Perceived Efficacy of HIV Treatment-as-Prevention Among University Students in Johannesburg, South Africa

Ten years ago, the medical community received conclusive results demonstrating that antiretroviral therapy (ART) is effective at preventing the sexual transmission of HIV. ART has traditionally been used to manage HIV symptoms in people living with the virus, but the strategy of treating HIV-positive individuals with ART to prevent transmission—a strategy known as treatment-as-prevention (TasP)—has been slow to disseminate to the public. Information about TasP as a highly-effective tool for epidemic control has been especially slow to diffuse in Sub-Saharan Africa, a region that experiences the world’s highest rates of HIV positivity.

While evidence from South Africa, Zambia and Uganda suggest low familiarity with TasP in rural areas, information may have diffused faster in urban areas among young adults and those with access to secondary school HIV education and university health services. In a new journal article published in the journal Sexually Transmitted Infections, Human Capital Initiative Core Faculty Member Jacob Bor, Nozipho Musakwa, Dorina Onoya and Denise Evans assessed beliefs about TasP among first-year university students in Johannesburg, South Africa, who would have all received HIV education throughout their primary and secondary schooling.

Main findings:

• Respondents believed HIV transmission to be much more likely than reported in the scientific literature. On average, respondents perceived a 78.3 percent likelihood of transmission after one condom-less sex act in a mixed-HIV status couple, and an 87.9 percent likelihood of transmission after 52 sex acts, compared with objective risks of 0.3 percent and 14.5 percent.
• Participants perceived lower risk of transmission when the HIV-infected partner was on virally suppressive ART; however, their perceptions of risk remained high. The average perceived risk of transmission was 65.1 percent in one sex act and 73.1 percent in 52 sex acts when the HIV-positive partner was on ART and virally suppressed. The objective risk in these scenarios is zero, or very close to zero.

The gap between participants’ beliefs about TasP and the scientific consensus on the strategy demonstrates that young adults in South Africa remain largely unaware of the TasP benefits. Overestimating HIV transmission while using TasP may contribute to greater HIV stigma and lower testing rates, while addressing knowledge gaps regarding the prevention benefits of ART could encourage greater HIV testing and care-seeking among vulnerable populations. In particular, educational institutions have significant and valuable opportunities to provide accurate information to young adults about the benefits and limitations of TasP and to reduce stigma associated with HIV treatment.