HIV in South Africa – the imperative for women initiated prevention technologies

On the occasion of Solidays, the European Music Festival against HIV, Quarraisha Abdool Karim, 2016 Laureate of the L'Oréal-UNESCO For Women in Science Awards, presents her research which has fought the spread of HIV. Through a clear and valuable overview of the situation in South Africa, Professor Abdool Karim reminds us that everyone has a role to play.

HIV/AIDS is a major global public health challenge and is one of the top 10 causes of deaths globally. South Africa bears a disproportionate 18% global burden of HIV infection despite being home to less than 1% of the global population. The South African epidemic is described as a generalized, hyper-endemic epidemic where despite a high HIV prevalence it continues to experience high rates of new HIV infections. It is estimated that there are about 6 million people living with HIV in South Africa and each day there continues to be about 1000 new infections. The evolving epidemic in South Africa has been monitored since 1990 through annual, anonymous surveys in pregnant women utilizing the public sector health services for antenatal-care. These antenatal data, validated by less frequently conducted population based surveys reveal that the South African HIV epidemic is made up of a diversity of epidemics within and between the nine provinces while the overall prevalence has remained stable at about 30% in the past 8 years. The province of KwaZulu-Natal on the east coast is most severely affected with four of its eleven districts having an HIV prevalence >40% and the remaining 7 districts have an HIV prevalence between 30% -40%. In contrast the HIV prevalence on the west coast of South Africa has an HIV prevalence <5%. Population based data undertaken since 1990 have highlighted that women have a 3-4 higher burden of HIV infection compared to males and women acquire HIV infection about 5-7 years earlier than men. Adolescent girls and young women between the ages of 15-24 years have up to 6 fold more HIV infection compared to their male peers.


Available HIV prevention options also referred to as the “ABCCs” or safer sex practices that include Abstinence, Be faithful, use of male and female Condoms, medical male Circumcision are all dependent on male co-operation. For women unable to negotiate safer sex practices with their male partner there are no options available. Microbicides are chemical that women can insert into their genital tract that could potentially prevent HIV infection. Since the early 1990s about 11 microbicide trials have been conducted with a variety of products but none have been able to demonstrate protection. In 2003, a team at the newly established Centre for the AIDS Programme of Research in South Africa conceptualized and developed a study to evaluate the use of an anti-retroviral agent, Tenofovir as a topical microbicide. The overall goal of CAPRISA is to undertake locally important and globally research in HIV prevention and treatment. Prevention of HIV infection in young women is the highest priority at CAPRISA and includes advancing understanding of transmission dynamics, why HIV infection rates are so high despite low coital frequency and evaluating strategies to prevent HIV in young women. This research is undertaken by large multi-disciplinary teams of scientists and in close partnership with the most affected communities.


The CAPRISA 004 study demonstrated for the first time in 2010 that tenofovir gel used by HIV uninfected people reduced HIV infection rates by 39% and by 54% in women who used the gel consistently. Further, tenofovir gel prevented genital herpes (HSV-2) infection by 51%. These data signalled new hope in the HIV prevention field on the role of pre-exposure prophylaxis (PrEP) and specifically for women initiated technologies. The study received international acclaim and was ranked among the top 10 scientific breakthroughs in 2010 by the journal Science.


In September 2015, the World Health Organization (WHO) released guidelines for the provision of daily tenofovir containing tablets as part of combination prevention for all populations at high risk of acquiring HIV infection. Research on women initiated technologies is ongoing and includes evaluation of new and more potent drugs and less user dependent formulations that are slow release and longer acting by ourselves and other research teams. 


The potential for a wide array of women initiated technologies giving women choice for remaining HIV uninfected is growing as a first step for reducing their risk. Structural, social and behavioural factors that render women more vulnerable to HIV will need to be addressed to bridge gender disparity gaps in the longer term.   

L’Oréal–UNESCO
For Women in Science

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