Nabeela Cassim | Confronting the Crisis: SA's battle against rising STIs and HIV

A dual epidemic deeply scars South Africa's public health landscape: the unyielding spread of sexually transmitted infections (STIs) and the pervasive impact of HIV/AIDS. This connection between STIs and HIV is crucial, as STIs can significantly increase the risk of acquiring or transmitting HIV, creating a compound health crisis that requires an integrated approach to management and prevention. The history of HIV in SA is poignant, marked notably by the era of HIV denialism between 1999 and 2008 when a reluctance to accept and act on scientific recommendations delayed the widespread introduction of antiretroviral therapy (ART), claiming a plethora of victims.

However, following intense criticism, South African received one of the world's largest ART programmes, drastically improving access to these lifesaving drugs. As some might say, it's something our nation should be both proud to have but ashamed to need – ideally, such a programme wouldn't be necessary as HIV is preventable. This turnaround helped reduce the incidence of HIV and highlighted the importance of addressing STIs, which are often facilitators of HIV transmission. Today, as the country battles both a high HIV prevalence and rising rates of other STIs, the lessons from the past underscore the critical need for evidence-based public health policies that integrate the treatment and management of HIV and STIs.

The continued crisis of HIV and STIs in SA, despite the availability of treatment, is multifaceted. One significant factor is the phenomenon known as ‘risk compensation’, where individuals adjust their behaviour in response to the perceived level of risk. In the context of HIV and STIs, the availability of effective treatments, such as ART, can lead to complacency among the population. Some may believe that the treatability of HIV reduces the need for preventive measures like condom use, resulting in riskier sexual behaviours.

Additionally, there are systemic issues at play that perpetuate the crisis. The stigma surrounding HIV and STIs still heavily influences individuals' willingness to seek testing and treatment. It can lead to underreporting and late diagnosis, which not only worsens health outcomes but also increases the likelihood of transmission. Moreover, while medication is accessible, there are disparities in healthcare access and quality, particularly affecting rural and underprivileged communities. These groups might have ART available but struggle with consistent supply, adequate healthcare infrastructure, or the necessary education to effectively manage their treatment.

South Africa is trying to tackle the dual threats of HIV and STIs with a comprehensive suite of public health initiatives that smartly integrate education, technology, and enhanced access to medical treatments. Central to these efforts is the robust National Strategic Plan on HIV, TB, and STIs, which orchestrates a nationwide push to reduce new infections. This plan champions the use of Pre-Exposure Prophylaxis (PrEP) and drives public campaigns to encourage safe sexual practices.

In the educational arena, the Integrated School Health Programme is pivotal, providing students with knowledge and healthcare services directly in their learning environments. This initiative ensures that sexual and reproductive health education, along with HIV testing and access to condoms, are part of the school curriculum, empowering the next generation with the information they need for healthy lives.

Digital platforms like MomConnect and B-Wise are also critical, offering targeted health information and services to youngsters and expectant mothers through their mobile devices. MomConnect educates expectant mothers about necessary prenatal care, including crucial information on HIV testing and prevention of mother-to-child transmission. The platform encourages early prenatal visits, increasing the likelihood of early HIV detection and management. B-Wise plays a significant role in HIV and STI prevention by offering accessible, youth-centric health education. It provides comprehensive information about safe sexual practices, the importance of regular STI and HIV testing, and how to access treatment services. Interactive features like quizzes and risk assessments help young individuals understand their personal risk levels and encourage proactive health behaviours.

The ‘She Conquers’ campaign is another significant endeavour, specifically aimed at reducing high rates of HIV infections, teenage pregnancies, and gender-based violence among young women. By focusing on this vulnerable group, the campaign seeks to foster a safer and more equitable society.

Community-based initiatives further extend the reach of healthcare services, ensuring that even those in remote or underserved areas have access to HIV testing and treatment. The widespread availability of ART across communities marks a critical advancement in managing HIV effectively and reducing its transmission.

As SA continues to navigate the complexities of its HIV and STI epidemics, the journey from a past marred by denialism to a present empowered by proactive health initiatives reveals both challenges and triumphs. The nation has learned hard lessons about the consequences of ignoring science, leading to embracing evidence-based strategies that now guide its public health efforts. Integrating advanced treatments like ART with preventative measures such as PrEP and educational campaigns offer hope, highlighting a multifaceted approach that could serve as a model for global health governance. In this ongoing battle, the resilience and adaptability of SA’s public health system are tested but also strengthened, inviting us to ponder: How will SA’s next steps influence global strategies in combating similar public health crises?

*Nabeela Cassim, Clinical Consultant at Insight Health Solutions.