South Africa continues to face one of the world’s most severe HIV epidemics, with young people, particularly those aged 15 to 24, among the most vulnerable. KwaZulu-Natal (KZN), the province with the highest HIV prevalence, remains the epicentre of the crisis. Despite national progress in HIV treatment and prevention, factors such as poverty, gender inequality, and limited access to health education contribute to the high rate of new infections among youth in KZN. According to recent data, adolescent girls and young women are disproportionately affected, with infection rates significantly higher than their male counterparts.
A complex mix of social and economic conditions drives the epidemic in KZN. Many young people face limited employment and educational opportunities, which can increase reliance on transactional relationships and reduce access to healthcare services. Cultural stigma around HIV and sexual health further discourages testing and open conversations. While school-based sex education and government programmes like ONEVOICE SOUTH AFRICA and DREAMS have made and are making inroads, gaps remain in reaching rural and underserved communities effectively.
To reverse the trend, a multi-pronged approach is essential. Youth-friendly health services, comprehensive sex education, and stronger support networks are critical to empowering young people to protect themselves. Initiatives that address the root causes—such as economic inequality, gender-based violence, and limited access to contraception—must be prioritised. Investing in young people, particularly in high-burden areas like KwaZulu-Natal (KZN), can move closer to achieving its goal of ending HIV as a public health threat.
HIV among youth nationwide in 2025
As of early 2025, young people aged 15–24, especially adolescent girls and young women (AGYW), remain disproportionately affected by HIV in South Africa. In 2024 alone, over 210 000 AGYW acquired HIV—an alarming average of 570 new infections every day (the Mail & Guardian & the United Nations in South Africa). Despite ambitious progress—such as national initiatives aiming to enrol another 1.1 million people on life-saving antiretroviral therapy (ART) by the end of 2025—key prevention services for youth face severe disruption due to international funding cuts (unaids.org & the United Nations in South Africa).2.
KwaZulu-Natal’s youth HIV landscape
KZN, with approximately 1.98 million people living with HIV in 2022, holds the second-highest provincial prevalence in South Africa, at 16.0% (hsrc.ac.za). ART coverage improved overall to 87.3%, yet among those aged 15–24, only about 62.8% were on treatment, with viral suppression achieved by just ~74% of that group (the United Nations in South Africa &The Mail & Guardian & IOL). Prevalence among young women aged 15–24 (~9.3%) is nearly three times higher than in young men (~3.3%) (hsrc.ac.za & IOL). According to the Mail & Guardian, Condom use has also declined—only 32.8% reported using a condom with their most recent partner in 2022, down from 44.9% in 2017. Inconsistent condom use is one of the main drivers of the HIV epidemic in South Africa.
Challenges and emerging strategies in 2025
South Africa’s HIV response in 2025 is at a turning point. International aid cuts—especially via PEPFAR—have led to closures of youth-focused NGOs, setbacks in testing and treatment adherence, and a rise in viral load testing gaps among young people. However, promising interventions are on the horizon: lenacapavir, a twice-yearly injectable PrEP agent, showed 100% efficacy in trials with young African women—including in South Africa—offering hope for reducing new infections significantly. Together, these insights reveal that while some strides have been made, young people in South Africa—particularly in KZN—continue to face elevated HIV risks fuelled by socio-economic inequality, disrupted services, and structural barriers. Renewed investment in youth-friendly, community-led solutions, alongside advances in prevention technology, is essential to redefine the trajectory in 2025 and beyond.
