By Sitha Maliwa:
HIV remains one of South Africa’s most urgent public health challenges, and its burden
continues to fall unevenly across society. Women – particularly adolescent girls and
young women – remain at the centre of the epidemic, accounting for a disproportionate
number of new infections. As the country marks World AIDS Day this month, public
health leaders are intensifying calls for an equitable, human-centred and prevention-
focused response to turn the tide.
Jessica Bates, Dis-Chem Integrated Health Executive, says World AIDS Day is both a
moment of reflection and a challenge to confront lingering inequality. “Not everyone
experiences the epidemic equally, and it’s crucial that we interrogate the underlying
factors that put women at increased risk and take action to shift this trajectory,” she
says.
While South Africa has recorded important gains at the national level, the realities faced by
many women reveal systemic shortfalls. Structural inequality, deep-rooted social norms
and persistent gaps in the health system continue to restrict access to prevention tools
and comprehensive care. Women also face a unique set of compounding risks, including
biological vulnerability, age-disparate relationships, gender-based violence, economic
dependence, stigma, and limited awareness or access to life-saving prevention options
such as Pre-Exposure Prophylaxis (PrEP).
For Bates, the response must go beyond statistics and policy. “We need to move from a
narrative rooted in fear and stigma to one grounded in empowerment and access,” she
says. “Women deserve healthcare that reflects their realities – whether in clinics,
communities, or in their day-to-day interactions with the health system. By strengthening
person-centred, tech-enabled, and nurse-led models of care, we can meaningfully
expand prevention options and reshape the future of HIV for women in South Africa.”
PrEP is one of the most promising tools in HIV prevention, capable of reducing the risk
of infection by up to 99% when taken correctly. Yet its uptake among women remains
alarmingly low. Many women are unaware of the medication, find it difficult to access, or
encounter social and cultural barriers that prevent consistent use.
National figures reflect both progress and persisting gaps. By February 2024, over 1.4
Million people had initiated PrEP at more than 4,000 public health facilities across the
country. While this marks a significant step forward, health experts argue that the
numbers still fall short of what is needed to protect women before they are exposed to
risk.
Advocates say a transformed HIV response must be accessible, proactive and
integrated into everyday healthcare. Prevention needs to become a routine part of
maternal and child health services, supported by expanded community-based and
nurse-led care. Affordability, acceptability and convenience are essential if prevention
tools are to reach women who need them most.
As South Africa reflects on its HIV journey this World AIDS Day, a central truth remains:
Women did not choose the inequality that fuels their vulnerability. But with inclusive,
affordable and accessible healthcare, the trajectory of the epidemic can change. For
millions of women and girls, the promise of a safer, healthier future depends on what the
country does next. – @NewsSA_Online
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