Is injectable HIV medication really a “silver bullet”?

DW (English)

In South Africa, injectable HIV prevention drugs could be a game changer, offering hope and protection to some of the most vulnerable groups. But high costs, accessissbility and effectiveness in women and the LGBTQ+ community remain a concern.

Transcript

00:00Nearly 20% of adults in South Africa live with HIV.

00:05That's among the highest incidence rates in the world.

00:08LGBTQ plus individuals and young women like Vuyokazi Makele are particularly vulnerable.

00:15As a young woman living in South Africa, especially females,

00:19they're not really, really much given the proper education, you know, about health.

00:27Economic inequality also disproportionately affects women,

00:31limiting their access to quality health care.

00:34Many feel pressured into relationships with older men, often without access to protection.

00:39But promising clinical trials exploring injectable HIV medication could be a game changer.

00:46Patients receive injections every two or six months as opposed to taking daily pills.

00:52I'm still young.

00:53It's only old people that will, you know, keep the discipline of always having to remind themselves,

00:58OK, I need to drink black pills, you know.

01:01So, yeah, I'm young. I live my free life. I will forget.

01:06Experts say injectable PrEP eliminates needing to carry or take pills publicly,

01:11reducing the stigma associated with HIV.

01:14PrEP can also be used without a partner's cooperation.

01:18This is particularly important when a woman fears violence from her partner

01:22if she asks them to use a condom.

01:25Researchers like Angela Tembo say these factors could revolutionise HIV prevention.

01:31Their vulnerability is because of their social and economic status in the country.

01:36They have least access to economic benefits because of cultural issues as well.

01:40The girl child is often forgotten in the household.

01:43You find that they make very bad decisions with regards to older partners

01:47and also in terms of their sexual activities where they succumb to condom-less sex

01:52and even in some cases multiple partners as a way to make an income.

01:57In South Africa, clinical trials are underway for long-acting drugs called Lenacapavir and Cabotagravir.

02:05However, there are hurdles to overcome.

02:08While PrEP has been used successfully in homosexual men for several years,

02:12clinical studies have shown a mixed picture regarding the effectiveness of PrEP in women.

02:17It's also not certain how transgender people respond to long-acting HIV medication.

02:23A disproportionately high number of transgender South Africans are HIV positive.

02:28Researchers in Benizintwana feel trans people are being excluded from consideration.

02:34A huge part of our transgender population is poor, is working class,

02:39and I feel like they aren't being accommodated in terms of access to care or healthcare.

02:43Benizintwana's partners are also considering trying injectable medication,

02:47but they want more information first.

02:49Yes, I have heard about the injectables and I thought about them as something

02:53that I would rather get onto as opposed to the pills.

02:57I'm not very educated on the side effects involved with PrEP,

03:00so there's not much awareness I think available to me.

03:03And I lack a person who's going to give me their lived experience

03:07on how PrEP treated them in my community.

03:12Among the unknowns, there's one fact.

03:15Long-acting HIV medication is currently more expensive than daily pills presently on the market.

03:21Getting the drugs to remote communities will also be a challenge.

03:26A realistic timeline to get these injectables at a fair price to people who need it,

03:31I mean it depends on how hard we want to fight and how much we want to lobby and advocate.

03:38Realistically speaking, 10 to 15 years, that's when we'll have access to these things,

03:44if we do it the right way.

03:46While advances in HIV treatment are promising and indeed groundbreaking,

03:51health officials are still wary of calling PrEP and other long-acting drugs the silver bullet.

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