Researchers from North West University (NWU) have uncovered alarming concentrations of antiretroviral (ARV) drugs in South Africa’s water sources, particularly downstream of wastewater treatment plants. The findings raise concerns about long-term ecological impacts, though experts say the immediate risk to human health remains low.
ARVs in Water: A Growing Concern
Professor Suranie Horn, part of the research team at NWU’s Occupational Hygiene and Health Research Initiative, explained that wastewater treatment plants are not designed to filter out pharmaceutical compounds like ARVs.
“There is a high number of people using ARVs in South Africa, and these drugs enter the sewage system,” Horn said. “Current treatment plants focus on removing solids and bacteria, not chemicals.”
While trace amounts of pharmaceuticals in water are not uncommon globally, the levels detected in South Africa are significantly higher—a consequence of the country’s world-leading antiretroviral treatment program.
Ecological Risks Outweigh Human Health Threats
Though the ARV concentrations in drinking water are currently too low to pose a direct risk to humans, Horn warned of potential harm to aquatic ecosystems. Studies cited in the research showed that freshwater snails exposed to ARVs experienced altered embryonic development, while bacteria crucial for wastewater treatment were also affected.
“The real risk is to the environment,” Horn said. “Long-term exposure in aquatic life can lead to hormonal disruptions, liver damage in fish, and broader ecosystem imbalances.”
Compounding the issue is the “chemical cocktail effect,” where multiple pharmaceuticals in water may interact unpredictably, amplifying their impact.
Calls for Improved Water Treatment
The study recommends upgrading wastewater treatment infrastructure with advanced filtration methods, such as activated carbon filters or ozonation. However, Horn acknowledged the challenges in a country already struggling with basic water and sanitation services.
“Improving wastewater plants is key, but we also need better medication disposal practices and sewage infrastructure in informal settlements,” she said.
The findings have been shared with the Water Research Commission, urging policymakers to address the issue before ecological damage becomes irreversible.
A Wake-Up Call
As South Africa grapples with water scarcity and aging infrastructure, the study highlights an emerging environmental crisis—one that demands urgent attention to safeguard both ecosystems and future water quality.
“This is just the beginning of understanding the problem,” Horn said. “Awareness and action are critical now.”
