Imagine if every person who passed the matric National Senior Certificate last year was infected with HIV? Well, that’s close to the number of South Africans infected in 2012 alone – some 469 000 people.

Yet South Africans have pushed safe sex practices out of the window in much the same way that Ugandans and gays in San Francisco did once they felt HIV was under control.

Like South Africa, these communities witnessed high death rates from AIDS – yet it wasn’t enough to make them permanently change their sexual behaviour.

Once the risk seemed under control, it was condomless sex as usual.

The National HIV Prevalence, Incidence and Behaviour Survey for 2012, released this week by the Human Sciences Research Council (HSRC), reports a 2% overall increase in HIV infection in the past four years – and plummeting condom use, increases in multiple sex partners and more boys having sex before they turn 15.

HIV prevention is only working is among young people aged 15 to 24, where HIV infection has dropped from 10% in 2005 to 7,1%.

[quote float=”left”]”We seem to have dropped our guard about HIV because we either believe HIV to be a distant threat or because we no longer fear infection because we know it can be easily treated.”

Many of these young people are exposed to safe sex message in schools, as there is precious little other national HIV prevention messaging.

HIV prevention is also working among HIV-positive mothers and their babies, but because antiretrovirals prevent HIV-positive mothers from passing the virus on to their babies – this intervention does not need the women to change their sexual behaviour.

We seem to have dropped our guard about HIV because we either believe HIV to be a distant threat or because we no longer fear infection because we know it can be easily treated.

Far and wide, South Africans have faith in our energetic health minister and believe that HIV is “under control.” In fact, three-quarters of the 38 000 people interviewed in the survey did not think that they were at risk of HIV!

At the survey’s launch, Health Minister Aaron Motsoaledi also noted that people knew that HIV could be controlled by one pill a day, perhaps making infection less scary.

“There is always the risk that if you lower the stigma of HIV, you lower the concern,” added Science and Technology Minister Derek Hanekom at the launch.

Perhaps the sex has also been taken out of HIV. After all, doctors are referring to it as chronic disease just like diabetes and hypertension.

We’ve taken the sex out of HIV

But HIV is not like other chronic diseases. It is primarily sexually transmitted, and if people are to avoid infection they need to practice safe sex.

Yet amid the hype about treatment, the link between HIV and sex seems to be getting lost. We know about ARVs and how to take them – yet only about 27% of people interviewed knew how HIV was transmitted.

Yet about 6,4-million people are now infected with HIV – including 36% of women aged 30 to 34 and 28,8% of men aged 35 to 39.

We cannot sustain a treatment programme that is growing by almost half-a-million new HIV infections a year.

We have to turn off the infection tap, not increase the size of the treatment bucket.

One pill a day doesn’t solve everything

As Wits University’s Professor Francois Venter points out, for every three people newly infected, only two people are getting ARV treatment.

Given the failure of HIV prevention efforts to curb new infections, some scientists say it is time to consider the biomedical solution – putting every HIV-positive person on ARVs. People on ARVs with undetectable viral loads are virtually non-infectious.

The HSRC’s Thomas Rehle says there is no longer a debate internationally about whether “treatment as prevention” can work – but rather how to implement it.

But this would be a massive, costly exercise – and in the meantime the humble condom remains a powerful weapon against HIV.

But sadly national campaigns to promote condoms also seem to have been subsumed by the hype over HIV treatment.

Condom use amongst young men between 15 and 24 – traditionally the highest users – has plunged almost 20 % (from 85% in 2008 to 67,5% in 2012).

Motsoaledi has promised coloured, flavoured, “nice-smelling” condoms to replace the government-issue Choice condoms that “were no longer cool.”

But these won’t be attractive unless people accept that they are still at great risk of HIV and act responsibly.

In addition, perhaps we have been too glib about the ease with which HIV can be treated. Taking ARVs every day for the rest of your life comes with a myriad of its own problems – including side effects and drug resistance.

Prevention is always better than treatment – especially in the face of no apparent cure. – Health-e News Service.