Plenary Session 3, 20 June 2013 - "HIV/AIDS in South Africa: At last the glass is half full"

CATEGORY: HIV/AIDS, STIs and TB
DATE: 20 June 2013
AUTHOR: Ina van der Linde

Figure 1: HIV prevalence by age and sex, South Africa, 2012

Speaker: Dr Olive Shisana

Many more people with HIV are alive because of ARV treatment

The HSRC released the key findings of the 2012 household survey at the 6th South African AIDS Conference in Durban. The results show that an estimated 6.4 million people are living with HIV/AIDS in 2012. The estimated prevalence of HIV (the proportion of people living with HIV in the country) increased from 10.6% in the 2008 HIV Household Survey, to 12.3% in 2012.

Another key finding of the 2012 survey was that over 2 million people were on antiretroviral (ARV) treatment by mid-2012. This dramatic increase of ARV treatment coverage in the country has had a major impact on the survival of people living with HIV, which was more prominent in the older age groups.

“I am pleased to see that more people with HIV are living longer because of the large ARV treatment programme of government. I am equally delighted to see that there has been a decline of HIV prevalence among youth aged 15 – 24 years”, said Dr Olive Shisana, CEO of the Human Sciences Research Council (HSRC), explaining why she believes “the glass is half full”.

Shisana presented the first high-level results of the household survey at a plenary session at the 6th South African AIDS Conference in Durban. The 2012 results are the 4th in a series of repeated national population-based HIV surveys that monitor responses to the epidemic, conducted since 2002.

These surveys collected data on the HIV status but also information on socio-demographic and behavioural factors that greatly enhance the analysis and interpretation of the observed trends in HIV prevalence and incidence (new HIV infections). For the 2012 study the research team conducted 37 021 interviews and tested 28 089 people for HIV, using dried blood spots

Figure 1 below shows the HIV prevalence profile for females and males in 5-year age groups. HIV prevalence peaked in females aged 30-34 years at 36.8% and among males at 24.2% in the 35-39 year age group.  In this survey the prevalence peaked 5 years later for both males and females as compared to the previous three surveys (2002, 2005, 2008), which also reflects increased ARV treatment coverage.

Figure 2: HIV prevalence by province (15 - 49 years) South Africa 2012

In the key age group of adults aged 15–49 years, HIV prevalence is 23.3% among females and 13.3% among males.  This shows a 10% difference between the sexes which highlights that the brunt of the epidemic is still felt mainly among females.

One positive observation is the significant decline of HIV prevalence among youth aged 15 – 24 years from 10.3% in 2005 to 8.7% in 2008 and 7.3% in 2012.

Figure 2 shows the HIV prevalence by province in the age group 15 – 49 years.  KwaZulu-Natal was highest with 27.6%, closely followed by Mpumalanga with 26.0%.  These are the two provinces with well over 20% HIV-prevalence levels. Compared to 2008, HIV prevalence increased in all provinces in 2012. Although Western Cape still has the lowest HIV prevalence it increased from 5.2% in 2008 to 9.2% in 2012.

Figure 3: Awarness of own HIV status, South Africa 2012

An encouraging finding is that more South Africans are aware of their HIV status (see figure below). This is largely due to the success of the National HIV Counselling and Testing (HCT) campaign.  Females are substantially more aware of their HIV status than males due to the additional effect of the Prevention of Mother to Child Transmission (PMTCT) programme.

Table 1: Multiple sexual partnerships in the last 12 months by marital status by sex, South Africa 2012

Awareness of own HIV status, South Africa 2012

A disturbing finding is that HIV prevalence among unmarried persons is twice that of married persons, 19.2% compared with 9.8%. The proportion of unmarried persons in South Africa is high at 69.4% of the population aged 16 years (the legal age of marriage) and older.  As the table below shows, people who are unmarried are more likely to report having multiple sexual partners within the last 12 months (Table 1).

A pillar of the national prevention programme is condom promotion and distribution. In 2012 there was a decline in condom use in all age groups, although for young males aged 15 – 24 years the proportion reporting condom use at last sex remained high at 67.4%. This is also the group that reported the highest proportion of multiple sexual partnerships at 34.6%.

“I am sad to see that people are not changing their behaviour in terms of more people using condoms, especially in the older age group, and also concerned about the fact that more people are having multiple sex partners than in the 2008 survey,” Shisana said.

“The disproportionately high HIV prevalence levels among young females in the country, however, require a rethinking of conventional approaches to HIV prevention that address the underlying socio-cultural norms including getting married. Also, because young males have become complacent when it comes to condom use, this needs to be addressed as well.”

She believes the country is on the right track with regard to the provision of ARV treatment resulting in a substantial increase in survival among people living with HIV. The successful national HIV counselling and testing (HCT) campaign and also increased coverage of PMTCT programmes among women should be sustained.

Shisana said the full report will be available later this year, together with further results on HIV incidence, which gives an indication of how many people were newly infections over the last year. Incidence testing is a good measure of whether the AIDS pandemic is declining.  International bodies such as the Centers for Disease Control (CDC), UNAIDS, and WHO will be involved in the processing of the dry blood spots to look for new infections.

For interviews with Dr Shisana, please contact Julian Jacobs at the AIDS Conference on jjacobs@hsrc.ac.za// cell phone: 0833266821 between 11:30 and 13:00; or Ina van der Linde on ivelinde@hsrc.ac.za // cell phone: 0823310614.