Health and Wellness

(a)(i) In the Western Cape, the provision of HIV prevention modalities are embedded into the comprehensive service package through the Western Cape Department of Health and Wellness. Key programmes include:

• Condom provision and promotion (male and female condoms as well as lubricant)
• HIV testing services (including provider-initiated testing, community and antenatal testing).
• Medical male circumcision services (offered via an implementing partner)
• Pre – exposure Prophylaxis – for persons at substantial risk of HIV infection
• Post Exposure Prophylaxis – for survivors of sexual assault and unintended HIV exposure
• Vertical Transmission Prevention (previously known as PMTCT) – prevention of transmission between mother and child
• Treatment, care, and support for people living with HIV, including antiretroviral therapy (ART) initiation, differentiated models of care, and TB preventive therapy.
• Sexual Reproductive Health Services and Management of Sexually Transmitted Infections.

(a)(ii) Large numbers of residents make use of these services each year. In 2024/25, the Western Cape Department of Health and Wellness distributed about 66 million male condoms and nearly 1 million female condoms, performed over 1,48 million HIV tests, and carried out 17 497 medical male circumcisions. A total of 29 580 people started PrEP and 3 275 HIV-negative sexual assault survivors received PEP. Community health workers made over 2,6 million household visits and traced more than 70 000 HIV clients who had been lost to follow-up.

(a)(iii)  HIV prevention programmes are funded mainly through the Comprehensive HIV/AIDS component of the District Health Programmes Grant, supplemented by the provincial equitable share. The conditional grant allocation for the Comprehensive HIV/AIDS component in 2024/25 was R1,891 billion, which was fully spent on prevention, treatment, and related HIV and TB services. For 2025/26, HIV prevention activities continue to be funded from this component and from equitable share. Budgets are developed for the integrated HIV package rather than as separate amounts for individual interventions such as condoms, MMC, or PrEP, so a split “per programme” is not available.

(a)(iv)  The most recent Annual Report (2024/25) reflects that the province has made steady progress towards the UNAIDS 95-95-95 targets. By the end of 2024/25, an estimated 94% of people living with HIV in the Western Cape knew their status, 65,4% were on treatment, and 91% of those on treatment were virally suppressed. The Western Cape Department of Health and Wellness met or exceeded targets for key indicators such as ART initiation, condom distribution, MMC, HIV testing, PrEP initiation, and services for high-risk populations, despite disruptions caused by the early-2025 stop-work order affecting donor-funded posts.

(b)(i)  The PrEP has been integrated into routine primary health care services. In 2023/24 and 2024/25, 7200 and 9719 persons were initiated onto PrEP respectively.  For the 2025/26 financial year 4085 person have been initiated from April to September 2025.  This reflects an increase in the demand for PrEP as implementation is further scaled up in response to the demand. 

(b)(ii)  PrEP is offered across the provincial service platform including specific high-transmission area and key-population outreach sites supported by the Western Cape Department of Health and Wellness. The full facility list is extensive and is available through WCDHW programme guidelines and the Western Cape Government website.

(b) (iii) Expansion plans in place:

• Extending PrEP integration to ensure access and implementation at all primary health care clinics, especially in communities with high HIV incidence.

• Strengthening provision of PrEP at high-transmission area sites and through key-population programmes.
• Integrating PrEP into routine services for adolescents and youth, especially  young women, including linkages from school health, sexual and reproductive health, and gender-based violence services.
• Exploring models to reduce facility visits for PrEP continuation such as alignment with other services and multi-month dispensing where clinically appropriate, to improve access, convenience and adherence.
• Exploring public private partnerships for the provision of PrEP in private Pharmacies to increase access.

(c)(i)  According to the 2024/25 Annual Report, 330 828 patients were on ART and remained in care in the Western Cape. This reflects a large, mature treatment cohort supported by facility-based and community-based services.

(c)(ii) Over the past three financial years, the number of people on ART in the province has remained above 300 000, with relatively stable overall volumes as new initiations balance deaths, out-migration, and patients returning to care. The stable ART cohort and high rate of viral suppression described above indicate that the Western Cape Department of Health and Wellness has broadly maintained treatment coverage while working to close remaining gaps.

(d) The Western Cape Department of Health and Wellness has a number of measures in place to improve ART adherence and retention in care, including:

• Differentiated models of care such as external pick-up points, facility pick-up points, and adherence clubs, which now support more than 133 000 decanted ART patients.
• Multi-month dispensing and integrated HIV/TB services that reduce the number of clinic visits and strengthen continuity of care.
• Community health worker programmes that trace clients who miss appointments, conduct home visits, and reinforce adherence messages in households.
• Ongoing training of doctors, nurses, and non-professional staff in HIV, TB, sexually transmitted infections, and chronic disease management, to support high-quality, patient-centred care.
• Use of digital tools and data systems to monitor treatment outcomes, identify patients at risk of interruption in treatment, and support targeted interventions at facility and district level.

Together, these measures aim to maintain high levels of viral suppression, prevent drug resistance, and ensure that people living with HIV in the Western Cape can remain well and productive on long-term treatment.