North-West University (NWU) researchers have uncovered a serious environmental issue: widespread antiretroviral drugs (ARVs) in South Africa’s water.
Zuko Komisa

The comprehensive report found high concentrations of ARVs, especially lopinavir and efavirenz, downstream of wastewater treatment plants, often exceeding global norms.
This is attributed to South Africa’s vast HIV treatment programme.
The study highlighted alarming effects on aquatic life, with altered embryonic development in snails and impacts on crucial wastewater bacteria.
According to the research, South Africa has the world’s largest HIV treatment programme, with an estimated 6.2 million people on antiretroviral drugs (ARVs) in 2024.
The presence of these ARVs in drinking water, especially downstream of wastewater treatment plants, poses a “hidden or latent risk” to human health. While research indicates that current concentrations may not immediately cause acute harm, long-term exposure to these bioactive compounds, potentially ingested via drinking water or aquatic organisms like fish, could interfere with metabolic systems and lead to adverse effects.
Researchers stressed that current wastewater treatment processes are inadequate for removing ARVs.
Key recommendations to the Water Research Commission include new regulatory guidelines, improved treatment technologies, and further research. This pivotal study showed the need to balance HIV treatment with protecting South Africa’s vital water resources.
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