Older men sleeping with young women a concern for HIV spread: doctor

Young women engaging in unsafe sex with older men is still a major factor in the spread of HIV/Aids, says an expert on health systems.

Dr Ernest Darkoh from BroadReach was reflecting on the lessons learnt and best practices in dealing with the rate of infection of HIV/Aids as they celebrate the 20-year anniversary of the PEPFAR Community Grants Programme.

“We are concerned about the people we have not yet found and put on treatment. It’s difficult to get people into the system, especially young people: women in particular who could have been recently infected. Young women are disproportionately affected because older men sleep with them.    

“They are not sick yet, they wouldn’t necessarily be motivated to test though they usually have no negotiating power in these types of relationships.

“When the HIV/Aids epidemic started we could see our loved ones dying at a rapid pace and the graves were pilling up, it was in your face. So people knew to condomise and test regularly, but when the treatment started working and prolonging lives they stopped being afraid. People wore masks during the pandemic because we would see our loved ones dying, but once there’s immunity people stopped paying attention. There’s no pressure for them to take the disease seriously and that’s of concern. 

“This is real life, people should still be scared of Aids. Most young people are more scared of falling pregnant than getting HIV/Aids,” said Darkoh.

The other group he is concerned about is men who sleep with men, people who engage in commercial sex and industries such as trucking.

“These people are vulnerable to judgment and often experience potential negative repercussions. There is still a lot of stigma with the way this group chooses to live its life and in some countries their sexual orientation is criminalised. Naturally, they wouldn’t come forward,” he said.

In 2013, the UNAids Programme Co-ordinating Board called on UNAids to support country and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015. They came up with a three-part target called Triple 90, aimed at having 90% of people living with HIV knowing their status, 90% of people diagnosed with HIV receiving sustained antiretroviral therapy and 90% of people receiving antiretroviral therapy having viral suppression by 2020.

The goal was that with this target at least 73% of people living with HIV worldwide would be virally suppressed. However, this was not achieved - and infections have actually increased.

“We also have a group that was taking the treatment but hit 'treatment fatigue'. Patients get tired, their life circumstances get in the way, like if they need to take three taxis to get to the healthcare centre for the medication, or other factors,” said Darkoh.

He said in KwaZulu-Natal, the Ugu district municipality made up of four local municipalities — Umdoni, uMzumbe, Ray Nkonyeni, and Umuziwabantu — has fallen back after being the first municipality to reach the target of 80% of the 90:90:90 in South Africa.

“After the Covid-19 pandemic, the floods, and the July unrest, we have seen a decline in the number of patients on the system. And HIV/Aids is not the only disease the healthcare system is dealing with, so the burden keeps growing,” he said.

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