While groundbreaking HIV prevention drugs like Lenacapavir promise to transform South Africa’s fight against the pandemic, treatment adherence remains the critical battleground that could determine success or failure.
In the lead up to International Aids Day on 1 December, Dr Odwa Mazwai, managing director of Universal Care, lauded Government’s commitment to provide HIV the prevention drug from 2026. This according to him is a major step for South Africa, which has over eight million people with HIV and remains the global pandemic’s epicentre.
“As a nation, we all share the responsibility to ensure that existing efforts to prevent the further spread of HIV do not decline in the wake of this positive news. Rather, we must strengthen our approach to increase support for accessing care and taking medication correctly, both at home and in the workplace,” says Mazwai.
He notes that while access to antiretroviral therapy (ART) has expanded significantly, consistent adherence to ART is essential to achieving viral suppression, preventing drug resistance, and ultimately, reducing HIV transmission.
This is the only way to maintain an undetectable viral load, which means the virus cannot be transmitted to others.
He says various challenges face people living with HIV in taking their medication routinely and as prescribed.
“This is the only way to maintain an undetectable viral load, which means the virus cannot be transmitted to others. Medication adherence is crucial for maintaining health, but can be affected by factors such as complex dosing schedules and a lack of social support.”
Irregular medication use, he says is dangerous for people with HIV because it increases the risk of treatment failure, opportunistic infections, and the emergence of drug-resistant HIV strains. This, in turn, places additional strain on the healthcare system and impedes national efforts to end AIDS by 2030.
“In the journey to zero, every dose counts and every moment matters.”
Workplace support vital
Mazwai encourages employers to provide proactive workplace support by creating stigma-free cultures, training management on confidential health handling, allowing flexibility for check-ups, and providing private medication spaces.
“Adherence is collective responsibility for public health. Companies must reassess policies to support HIV-positive employees, identify gaps, and ensure nobody falls through the cracks.”
Three main HIV approaches exist: ARVs (ART) – ongoing treatment for HIV-positive people to reduce viral load and prevent illness and transmission. PrEP – ongoing prevention for HIV-negative people at continued risk, like those with HIV-positive partners. PEP – short-term emergency treatment for HIV-negative people after recent possible exposure through unprotected sex, assault, or healthcare incidents.
Mazwai says enormous progress has been made in HIV treatment and prevention, particularly in preventative medicine. “The world has advanced beyond promoting condom use alone, though it remains important.”
Living longer with HIV
With effective treatment and early diagnosis, more people with HIV are living to an older age than ever before, according to pharmacist Vukona Baloyi of Medipost, which dispenses and delivers chronic medications to support better treatment adherence nationwide.
“You can and will live a healthy and normal life with HIV for as long as you stick to your treatment. The life expectancy of someone living with HIV who is taking ART has increased substantially over the past 25 years and is now predicted to be similar to the average life expectancy of someone who is HIV negative,” she says.
If you do test positive, the first thing to remember is that you have the right to your privacy.
She points out that testing regularly is key to early detection, which allows people living with HIV to start ART immediately, which can significantly reduce the virus multiplication in their body to undetectable levels and help prevent transmission.
“If you do test positive, the first thing to remember is that you have the right to your privacy, and no one else will know of your condition unless you decide to share this information. Secondly, we understand HIV so much better, and the medication available has improved to such a degree that if you are diagnosed early, adhere to your treatment and have your regular checkups, HIV is a highly manageable chronic condition,” she says.
“If a person does not know that they are living with HIV, the virus keeps growing in their body. Without treatment, over time, HIV infection progresses to AIDS, and from there on, the average survival is tragically only about three years. Early diagnosis and treatment are therefore essential for preserving life and increasing life expectancy.”
Millions living normal life
Baloyi says regular check-ups monitor response and update medication as needed. “High CD4 counts and undetectable viral loads significantly increase life expectancy. Maintaining current levels is more important than past counts.”
She advises patients to seek early treatment for new symptoms. “Illnesses developing before or after diagnosis can become serious with weakened immunity. Consult practitioners early for unusual symptoms like swelling or rashes, and screen for heart disease, liver disease, and cancers, as these often affect life expectancy more than HIV.
“Prevention remains priority through knowing status, safe sex, condoms, and faithfulness. There are millions of people living with HIV who live completely normal lives. We are fortunate to live in a time and a country where HIV treatment is readily available. We all have an interest in knowing our scludes.
