MALAIKA MAHLATSI | HIV prevention injection great but I have anxieties about it

Like millions of South Africans, I’m very excited that our country is ready to roll outlenacapavir, the ground-breaking HIV prevention injection. The treatment, which will be launched by President Cyril Ramaphosa this Friday, is recommended by the World Health Organisation (WHO) as a twice-yearly injection for HIV-negative adults and adolescents (weighing at least 35kg) at high risk of acquisition. It will also be used in combination with other antiretroviral (ARV) therapies for heavily treatment-experienced adults who have multi-drug-resistant HIV and for whom existing treatments are ineffective.

Lenacapavir is a crucial intervention in SA, where the number of people living withHIVis the highest in the world at roughly eight-million, translating to an estimated 12% of the population. In addition to this, there are about 170,000 new infections and 53,000 Aid-related deaths every year. These numbers are extremely high and are disturbing when we consider that adolescent girls and young women between the ages of 15 and 24 years are the group most vulnerable to acquiring HIV in SA.

They’re particularly vulnerable due to intimate partner violence, economic dependency and systemic involvement in age-disparate relationships (partners five or more years older), which makes it difficult to negotiate condom use. For this reason, the importance of lenacapavir in our country extends beyond HIV prevention and treatment but also addresses the gendered nature of our country’s burden of disease. And while the lenacapavir injection will initially be given to only 400,000 people, we must remain hopeful that it will eventually reach everyone who needs it.

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Although I’m happy about the rollout of lenacapavir, I also have some anxieties about it. The first is that as things stand, more than one-million South Africans are defaulting on their ARVs, as confirmed by the Treatment Action Campaign (TAC). Gauteng, the most populous province in the country, has an HIV treatment gap of more than 325,000 people, while the number stands at over 110,000 in the Western Cape.

More than 1.1-million people across the country have stopped taking their ARVs and cannot be traced by healthcare workers. More concerning is that a high number of the defaulters are young people, a significant number of whom live in urban areas where there is greater mobility and higher numbers of people to potentially infect. My second concern is that people who are defaulting on their treatment further weaken an already compromised immune system, which makes them susceptible to opportunistic diseases such as herpes simplex virus, TB, cytomegalovirus, bacterial pneumonia, oral and oesophageal candidiasis (thrush) and several others.

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