HIV remains one of South Africa’s most urgent public health challenges, yet its impact is not evenly experienced. Women, particularly adolescent girls and young women, continue to carry a disproportionate share of new infections. As the world marks World AIDS Day this month, the call for a more equitable human-centred, and prevention-focused HIV response grows ever stronger.
Jessica Bates, Dis-Chem Integrated Health Executive, says the day is a reminder of progress, but also of the stark disparities that persist. “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. Bates emphasises the need for a fundamental shift in how prevention is approached.
Despite advances at national level, structural inequalities, entrenched social norms, and gaps in the health system continue to limit women’s access to prevention tools and comprehensive care. Biological vulnerability, age-disparate relationships, gender-based violence, economic dependence, stigma, and limited awareness or availability of prevention options such as Pre-Exposure Prophylaxis (PrEP) all compound women’s risk.
“We need to move from a narrative rooted in fear and stigma to one grounded in empowerment and access,” Bates 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.”
Although PrEP is highly effective—reducing HIV acquisition by up to 99% when used consistently—uptake among women remains low. Many are unaware of it, struggle to access it, or face social barriers that hinder ongoing use. National data shows that over 1.4 million people in South Africa had initiated PrEP across more than 4,000 public health sites by February 2024. While this represents significant progress, it still falls short of the potential to protect more women before they are exposed to risk.
A transformed HIV response must prioritise accessible, proactive, and integrated care. This includes embedding prevention into routine maternal and child health visits, expanding community-based and nurse-led care models, and ensuring that prevention tools are affordable, acceptable, and easy to access.
As conversations around HIV continue to evolve, one truth remains: women in South Africa did not choose the inequality that increases their risk. But with inclusive, affordable, and accessible healthcare, meaningful change is within reach.