On-campus HIV treatment has become a norm at many institutions across the country, but as the rest of SA takes action Gauteng engages in talks
An accidental needle-stick injury suffered in February 2019 by fifth-year Wits medical student Thembi Mojapelo* exposed the fact that adequate treatment for HIV exposure at university facilities is often not immediately available.
Mojapelo frantically searched for instant access to post-exposure prophylaxis (PEP), a pill taken after possible exposure to HIV. She felt more comfortable going to her university clinic, but the Wits Campus Health and Wellness Centre (CHWC) could only give her an older PEP treatment with known severe side effects, a treatment that has long since been replaced.
To make matters worse, the 23-year-old was only given three days’ worth of the emergency treatment, knowing that an effective prescription is required to last four weeks.
“They couldn’t give me the whole treatment package I needed for PEP and they gave me an old one … where you have to drink six pills a day. I also couldn’t do follow-ups at CHWC because they didn’t cover the blood tests, they only did a rapid HIV test,” Mojapelo told Wits Vuvuzela.
“Basically, it was useless for me. I had to get a script from them to buy my own PEP from the pharmacy. I think it’s just a very poor system in terms of HIV treatment and management.”
Sister Ludo Dube from CHWC said that Combivir, the PEP treatment the student is talking about, is a dual-drug starter pack which involves taking one pill twice a day for three days.
“Her information is not true … She might not have gotten the correct instructions and took all six pills at once. I’ve never known about us having to follow such a protocol here … We cannot afford the [fixed dosage] treatment. Remember, we buy these treatments; it is not like it is subsidised. The fixed dose where they take one a day is very costly (R800 for one treatment).”
Prevalence
Avert, a global HIV and Aids charity, reports that South Africa is home to the biggest HIV epidemic in the world, with an estimated 7.7 million people living with the virus in 2018. An undetermined number of these people are university students, a demographic often targeted in the HIV and Aids education. However, when it comes to a student taking preventative measures or being diagnosed as HIV-positive, convenient and comfortable access to antiretroviral drugs (ARVs), PEP and pre-exposure prophylaxis (PrEP) remains an issue.
The only statistics reflecting HIV prevalence among students come from an outdated 2008/2009 Higher Education and Training HIV/Aids study that found 3.4% of students at public universities in SA to be HIV-positive, with students in Gauteng showing an HIV prevalence of 2.2%.
Despite ARVs being distributed at service points around the country since 2004, a 2019 study carried out by the Institute for Health Metrics and Evaluation said 34% of HIV-positive people in east and southern Africa have yet to receive treatment.
Delay
University clinics across the country, such as at the University of Zululand, have started catering to students’ HIV needs to combat these statistics, but the Gauteng Department of Health (DoH) has failed to implement such programmes itself. The DoH is still in talks with universities in Gauteng that have met the requirements but have yet to receive accreditation to dispense the treatment and preventative medication on site.
The University of Johannesburg (UJ) is closest to receiving the DoH accreditation which, after a two-year wait, could be verified by the end of September this year. Sister Rainny Nkatho, head of the UJ Institutional Office for HIV and Aids, revealed that the DoH has confirmed their clinic as suitable to provide antiretroviral treatment (ART), “but [they] have yet to accredit the facility. It is frustrating to both nursing staff and students as the delays are taking too long,” she said.
This laborious process is not unique to UJ. All Gauteng universities pushing to offer ARVs and PrEP on site are subjected to this waiting period.
Sister Maggie Moloi, head of CHWC, told Wits Vuvuzela that before universities can introduce this programme as part of their health services and receive accreditation, they must roll out appropriate training of staff.
“This is a process, and with new staff who have taken office at the DoH we do not know how long it will take,” she said.
Thembinkosi Ngwenya, Wits HIV testing counsellor, said providing treatment on campus will prevent HIV-positive students from defaulting on an almost R900-a-month ARV treatment. Ngwenya said the main reasons students do not stick to their prescribed ARV treatments stem from discrimination and lack of accessibility.
“Some students are scared to be seen at their nearest clinic or local areas where they would access medication. It’s also never easy to take pills; some people are not used to it. That’s why we need to be there to encourage them,” he said.
Operating on a small budget from the university, the CHWC has engaged with the DoH, which Ngwenya says is willing to provide them with ARVs, PrEP and PEP medication.
“Soon enough we will be able to give [medication] to the students,” he said.
A necessity
Zenzele Phakathi, a second-year Wits BSc computer science student who found out he was HIV-positive after testing at CHWC, said it was not easy for him to accept his status.
“But HIV professionals at Wits advised me and now I’m just fine and taking medication as prescribed. But universities should give ARVs to students like us.”
The CHWC sees an average of 60 students and staff members every month who use the facility for HIV testing. With so many people concerned about their status it is crucial to have a post-test programme in place, especially if patients test positive.
Students who, like Mojapelo and Phakathi, spend most of their time at university need to have the peace of mind that they can receive immediate treatment at their university facilities.
Mojapelo, who had to find a different health centre and pay for the PEP treatment herself, described her experience, saying “CHWC referred me to a hospital but you need a letter from your clinic (CHWC) to refer you, otherwise you have a lot of issues at the hospital.
“If I wake up today and I’m scared, and I want to get tested or receive treatment, then I should be able to without waiting an entire week (or being referred somewhere else) where I have space to change my mind.”
The lack of accessibility to on-site HIV treatment for university students runs the risk of these students not being able to fulfil their studies to the best of their abilities. Living with HIV is a burden that should be made lighter by the same institutions that instil stringent sex and HIV education. In saying that, the same funds and energy applied to preventative education should be applied to preventative and post-infection treatment.
*Name has been changed
FEATURED IMAGE: HIV testing equipment used by the CHWC to test students free of charge. Photo: Gemma Gatticchi
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