In a groundbreaking approach to combating HIV, artificial intelligence (AI) chatbots are emerging as vital tools for HIV prevention, particularly among young women in South Africa. The story of Unathi Mazibuko, a 24-year-old university graduate from Cape Town, illustrates this innovative strategy. Through her WhatsApp chat with Self-Cav, an AI-generated buddy created by the health organization Audere, Unathi seeks judgment-free information on various health topics, including pre-exposure prophylaxis (PrEP), an HIV-prevention medication.

PrEP, or pre-exposure prophylaxis, is a daily medication for HIV-negative individuals that can reduce their chances of contracting HIV by over 99% when used consistently for about seven days. While highly effective, adherence is crucial, as missing doses can reduce its protective power. Unathi’s demographic—girls and women aged 15 to 24 in South Africa—is disproportionately affected by new HIV infections, accounting for four out of every 10 new cases despite making up only 8% of the population. This vulnerability often stems from relationships with men significantly older than them.

Despite the daily HIV-prevention pill being freely available in most government clinics since its nationwide rollout in 2021 (initially for sex workers in 2016), awareness and consistent use remain significant challenges. Many young women do not perceive themselves as being at risk, and stigma often deters them from using PrEP. Because HIV-prevention medication contains antiretroviral drugs, similar to HIV treatment, some fear being perceived as HIV-positive or promiscuous. Furthermore, many struggle to stay on PrEP for sufficient periods to prevent infection, highlighting a critical gap in demand creation and sustained adherence.

This is where AI bots like Self-Cav and Audere’s earlier chatbot, Aimee, play a transformative role. Designed to mimic human thinking and endorsed by the health department, Self-Cav offers 24/7 information on where to find the daily anti-HIV pill and how to use it correctly. For users like Unathi, these AI companions provide a comfortable, private space to ask sensitive questions about sex and HIV prevention without fear of judgment from healthcare workers. The bots also provide advice on self-tests for HIV, mental health issues, self-harm, gender-based violence, and other sexually transmitted infections.

Self-Cav, which was piloted in May and is set for a full launch on World Aids Day on December 1, has already assisted nearly 10,000 young South Africans (including users being migrated from Aimee). Audere's data indicates that about a quarter of Aimee and Self-Cav users have been linked to clinics or healthcare workers for PrEP, HIV testing, contraceptives, or mental health support. The AI is trained to understand HIV risk indicators within conversations, guiding individuals towards PrEP if they are identified as needing it most. Users can also choose for the bot to respond as a trusted friend or nurse, with the option to connect to a real nurse, enhancing trust and relatability through quality-controlled conversations that incorporate local slang.

Looking ahead, South Africa's health department plans to roll out a once-every-six-months anti-HIV jab, lenacapavir (LEN), in April next year. Modeling studies suggest this injection, easier to adhere to than the daily pill, could significantly halt AIDS within 14 to 20 years if widely adopted. Researchers and policymakers recognize that the success of such innovations, whether pills or injections, hinges not just on availability but crucially on robust demand creation campaigns. AI bots are seen as instrumental in supporting the LEN rollout by providing reminders, guidance on appointments, and general self-care support, particularly for patients receiving six-month supplies of ARVs or the LEN injection who have less frequent engagement with healthcare workers.

While AI chatbots offer immense potential, they are not without challenges. Concerns include poor connectivity, data costs, inconsistent responses, and users' understanding of how to interact with these tools. Instances of chatbots producing inappropriate content or users forming emotional attachments also highlight the need for careful development and oversight. Audere addresses these by contracting young people to review de-identified conversations, ensuring responses are relevant and relatable. Self-Cav is available on B-Wise, the health department’s platform, and is being piloted by other NGOs and Higher Health at universities and colleges. However, experts like Mitchell Warren of Avac caution that these tools must be integrated into comprehensive prevention programs for maximum impact, emphasizing a continuous journey of growth and development for the platform.