Whether it’s Taking Your ARVs Consistently, Always Having Protection or Being on PrEP; Protect Yourself and Others

The 1^st of December is observed as World AIDS Day and marks the beginning of Dezemba (What South Africans look forward to throughout the year); the festive season living up to its reference, filled with festivities whether at home or while traveling. This care-free season can lead to many releasing their inhibitions and lean more on the careless side of things, which can include some irresponsible sexual encounters.

Here, we will be discussing ways to be prepared in the continuing fight against spreading HIV/AIDS in and out of season. While the stigma around HIV/AIDS is nothing like it used to be in years past, with those who are infected living healthy and long lives if they take their medication as they should and live a healthy lifestyle instead of the images that we used to see of people infected with HIV/AIDS. We are rightfully no longer afraid of the disease, but we should continue to decrease infection rates. This has now been made possible easier by the discovery of PrEP.

Understanding New HIV Prevention Options: Oral PrEP & Lenacapavir (Twice-Yearly PrEP)

What Is PrEP?

• Pre-Exposure Prophylaxis (PrEP) is a preventive medicine for people who are HIV-negative but at risk of infection. It works by stopping HIV from taking hold in the body if exposed through unprotected sex or injection drug use. Adherence is key to note that it only works if taken as it should be – oral PrEP should be taken consistently to ensure full protection.
• When taken correctly, PrEP reduces HIV risk by over 90%.

Oral PrEP (Available now in South Africa)

• The current PrEP option in South Africa is a daily oral pill containing Tenofovir + Emtricitabine.
• It is available free of charge at public health facilities, youth zones, some workplace health programmes, and many pharmacies under national HIV prevention campaigns.
• PrEP should be considered by people who are sexually active, especially those exposed to HIV such as sero-discordant couples (one partner positive, one negative).

Lenacapavir to be taken twice-yearly PrEP, every six months. It has been recommended by WHO but it is not yet available in SA until 2026. Currently, PrEP is offered widely and support adherence.

• Lenacapavir is a long-acting injectable form of PrEP — a new generation prevention option developed by Gilead Sciences.
• It was shown in global trials (PURPOSE 1 & 2) to provide very high protection against HIV, especially for young women in sub-Saharan Africa.

HIV Post-Exposure Prophylaxis (PEP) —South Africa

• What is PEP?

A 28-day course of antiretroviral (ARV) medication taken after a potential HIV exposure to prevent infection. Start as soon as possible—ideally within 24 hours and not later than 72 hours after exposure.

• Who should get PEP?

Anyone HIV-negative (or of unknown status) with a recent potential exposure through sex, blood/body fluids, needle/syringe sharing, or occupational injury (e.g., needlestick).

What To Know

Baseline & follow-up (do not delay first dose whilst awaiting lab results)

• Baseline (Day 0): Rapid HIV test plus 4th-gen ELISA; HBV serology (HBsAb; HBsAg if indicated), HCV Ab (if source high risk/unknown), creatinine if using TDF, pregnancy test where appropriate; STI testing as indicated.
• Follow-up testing: 6 weeks and 3 months—4th-gen HIV ELISA (PCR in children <2 years).
• Provide the entire 28-day supply at first visit to improve completion.
• Daily adherence to all tablets for 28 days; most mild side-effects settle within ~2 weeks (e.g., nausea, headache, diarrhoea, insomnia).
• Secondary prevention (first 3 months): use condoms, avoid blood/tissue donation; consider PrEP if ongoing risk or repeated PEP use.
• Pregnancy & breastfeeding: PEP can be used; manage per adult regimens with obstetric input.
• HBV exposure: TDF + 3TC/FTC in PEP also treats HBV; screen and vaccinate if non-immune (don’t delay HIV PEP while checking status).

Where to access PEP urgently

• Public sector: local clinics, community health centres and hospital emergency departments.
• Sexual assault care: Thuthuzela Care Centres (TCCs) at hospitals provide one-stop medico-legal care including PEP—see list via the SA Government/NPA.
• For advice and referral, contact the National AIDS Helpline: 0800 012 322 or visit your onsite OccuFit clinic and ask to speak to one of our nurses.

The most important thing to remember is U=U. Undetectable equals untransmittable. The stigma around HIV/AIDS is no longer what it was because we are better educated about it, let’s use the same education to stop spreading it by taking every possible preventative measure.

Sources

• Southern African HIV Clinicians Society (SAHCS) PEP Guideline, 2023—adult & paediatric regimens, lab schedule, interactions.
• WHO HIV PEP Guideline, 22 July 2024—timing, 3-drug preference, 28-day supply. (World Health Organization)
• National Dept. of Health (NDoH) PEP Fact Sheet & PEP Guidelines—public messaging, helpline; occupational & non-occupational guidance. (National Department of Health)
• Thuthuzela Care Centres (SA Government/NPA)—access points for sexual-assault care including PEP. (South Africa Government)