances made in antiretroviral treatment, PEP is now also as simple as taking one tablet once a day, with minimal side-effects, improving compliance and outcomes.
PrEP is defined by the World Health Organisation as the use of antiretrovirals by HIV-negative people, who are at substantial risk of acquiring the virus, before potential exposure to HIV, to prevent transmission.
Specific populations considered to be at significant risk of HIV infection include adolescent girls and young women, men who have sex with men, people with more than one sexual partner and sex workers.
South Africa was the first country in sub-Saharan Africa to fully approve PrEP. The preferred regimen is also a fixed-drug combination containing two antiretroviral drugs in a single tablet, taken once daily.
Let’s continue fighting HIV together
Although we have effective preventive strategies and excellent treatment available for people living with HIV, a cure still has to be found. A cure is defined as either sterilising or functional. A sterilising cure would remove HIV from the body altogether. A functional cure means that HIV is not entirely eradicated from the body, but the virus is no longer increasing; thus, treatment is not needed.
So far, two people have been cured of HIV. These patients received bone marrow transplants as part of blood cancer treatment. In both cases, the donor cells were naturally resistant to HIV. The cancer treatment eliminated the HIV-infected cells from the body, and, because the new cells were not susceptible to HIV, the virus was no longer produced. Unfortunately, the first patient, Timothy Ray Brown, passed away this year due to a recurrence of cancer.
A sterilising cure of this nature is not the answer, and, therefore, intensive research is ongoing.
Despite the enormous scientific strides made since the identification of HIV in 1984, it remains a significant public health concern. Globally, millions of lives are still lost every year due to Aids-related illnesses. In South Africa, 72 000 deaths were recorded during 2019. This number is substantially higher than the deaths due to Covid-19 in 2020.
World Aids Day remains as relevant today as always, reminding people and governments that HIV has not gone away. It is a public responsibility to continue to fight the epidemic together.
Van Zyl is a senior lecturer and medical specialist in paediatrics and child health at the University of the Free State