Youth and HIV in South Africa: living and thriving with HIV

Complex inequalities have shaped the trajectory of the HIV epidemic in South Africa. These include factors related to gender disempowerment, poverty, family disruption and violence all of which have intensified the risk of HIV infection among the majority of South Africans, contributing to one of the most severe country-level HIV epidemics globally. Neo-liberal economic policies adopted in the post-apartheid period failed to address poverty and burgeoning urban migration both of which were key factors exacerbating vulnerability to HIV. While there was, ostensibly, a strong commitment to addressing the HIV epidemic by the post-apartheid government, HIV prevalence among pregnant women quadrupled from 7.6% in 1994 to 30.2% in 2005. Contributing to this rise, was a series of missteps by the national Department of Health in the late 1990s, which constrained HIV prevention efforts and stifled HIV treatment. The mid-2000s saw a reprioritisation of the response to the epidemic, with international guidelines supported by biomedical and social research underpinning a rights- and evidence-based response. Multisectoral HIV prevention activities were complemented by high levels of investment in implementing prevention of mother to child HIV transmission and expanding access to antiretroviral therapy (ART) for HIV through the public sector. While these efforts contributed to stabilising the epidemic, stark inequalities in vulnerability and susceptibility to HIV infection continued in particular, among youth. In this chapter, we draw on a review of the research literature to describe concerns and explore opportunities for a response.