AIDS Healthcare Foundation calls for urgent action to combat rising STIs in South Africa

The AIDS Healthcare Foundation (AHF) South Africa has sounded the alarm over the escalating crisis of sexually transmitted infections (STIs) plaguing the nation.

With alarming figures indicating millions of new STI cases each year - 4.5 million gonorrhoea, 5.8 million chlamydia, and over 70 000 syphilis cases in 2017, as estimated by the World Health Organization (WHO) - the AHF says that immediate and robust action is needed.

The incidence of congenital syphilis is also surging, now standing at 198 per 100 000 live births, marking a public health emergency that requires a multifaceted response.

Dr Nombuso Madonsela, Country Programme Director for AHF South Africa, highlighted the glaring gap in existing prevention strategies.

“While biomedical advancements like Lenacapavir, a groundbreaking injectable PrEP offering near-perfect HIV prevention efficacy, are indeed transformative, they do not shield individuals from STIs,” she cautioned. “Without comprehensive education, we risk declining condom use and escalating STI rates, as observed in earlier PrEP rollouts.”

The prevalent misconceptions surrounding PrEP - many patients mistakenly believe it provides complete protection - underscore the urgent need for a renewed focus on condom use, which remains the cornerstone of STI prevention.

AHF, which provides of HIV/AIDS prevention, testing, and treatment services, warns that a heavy reliance on biomedical solutions, devoid of robust grassroots education, could exacerbate the current crisis. There is a pressing need for community-based sexual health literacy programmes designed to resonate with diverse populations, it said. AHF’s vision includes youth-led workshops in urban areas, where peer educators can debunk myths about STIs and promote the use of condoms as vital, empowering tools for sexual health.

Similarly, in rural regions like KwaZulu-Natal, community health workers are set to deliver culturally relevant messages that link untreated STIs to severe repercussions, including infertility and neonatal deaths. These initiatives are built on the foundations of trust and relatability, aiming to make safer sex practices not only accessible but also appealing.

Equally important is the establishment of robust health data systems. AHF’s National Medical Director, Dr. Logandran Naidoo, expressed the pressing need for comprehensive surveillance systems that provide regularly updated aetiology-specific data relating to STI incidence and prevalence. Current public health strategies often rely on scientific studies, which are limited in scope and frequency, leaving gaps in understanding important aetiological trends.AHF advocates for a review of STI diagnosis guidelines to better track aetiological patterns, particularly targeting populations most vulnerable - like young women in transactional relationships or cases of undetected congenital syphilis - that require immediate intervention.

The social determinants influencing STI prevalence demand urgent exploration. Factors such as poverty-driven transactional sex, stigma faced by sex workers, and judgemental attitudes in health services for adolescents serve as significant barriers to adopting safer practices. AHF, which supports Health Department clinics and services nationwide, insists on conducting research that elevates community voices to inform policies designed to empower, not marginalise. By addressing these root causes - through economic empowerment initiatives and stigma-reducing programmes - South Africa stands a chance to dismantle the systemic vulnerabilities exacerbating the STI crisis.

Dr. Naidoo said behavioural risk factors and structural vulnerabilities within key populations significantly contribute to the transmission dynamics of STIs. These interconnected epidemics, often manifesting as syndemics - mutually reinforcing disease burdens - underscore the need for integrated diagnostic and management strategies essential to eliminating these public health threats. Currently, dual HIV-syphilis testing focuses primarily on pregnant women and there is a strong call from AHF to extend this testing to other high-risk populations to enhance STI detection.

An integrated diagnostic approach is crucial for the early identification and treatment of STIs, ultimately saving lives and alleviating long-term health burdens.

“Combination prevention is not about choosing between condoms and injections; it’s about equipping communities with the knowledge and tools necessary for comprehensive protection,” said Dr Madonsela.

AHF advocates for affordable access to innovations like Lenacapavir through generic production, alongside investments in education, data systems, and transformative social reforms. It is only through adopting a holistic approach to STI programmes that South Africa can pave a path towards healthier communities, it said.