Stopping your car at this Philippi intersection is equivalent to taking a risk. Being robbed at gunpoint is a classic in this sea of prefabricated houses and mountains of garbage, considered the crime capital of South Africa. In this focus of urban poverty, racial segregation is total and it is also an area with a high incidence of AIDS, in the country with the largest number of HIV-positive people in the world. But a pilot health project is also underway here, which could change the lives of thousands of Africans, especially women and girls often forced to have unprotected sex.
Inside three caravans lined up in a parking lot and guarded by plainclothes police, science advances in Philippi. In these cubicles, a pilot project has been launched to administer CAB-LA, injectable pre-exposure prophylaxis (PrEP), free of charge to anyone who requests it. PrEP for HIV is a preventive treatment that prevents infection and contains antiretroviral medications, which are like those used to treat people who carry the virus and protect the cells of the immune system from infection. Anyone between 15 and 29 years old can receive it. It is simple and above all more discreet than going to a health center, where you can meet someone you know.
Andisiwe is 26 years old, she came to the mobile clinic today and waits her turn next to the entrance stairs. “I used the medication, but I’m going to switch to the injection because sometimes I forget to take it.” She assures that she has opted for prevention because “we don’t trust our partners. “I want to protect myself.”
“We have thousands of young women becoming infected every week,” reports Linda-Gail Bekker, head of the Desmond Tutu Center for HIV at the University of Cape Town. Bekker adds that “gender violence is a determining factor in infections. Many find themselves in violent relationships in which they cannot decide how to have safe sex and in which consent is a privilege that they cannot access,” she says.
In South Africa there are almost eight million people with HIV, of which two million are not receiving treatment. Mozambique and Nigeria are the other two countries that top the list of the most affected African countries. Of the nearly 39 million infected worldwide, 20 of them live in Africa.
Discretion is the key to the success of CAB-LA, (short for long-acting cabotegravir), whose effect lasts two months. Taking a pill means remembering to take it daily, but also finding a place to hide it from your parents or partner. “The injection is not seen anywhere. Your partner doesn’t see anything,” explains Buisisine Lento, a health worker who today works in the mobile clinics of the South African Desmond Tutu foundation installed in the Philippi parking lot. “We see that the injection is having very good acceptance and word is spreading among friends,” she adds.
We don’t trust our partners. I want to protect myself
Prevention program user
This method is especially effective in societies such as South Africa. Anne Githuku-Shongwe, UNAIDS regional director for Eastern and Southern Africa, explains that in the northern hemisphere, people who use preventive treatments are mainly men who have relationships with other men or other risk groups such as sex workers, but that in some regions of the African continent, the situation is very different. 63% of new infections in this area of Africa are in girls and women. The situation is even more serious in the age group between 15 and 19 years, where 77% of those infected are girls.
“Often they are girls who do not have sex on a regular basis. Maybe the school semester starts and they need a new uniform or buy pads and have to resort to transactional sex, in exchange for money. This is a structural inequality that greatly complicates prevention,” explains Githuku-Shongwe via videoconference. She also gives an example of how the situation is worsening with increasingly recurring droughts. Families have nothing to eat and girls become a tool to get food. “Girls do not have the ability to negotiate whether the man puts on the condom or not,” says the expert.
Philippi’s is one of the 10 pilot projects deployed in the country. Others have been launched in Zambia, Zimbabwe and Malawi, part of a US plan to fight AIDS, but they are currently specific initiatives. CAB-LA are taking time to reach the regions most affected by HIV, as happened with the rest of the treatments against this disease in the past. The reason is mainly economic.
“At the moment it is unaffordable for most African countries, but we need it to help control the epidemic in this part of the world. In South Africa we have never managed to control the infection,” explains Bekker. This scientist, who is a reference in the sector, considers that CAB-LA is an innovation similar to that of antiretrovirals, which began costing 20,000 dollars per person (18,500 euros) and today cost 70 (65 euros).
Lost lives
It took many years and many lives lost for the prices of antiretrovirals to drop. Now, experts are calling for the price of these other treatments to also be reduced so that women have access to different options other than condoms. Three Indian companies are working on the manufacture of generics, but in the absence of the necessary infrastructure, it may still take a couple of years to be able to supply injectables, according to experts.
In neighborhoods like Philippi, not only is the risk of becoming infected higher, but it is also increasingly difficult for the population to access services. Having easy access to treatments is the main demand of users, according to surveys. The goal is to take the treatments to the streets, where the people are. For this reason, in South Africa they have launched initiatives to bring prophylaxis to hairdressers, taverns and even schools. “We want to show that the more access points there are, the more people use them,” concludes Bekker.
In Philippi’s vans, users can also be tested for AIDS and other sexually transmitted diseases, as well as obtain contraceptives. In 90 minutes they have the test results. They go to buy something at the shopping center on the other side of the parking lot and come back to get their result.
Githuku-Shongwe believes that for thousands of girls like Philippi’s, projects like the CAB-LA are very effective, but they still represent a drop in the ocean. “It is clear that to end AIDS we must end inequalities. “HIV continues to be an indicator of gender inequality.”
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