1 December is World Aids Day – and certainly a time for us as South Africans to ask ourselves some tough questions.

Well, two questions, mainly.

– Does the availability and effectiveness of antiretroviral medication (ARVs) make young people born between 1995 and 2005 (GEN-Z) feel that HIV/AIDS is no longer a real threat to them?
– With widespread access to treatment and information, why, then, is Generation Z not AIDS-free?

Let’s start with some quick stats on HIV/AIDS in South Africa, as published by UNAIDS in 2021.
7.5 million people with HIV
18.3% adult HIV prevalence
210,000 new HIV infections
51,000 AIDS-related deaths
5.5 million people on antiretroviral treatment

With these stats in mind, let’s look at the first question on Gen Z and ARVs. In 2010, the UN tells us, 25% of people with HIV/AIDS were on ARVs – by 2022, that percentage had risen to 75%, which shows a massive increase. AIDS-related deaths in 2010 were 150,000, and by 2021, that had gone down to 45,000 – an enormous decrease.

Young people see HIV-positive people on ARVs leading a normal life, and this has made the threat seem less real. “Before, the impact of the virus was horrible, and there was no cure. There still isn’t, but now people see those on ARVs living a healthy and long life,” says Asanda Cele (21), originally from Durban and now studying Medical Bioscience at the University of the Western Cape. “I have a relative who is HIV-positive and on ARVs, and from what I can see, she seems OK,” says Asanda. “She recently had a baby, and the only problem was that she couldn’t breastfeed it for fear of passing on the HIV.”

But here’s the worrying thing – in Southern Africa as a whole, while the numbers of total infections have gone down among the populations of the various countries, between 38% – 63% of the new infections in women were in the age group of 15 – 24 years. So the GEN Z women now make out the biggest group at risk for new infections.

Why are young people still having unprotected sex? “I think because they think it is more pleasurable to have sex without using a condom,” says Asanda. While that is certainly part of the truth, the reality is also that many women in that age group experience gender-based violence and are sexually exploited. Many young women don’t feel they are able to insist on condom use, and they struggle to uphold their human rights in a society where they are often discriminated against.

“I also think gender-based violence and rape play a huge role in the transmission of HIV,” says Asanda. “And sometimes women don’t even know they have been infected – sometimes by their partners.”
But even considering the high incidence of GBV and the inequality between the sexes in our society, it still doesn’t entirely explain why such high numbers of people – and especially young women – are still dying from a disease that can, in many cases, be treated and prevented. “People shouldn’t see the spread of HIV as normal,” says Asanda. “While the stigma associated with being HIV-positive is difficult to live with, I think it is good that people should fear contracting this disease. I don’t think the incidence of HIV/AIDS is going down in my generation, and it shouldn’t be like that with all the information that is out there.”

So what can be done? “I think it is time for people to be confronted with the cold, hard truth about AIDS because people do not realise anymore how difficult this can make your life,” says Asanda. “It’s about so much more than the stigma.”

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