RENEE MONTAGNE, HOST:
And in South Africa, a technique used to block the transmission of HIV in gay men and sex workers is now being tried on sexually active teens. Healthy teens not infected with the virus are going on daily regimens of anti-AIDS drugs. NPR's Jason Beaubien reports from Johannesburg.
JASON BEAUBIEN, BYLINE: Eighteen-year-old Catherine Msimango lives in the sprawling township of Soweto on the western side of Johannesburg. She's in the 11th grade in high school. Her family, as she puts it, is not rich. Her father is self-employed. He fixes cars to make money. Msimango is afraid of HIV.
CATHERINE MSIMANGO: Some of my sisters have passed away from HIV - yeah, some of my brothers. So yeah, I know the experience of HIV. I don't want to get there, yeah.
BEAUBIEN: Having seen her siblings die from the disease, she wants to make sure she never gets it, so she's joined a pilot program in which HIV-negative teens like her take anti-retroviral drugs, just like someone who's HIV-positive would take.
MSIMANGO: Its a pack of pills - 30 pills inside. So you take one each and every day. You choose your time. I chose 8 p.m., so I take it every day at 8 p.m., yeah.
BEAUBIEN: Msimango lives in the heart of the HIV epidemic. South Africa has nearly 7 million people living with HIV, which is more than any other country in the world. And nearly 20 percent of all adults here are infected with the virus. The HIV rates are lower for adolescents, but increase rapidly as teens move into their 20s. Msimango says the pills give her power against HIV.
MSIMANGO: If they take the pill when my boyfriend doesn't know, it's all in my safety because I don't know what he does when I'm not around him. So, like, I'm doing it for my own safety. So if I take the pill and use protection - if he doesn't want us to use protection, then I know that I'm safe from the pill.
BEAUBIEN: Earlier studies have shown that taking daily doses of anti-retroviral drugs do offer an extremely high level of protection against HIV. If taken correctly and consistently, it's nearly 100 percent effective in blocking transmission of the virus. Researchers call the technique pre-exposure prophylaxis, or PrEP. Those earlier studies were primarily with gay men. Msimango is part of an ongoing pilot program in Soweto and Cape Town to see how well PrEP works with 150 teenagers.
LINDA-GAIL BEKKER: We did find that adolescents needed - well, certainly not all - but a number of them needed a little bit of hand-holding through that initial phase.
BEAUBIEN: Linda-Gail Bekker is the deputy director of the Desmond Tutu HIV Centre at the University of Cape Town. Bekker says they have counselors available at any time to answer the teens' questions or concerns about taking the drugs. They also set up a system of daily alerts, sent by text message, to remind the teenagers to take their pills. Bekker is extremely optimistic about PrEP as a new HIV prevention tool. And the reality is, she adds, prevention messages based primarily on trying to get people to use condoms haven't stopped the spread of HIV.
BEKKER: Thirty years into this epidemic, it's clear that condoms are not the solution for everyone.
BEAUBIEN: Globally, new HIV infections have essentially plateaued over the last five years. The number of additional people getting HIV is stuck at roughly 2 million each year. Bekker says PrEP is something a young woman can use discretely to try to keep herself from joining those statistics. Sabelo Sekhukhuni is one of the counselors helping to run the PrEP program in Soweto. He says the pressure on teenage girls in impoverished parts of South Africa to have sex is huge.
SABELO SEKHUKHUNI: When you look at an informal settlement where there isn't electricity, sex is a sport. Sex is an activity to keep themselves busy.
BEAUBIEN: And he says sex is also used as currency. Girls who have no money can be offered cell phones or new clothes by older men who want to sleep with them. Sekhukhuni says, even just behind the hospital where the PrEP study is being conducted, there's a settlement of shacks where the people don't have electricity.
SEKHUKHUNI: So there's this one guy who owns a tavern. He has a generator. And he makes people pay five rand to charge their cell phones, mobile phones.
BEAUBIEN: But the tavern owner offers to charge the girls' phones for free in exchange for sex, and some of the girls accept his offer. In these types of relationships, the tavern owner holds a lot of power in the community. He's got the generator. The man may be HIV-positive, and Sekhukhuni says he may insist the girls have sex with him without condoms.
SEKHUKHUNI: The same girls that sleep with this guy, they'll go back to their peers and sleep with the boys of the same age group, meaning it's still going to spread some more.
BEAUBIEN: But Sekhukhuni says this is the beauty of PrEP. In these complex, messy, real-world sexual networks, PrEP may be able to protect these teenagers from the lifelong burden of HIV. Jason Beaubien, NPR News, Johannesburg.
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