Young people engaging in casual sex are increasingly using pills to protect them from contracting HIV, rather than condoms, which could also prevent sexually transmitted infections.

This is one of the drivers of the increase in sexually transmitted infections (STIs), which the authorities last week warned had infected two in five men who sought medical treatment in Gauteng health facilities last year.

The trend shows that while many were informed about HIV, there is little civic education on STIs, which the provincial health department says have gone up since 2020 in areas such as Alexandra, Sandton, Braamfontein, Ekurhuleni and the West Rand.

Students, who spoke to Sowetan, said a lifestyle of hook-ups and casual sex is common in Braamfontein and condom usage is inconsistent.

Alinah Miya, 21, a university student in Braamfontein, said the usage of Pre-Exposure Prophylaxis (PrEP), an antiretroviral drug prescribed for HIV-negative people to prevent them from becoming infected with HIV, was common. 

“One does not plan to have unprotected sex, it often just happens but there is always PrEP that can curb the stress. I know what STIs are but they are not going to kill me like HIV,” said Miya.

Neo Malatjie, 20, another student, said the last time she was taught about sex education and STIs was in Life Orientation in high school.

“You don’t see any posters or pamphlets, anything like that in the streets. We mostly hear about HIV and the dangers of it and what you should take. We learn these things from the clinic when we get PrEP or PEP but never much attention is put on STIs,” said Malatjie.  

At least 50,293 people were put on this medication in Gauteng between April and November last year, indicating a heavy reliance on PrEP and PEP being used as a form of contraceptive. 

The Hillbrow Clinic has seen an increase uptake of PrEP medication being dispensed to 745 young people monthly. 

“They also request termination of pregnancy, which clearly indicates that they are practising unprotected sex and are less concerned about STIs. The youth accessing services at Hillbrow Community Health Centre is more concerned about acquiring HIV and pregnancy more than STIs,” said Johannesburg Health District spokesperson Sandile Gwayi. 

The department said  67,400 males were treated for male urethritis syndrome (MUS) last year while 66,377 pregnant women tested positive for syphilis. Gonorrhoea and chlamydia are the primary drivers of MUS.

The department said their studies have shown that STIs were high among young women receiving PrEP.

Portia, 24, a sex worker in Hillbrow, tested positive for chlamydia, herpes and gonorrhoea on separate occasions in her line of work. Prostitutes become prone to STIs because of burst condoms, rape and clients who offer to pay more money to have sex without condoms.

She said there is a general reliance on PrEP among them and sometimes free condoms aren’t available. 

Gwayi said the older generation was more concerned about risks associated with unprotected sex as compared to the new generation. 

At the height of the HIV pandemic in the late 1990, the government began strong safe sex campaign that included billboards, radio and TV adverts and pumped money in youth and peer-to-peer NGOs like LoveLife. They also introduced health ambassadors who would do door-to-door safe sex education education in townships and rural areas. 

Malatjie, a student, said the last time she saw health ambassadors was when she was in primary school more than a decade ago. 

“Nowadays you only find mobile clinics and they don’t really do anything besides testing or want dispensing,” said Malatjie. 

Thandiwe Nketsi, 42, a mineworker in Merafong, west of Joburg, said today's generation is growing faster and exposed to information which makes them less fearful of HIV compared to her generation where HIV was associated with instant death.   

“The world is now a lot freer and this has led to recklessness. Our kids are more prone towards these sexual activities and the government doesn’t spread the right information anymore. They only focus on HIV and PrEP,” said Nketsi.  

She said poverty in Merafong has driven a lot of young girls into the arms of mine workers who give them money for sex.

“You have grown men who admit to wanting to have sex with children without condoms because it’s better, even when they know they are ill, especially considering most men will never admit to being sick until they die,” said Nketsi. 

Sylvia Mzayiya, 25, a mineworker, said the community relied on mobile clinics for primary health services and minimal education on safe sex.  

“They just test for HIV but not the other infections. Long ago, we used to have people from the health department who would go to each home asking about how many people have STIs, diabetes or HIV in the family with pamphlets, but now there’s nothing,” said Mzayiya. 

Mzayiya said drugs and taverns were a breeding grounds for STIs and HIV.

“People seem to be too cool for condoms. They only think HIV can kill and only think about the PrEP as a safety net,” said Mzayiya.  

Khanyisa Mapipa from Section27 said sex education messaging has decline over the years and that HIV and STI messaging works hand in hand with other interventions that curb HIV and STI transmissions.

“We view the problem as a multifaceted one that also includes HIV testing and STI screening, HIV and STI treatment, the distribution of condoms, PEP, PrEP and a focus on mother to child transmission and HIV counselling as core interventions. While messaging is important, without proper implementation of these core interventions, HIV and STI infections will remain high,” said Mapipa. 

She said another component that is contributing to HIV and STI infections is a shortage of condoms available at healthcare facilities.