Declining Condom Use Hits Record Low in South Africa, Threatening Hard-Won Gains in HIV Fight Amid Funding Woes

South Africa’s ongoing battle against HIV has hit a worrying snag, with condom use dropping to its “lowest ever” levels. This decline comes at a time when the country is making strides in treatment but facing fresh hurdles from funding cuts and the lingering scars of the Covid-19 pandemic. Speaking ahead of World AIDS Day 2025, South African National AIDS Council (Sanac) CEO Dr Thembisile Xulu sounded the alarm, calling for a big push on prevention to protect the 52 million South Africans who remain HIV-negative. With about 8 million people living with HIV, experts warn that without urgent action, these gains could slip away.
The warning highlights a broader concern: while antiretroviral therapy (ARV) coverage has grown, with 6.2 million on treatment, new infections are still too high. Deputy President Paul Mashatile has urged all sectors to join forces in tackling the spread, stressing the need for teamwork across government, communities, and partners. As the nation marks World AIDS Day, the focus is on reigniting conversations about HIV, which many feel has faded from public talk.
Current HIV Landscape in South Africa
Latest figures from the Thembisa Project model, updated in March 2025, paint a mixed picture. Around 8 million South Africans are living with HIV, down slightly from past years, but the virus remains a major health challenge. The model shows new infections have fallen from 211,955 in 2017 to 157,676 more recently, with the incidence rate dropping overall. This progress varies by province, with KwaZulu-Natal seeing the biggest drop at 73% between 2010 and 2024.
The national HIV prevalence has eased from 14% in 2017 to 12.7% in 2022, according to surveys. Yet, with over 8 million affected, South Africa still has one of the world’s largest HIV burdens. Of those living with the virus, viral suppression—where the virus is undetectable and untransmittable—stands at about 63%, a key win in curbing spread. Projections from Thembisa extend to 2100, warning that without steady efforts, the epidemic could linger far longer than hoped.
Among youth, a “no-condom trend” is raising red flags, with many young people ditching protection despite high risks. This shift is part of why Xulu says people are asking, “Is HIV still a thing?” The silence around the topic is letting complacency creep in, undoing years of awareness campaigns.
Factors Behind the Decline in Condom Use
Xulu pointed out that condom use has “subsided to its lowest ever,” a trend linked to fading fear of HIV and less talk about safe sex. Stigma plays a big role too, making it tough for people to seek testing or stick to treatment. “People are no longer talking about it. Let’s normalise the conversation around HIV,” she urged.
Other factors include shifting behaviours, like more multiple partnerships without protection. Surveys show university students rely on testing and biomedical tools, but consistent condom use is slipping. In some groups, like men attending voluntary medical male circumcision (VMMC) services, awareness of options like pre-exposure prophylaxis (PrEP) is growing, but not fast enough to offset the drop in condoms.
Severe Impact of US Funding Cuts on HIV Programmes
Recent cuts to US funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) have dealt a heavy blow. In February 2025, funding was pulled, leading to job losses for staff and community workers who help bring people back to care. “The situation around the funding in February didn’t help because funding was pulled off. We lost some staff members, some community members that were funded to make sure we bring people back onto care, back onto treatment,” Xulu explained.
South Africa received $453 million from PEPFAR in 2024, with $439 million planned for 2025, but this was suspended amid political tensions. The cuts threaten 39 research sites, halting work on HIV vaccines, long-acting PrEP, and tuberculosis (TB) studies. Globally, these slashes could lead to 3.3 million new HIV infections by 2030, with sub-Saharan Africa hit hardest.
In South Africa, the abrupt withdrawal, plus a 16% drop in Global Fund allocations, has closed clinics and cut services like testing and outreach. Projections warn of 78% higher incidence and 85,000 extra infections by 2030 if cuts continue, plus 25,000 more deaths. Across countries like Ethiopia, Kenya, and South Africa, up to 74,000 additional HIV deaths could occur. These gaps disrupt community support, making it harder to link people to care and fight stigma.
Lingering Effects of Covid-19 on HIV Treatment
The Covid-19 pandemic’s shadow still looms large over HIV efforts. Lockdowns disrupted access, with many interrupting ARVs, and re-engaging them remains a struggle. “She added that the effects of the Covid-19 pandemic continue to be felt, as many HIV-positive individuals interrupted their treatment regimens, creating an ongoing struggle to re-engage them in care,” noted Xulu (though the provided text says Xaba, it’s likely a typo for Xulu).
In groups like men who have sex with men (MSM), treatment outcomes dipped during lockdowns in provinces like Gauteng and KwaZulu-Natal. Globally, the pandemic hit every stage of the HIV care continuum, from prevention to viral suppression. In South Africa, new ARV starts fell, especially among adults, and services like testing slowed.
Despite this, some positives emerged: differentiated service models, like multi-month dispensing, helped maintain coverage during tough times. But the ripple effects include higher risks for co-infections like TB, worsening the dual burden.
Key Prevention Strategies to Turn the Tide
Xulu stressed a multi-pronged approach: “For the people on treatment stay on treatment and their viral load becomes undetectable then they will not be able to transmit and we will be on the way towards a win, but we need to maintain funding and strategies for prevention.”
Core tools include condoms, PrEP—which cuts transmission by up to 99% when taken daily—and VMMC, proven cost-effective for men aged 15-24. Guidelines recommend combining these with partner testing and post-exposure prophylaxis (PEP). PrEP persistence is improving in integrated health sites, but awareness varies, with some men in VMMC programmes showing willingness but needing more info.
Collaborative efforts focus on reducing partners, boosting testing, and behaviour change. “If every South African is tested, knows their status, and if you test negative, you either get on pre-exposure prophylaxis (PrEP), use condoms, or get circumcised as a man. If you test positive, you start your treatment,” Xulu said.
Path Forward: Securing Funding and Sparking Change
“If we miss the mark on funding and we get it right even just in terms of prevention and make sure we push social behaviour change, we will be able to keep those 52-million South Africans that are negative. That is a win,” Xulu emphasised.
To reach 2030 targets, South Africa needs steady funding and innovation, like long-acting PrEP, now stalled by cuts. Sanac’s annual report calls for bridging gaps to hit 95-95-95 goals: 95% knowing status, on treatment, and suppressed. With tools like Thembisa guiding policy, the focus is on provinces with slower progress.

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Declining Condom Use

Declining Condom Use Hits Record Low in South Africa, Threatening Hard-Won Gains in HIV Fight Amid Funding Woes

Declining Condom Use Hits Record Low in South Africa, Threatening Hard-Won Gains in HIV Fight Amid Funding Woes

centralnewsza #news #politics #ngwathe #feziledabi #freestate

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