The HIV community has a vision: zero new HIV infections, zero discrimination and zero AIDS-related deaths. But how do we get there while HIV continues to devastate the globe? By the time you have finished reading this article (let’s say it takes 10 minutes), 25 people around the world would have become newly infected with the virus, three of those being in South Africa. During that same time, 12 people would have died from HIV, one of them in South Africa.

South Africa is of course one of the hardest-hit countries in the world. An estimated 7.6 million South Africans were living with HIV in 2022: this means one in every eight people in the general population and almost one in five people between the ages of 15 and 49 years. It is sobering to consider that our country is home to 20% of the global population living with the virus.

South African women continue to be disproportionately affected. In 2022, women aged 15 years and older made up 63% of people living with HIV and 67% of new infections. The disparity is even more pronounced in women of child-bearing age (15 – 49 years), who have double the prevalence rate of men (23.5% versus 12.1%). Among adolescent girls and young women (15 – 24 years) the picture is even more dire: they are 2.5 times more likely to be living with HIV than their male counterparts (8.7% versus 3.6%), and three times as likely to become infected.

Fortunately, 40 years into the epidemic, we have the knowledge and tools to get to zero. But, for this to work, we have a shared responsibility: to know our HIV status. We are all answerable to ourselves, our partner(s), and our community. If positive, we need to start and stay on antiretroviral therapy. If negative, we need to start and stay on pre-exposure prophylaxis (PrEP) while at risk. 

The transformation of treatment

Antiretroviral treatment has undergone a massive transformation in the past five years. Gone are the days of taking a handful of pills a couple of times a day. Gone is the fear of stigmatising side effects that could give one’s status away. The state-of-the-art treatment available in South Africa today is one tablet taken once daily. It is exceptionally well tolerated and effective. It is able to suppress the amount of virus circulating in the blood to below detectable limits in the vast majority of people. This is called an “undetectable viral load”.

Undetectable = zero transmission

An undetectable viral load means that a person is not able to transmit the virus to a sexual partner. This brings immense relief to people living with HIV and their partners. We need to motivate everyone living with the virus to be on treatment and ensure that their viral load remains undetectable. This will not only keep them healthy and enable the possibility of living a normal life, but also prevent the infection from being passed to their loved ones.

One tablet a day can definitely keep the doctor away!

The prevention revolution

While there is still no effective HIV vaccine, the prevention field has exploded with a number of new modalities that are now available in the country. Apart from male and female condoms, syringe exchange programmes and voluntary male circumcision, PrEP is available in the form of a daily tablet that can be taken by men and women alike. Taken correctly, it is 99% effective. For those struggling to take tablets, there is the dapivirine vaginal ring, which is self-inserted and replaced every month, as well as a two-monthly injection of the new cabotegravir agent.

On the horizon is a six-monthly injection that could potentially be self-administered twice a year, an implant that lasts for a full year, as well as a pill that combines oral contraceptives with PrEP. 

We need global solidarity to ensure all people receive the knowledge and means to protect themselves from HIV. We should be united in our vision. No one should be left behind. PrEP should be accessible, affordable and sustainable, everywhere. 

How do we get to zero? It starts with all of us. It starts with knowing your status. It starts with caring for yourself and those around you. It starts with standing together and sharing the responsibility to get to zero.

Professor Theresa Rossouw is a professor in the Department of Immunology at the University of Pretoria. World Aids Day is commemorated on 1 December annually.

Disclaimer: The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.