Abstracts

86 and build self-efficacy in order to continue progressing toward the end of the epidemic. The promotion of self-efficacy is the country’s best chance to end the epidemic, as it will have a lasting influence on the population and does not require decades of legislation and cultural change to enact. Foreign aid has temporarily bridged the gap between the public and private health care sectors. However, as aid begins to decrease, the bridge will begin to crumble. In 2020, the PEPFAR budget request was almost $2 billion less than the program’s 2019 total budget (Henry J. Kaiser Family Foundation, 2019). With less funding coming in from international sources, South Africa will need to adjust their methods for tackling the epidemic. Targeting self-efficacy will provide a long-lasting change that can be passed down to future generations through small acts and lessons from parents to children (Venter et al., 2015). The HIV/AIDS epidemic goes far beyond the disease and its physical spread; sociocultural norms like the marginalization of colored people and women have prevented key populations from taking action to protect their own health. Completely closing the gap in health care will require many more years and corrective legislation, but this process can be facilitated by encouraging and promoting the self-efficacy of these key groups. As funding decreases, a long-term strategy such as this will benefit South Africans more than continuing to use the same transient methods. The Future Lies in Pre-exposure Prophylaxis Pre-exposure prophylaxis (PrEP) for HIV infection involves taking an ART medication prior to an exposure event to prevent the contraction of HIV. It is similar in concept to taking antimalarial medication before going to an area where that disease is endemic. Currently, approximately only 45,000 South Africans are on PrEP of the millions of people who are at risk for contracting the disease. The country also is limited to the use of tenofovir in both the brand-name, Truvada, and generic forms. These medications can be taken daily for constant protection or taken temporarily following risky encounters (PrEP Watch, 2020). PrEP in South Africa to date has been limited mostly to clinical trials to assess its efficacy and uptake in key groups, yet it should be made available to all citizens. Models have shown that the initiation of widespread PrEP, especially in more forms than just the pill, would have a remarkable effect in terms of reducing HIV incidence rates and saving lives for generations to come (Venter et al., 2015). These medications work by killing the virus before it can enter and infect healthy cells. Having PrEP in the body before HIV is present prevents the HIV infection from taking hold and allows the body to eliminate it just like the common cold or another viral infection. At-risk groups where PrEP is indicated include anyone who is HIV negative, people who inject drugs, men who have sex with men, women ages 15 to 49, and anyone in a relationship in which only one partner is HIV positive. Further factors to consider are the number of concurrent sexual partners, HIV status of potential or past partners, history of condom use, commercial sex work, and recurrent use of postexposure prophylaxis (PrEP Watch, 2020). The group for which HIV can relieve the largest burden is pregnant women and breastfeeding mothers, who can pass HIV on to their children through vertical transmission. In the next 10 years, as PrEP begins to roll out, it is predicted to prevent 48,000 to 136,000 new cases of HIV via vertical transmission, not including the new infections these people will prevent simply by being HIV negative (Joseph Davey et al., 2019). PrEP can have a similar influence on every high-risk group. Therefore, it needs to be available to the South African public just like ART treatment once HIV is acquired. The efficacy and uptake of PrEP have been studied in many subgroups with a few variations in the delivery method, yet one thing is clear: its success depends on each individual. The average efficacy of PrEP across many studies is about a 51% reduction in the chance of contracting HIV; however, this level directly varies with adherence to the medication (Bekker et al., 2016). These same studies found that those who were aware that they were at higher risk were better at following through with medication adherence. “Easier” regimens, whether a daily pill, a silicone ring inserted in the vagina, an antimicrobial gel, or