Reckless hook-ups, pills instead of condoms: Why sexually transmitted infections are rising in Gauteng

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 (STIs).

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

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

Students said a lifestyle of hook-ups and casual sex is common in Braamfontein and condom use is inconsistent.

Alinah Miya, 21, a university student in Braamfontein, said the use of Pre-Exposure Prophylaxis (PrEP), an antiretroviral drug prescribed for HIV-negative people to prevent them 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 at high school.

“You don’t see any posters, pamphlets or 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 not much attention is put on STIs,” said Malatjie.  

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

The Hillbrow Clinic has seen an increased uptake in PrEP medication being dispensed to about 745 young people monthly. 

“They also request termination of pregnancy, which clearly indicates they are practising unprotected sex and are less concerned about STIs. The youth accessing services at Hillbrow Community Health Centre are concerned about 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 STIs were high among young women receiving PrEP.

Portia, 24, a sex worker in Hillbrow, tested positive for chlamydia, herpes and gonorrhoea on different occasions in her line of work.

Sex workers are prone to STIs because of burst condoms, rape and clients who offer to pay more for unprotected sex.

Portia 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 compared to the new generation. 

At the height of the HIV pandemic in the late 1990s, the government started a safe sex campaign that included billboards and radio and TV adverts and pumped money in youth and peer-to-peer NGOs such as loveLife. It also introduced health ambassadors who would do door-to-door safe sex education in townships and rural areas. 

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

“Now you only find mobile clinics and they don’t really do anything besides testing or 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 when HIV was associated with a fatal outcome.

“The world is a lot freer and this has led to recklessness. Our kids are more prone towards these sexual activities and government no longer spreads the right information. The focus is on HIV and PrEP,” said Nketsi.  

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

“You have grown men who admit to wanting to have sex with children without condoms because they say it is better, even when they know they are ill. Most men will never admit to being sick until they are dying,” said Nketsi. 

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

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

She said drugs and taverns were breeding grounds for STIs and HIV.

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

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

“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 and 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 STIs will remain high,” said Mapipa. 

She said another component contributing to HIV and STIs is a shortage of condoms at healthcare facilities.

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