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With the adop­tion of the test and treat pol­icy – where a per­son is put on treat­ment im­me­di­ately af­ter test­ing pos­i­tive, ir­re­spec­tive of their CD4 count – the num­ber of peo­ple on ARVs is ex­pected to mul­ti­ply. “In South Africa, we have to fo­cus on treat­ment and preven­tion. If we fo­cus on our pre-ex­po­sure pro­phy­laxis [PrEP] to pre­vent in­fec­tion in key pop­u­la­tions, in­clud­ing young women, we could have a greater ef­fect [on HIV preven­tion],” said Bekker. “We must in­crease our fo­cus on preven­tion in young women be­cause of their abil­ity to trans­mit to oth­ers.” Last year, the Cen­tre for the Aids Pro­gramme of Re­search in SA re­leased a study that showed how HIV moves from an older woman to an older man, who then in­fects a young girl. The girl grows up, be­comes a young woman and then starts dat­ing men her age, whom she then in­fects. Bekker was re­fer­ring to this cy­cle when she said young women’s abil­ity to trans­mit to oth­ers was con­cern­ing. “Oral PrEP is part of the preven­tion op­tion to­day ... and is ready for de­ploy­ment. The ben­e­fit of PrEP lies in avoid­ing 260 000 in­fec­tions among young South Africans. This out­weighs the risks,” Bekker said. South Africa ap­proved the use of PrEP last year in cer­tain high-risk pop­u­la­tions, in­clud­ing among sex work­ers and men who have sex with men. Cur­rently, 1 300 peo­ple are tak­ing PrEP in 17 pi­lot sites coun­try­wide. Sci­en­tists and pol­i­cy­mak­ers said that, while PrEP of­fered an ef­fec­tive way of pre­vent­ing HIV in­fec­tion in South Africa, it was not a magic bul­let. Sev­eral vac­cine tri­als are tak­ing place world­wide and South Africa is one of the coun­tries at the fore­front of this re­search.

Cur­rently, two tri­als – the vac­cine ef­fi­cacy trial known as HVTN 702 and the AMP study – are un­der way.

Pro­fes­sor Penny Moore, the re­search chair of VirusHost Dy­nam­ics at the Univer­sity of the Wit­wa­ter­srand and the Na­tional In­sti­tute for Com­mu­ni­ca­ble Dis­eases, said the AMP study – which seeks to find out if cloning broadly neu­tral­is­ing an­ti­bod­ies can pre­vent HIV in­fec­tion – was cur­rently en­rolling vol­un­teers.

Sci­en­tists work­ing on the AMP study plan to re­cruit 4 200 peo­ple, of which 1 500 will be women liv­ing in sub-Sa­ha­ran Africa at high risk of ac­quir­ing HIV.

Pro­fes­sor Thumbi Ndung’u, re­search group leader at the Africa Health Re­search In­sti­tute, said South Africa, like the rest of the world, needed a cure for HIV, but find­ing one would not be easy. He cited the evolv­ing na­ture of the HI virus and its abil­ity to hide as the big­gest ob­sta­cles to flush­ing HIV out of the hu­man sys­tem.

He men­tioned sev­eral meth­ods tried over the years, with­out suc­cess. These in­cluded stem cell trans­plants, done to elim­i­nate HIV from pa­tients’ im­mune sys­tems. The so-called func­tional cure was also tried on HIV­pos­i­tive peo­ple – this refers to stop­ping HIV treat­ment and al­low­ing the body to nat­u­rally con­trol the virus.

Ndung’u said even the stem cell trans­plant, which had worked for Ti­mothy Brown – the first per­son to be cured of HIV – was not vi­able “be­cause it was ex­pen­sive and could not be in­tro­duced on a large scale”. In 2006, Brown found out he had leukaemia. He re­ceived two stem cell trans­plants to treat his cancer and re­build his im­mune sys­tem – in the process, killing off his HIV.

TALK TO US What do you think should be done to help SA’s youth re­main free of HIV?

SMS us on 35697 us­ing the key­word AIDS and tell us what you think. Please in­clude your name and prov­ince. SMSes cost R1.50 Source: HSRC

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