The SABSSM series began in 2002 with the Nelson Mandela/HSRC-funded survey on HIV and AIDS. Since then, the HSRC has conducted subsequent surveys in 2005, 2008, 2012, 2017, and most recently the sixth survey in the series, SABSSM VI, in 2022. These surveys have evolved significantly over the years, expanding the range of biomarkers measured, increasing participation to include entire households, and adopting electronic data collection systems for immediate data access.

A shift in HIV demographics

SABSSM VI, has revealed important trends in South Africa’s HIV epidemic. The survey indicates a maturing epidemic, with a significant shift in HIV prevalence towards older age groups, likely due to the success of antiretroviral therapy (ART) allowing people to live longer with HIV. However, young people remain at high risk, with many still not using condoms despite extensive HIV awareness campaigns over the past two decades.

The 2022 survey found that the percentage of people living with HIV (PLHIV) in South Africa decreased from 14% in 2017 to 12.7% in 2022. According to Professor Khangelani Zuma, divisional executive of the Public Health, Societies, and Belonging division of the HSRC and the principal investigator of SABSSM, this decrease can be attributed to several factors: fewer new infections, more children being born HIV-negative, reduced AIDS-related mortality, and a natural ageing process among the population.

Ageing population and evolving healthcare needs

SABSSM VI highlighted a shift in HIV prevalence peaks between 2017 and 2022. For men, the peak prevalence moved from those aged 35-39 years in 2017 (26.7%) to those aged 45-49 years in 2022 (27.1%). This shift indicates an ageing epidemic, as more people on ART survive into older age. The reduction in prevalence among younger age groups suggests a decline in new HIV infections, although incidence data is still being processed and will be included in the final SABSSM VI report to be released in early 2024.

The ageing population of people living with HIV presents new healthcare challenges. Integrated treatment approaches are needed to address age-related non-communicable diseases and mental health issues alongside HIV care. Additionally, prevention programs must be intensified among young people to address the continued low condom usage.

Expanded scope: Including COVID-19 data

The sixth SABSSM survey was the largest to date, also incorporating data on SARS-CoV-2, the virus that causes COVID-19. Researchers approached 76,134 people across all nine provinces, with 62.7% agreeing to provide blood specimens. The inclusion of COVID-19 data is expected to inform South Africa’s future pandemic response policies and interventions.

The HSRC is finalising the main SABSSM VI report, anticipated for release in 2024. This report will include an analysis of new HIV infections (incidence) and provide summary sheets with data for provinces and selected districts.

The SABSSM survey series remains a cornerstone of South Africa’s efforts to combat HIV, STIs, and TB. By continually adapting and expanding its scope, SABSSM provides invaluable data that shapes public health policies and interventions, ensuring they are responsive to the evolving dynamics of the HIV epidemic. As the series celebrates over 20 years of tracking HIV, its findings continue to underscore the importance of sustained, evidence-based public health initiatives in improving the lives of millions of South Africans.

In a recent interview with the HSRC Dr Olive Shisana, special adviser to President Cyril Ramaphosa and former HSRC CEO, warned that continued funding of SABSSM is more critical than ever. “We continue to have the largest number of people with HIV in the world … failing to provide funds to prevent HIV does not mean that the problem is going to remain in Africa. People’s bodies are biological hazards. They travel from one place to the other …it is very important that [we have] resources to make sure that we do not have the epidemic continuing to become a pandemic … so that we end AIDS itself [and] so that no one should ever have to die of AIDS.”

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