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09 June 2009

SA epidemic has stabilized: third national HIV survey

Kim Trollip
Press Release

JOHANNESBURG – South Africa’s HIV epidemic has levelled off at a prevalence of 10.9% for people aged two years and older, with 5.2 million people estimated to be living with HIV in 2008. HIV prevalence has also declined among children aged 2-14, from 5.6% in 2002 to 2.5% in 2008, and a decline in new infections has also been noted among teenagers aged 15-19.

These findings emerge from the third national HIV prevalence, incidence and communication survey which was conducted in 2008 and which followed surveys in 2002 and 2005.

“This latest survey provides us with an opportunity to understand the HIV epidemic over time, and there are promising findings of a changing pattern of HIV infection among children and youth”, said Dr Olive Shisana, CEO of the Human Sciences Research Council (HSRC) and one of the two principal investigators of the study.

“The good news is that the change in HIV prevalence in children is most likely attributable to the successful implementation of several HIV-prevention interventions,” Shisana said. These interventions are related to addressing HIV in early childhood, particularly programmes to prevent mother-to-child transmission in the Western Cape, where the largest decline of 6 percentage points occurred.

Professor Thomas Rehle, the other principal investigator of the study, emphasised that “we may witness for the first time a decrease in HIV incidence among teenagers”. Indirect HIV incidence estimates were mathematically derived from single year age prevalence in 15-20 year olds. “This method is best applicable in younger age groups when the effect of AIDS-related mortality on HIV prevalence levels is still minimal,” Rehle explained.

Successes recorded in the study

    •    A reduction in HIV prevalence in the teenage population, which indicates an overall decline in HIV in the teenage population of 15-19 years in 2008.
    •    HIV prevalence among adults aged 15-49 has declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape and the Free State, with the largest decline of 7.9 percentage points in the Western Cape.
    •    The percentage of people in the age group 15-49 who reported awareness of their HIV status has doubled from 2005 to 2008. This is attributable to multisectoral communication and programmes that promoted knowledge of HIV status and the substantial increase in the availability of voluntary counselling and testing services (VTC) over the period.
    •    The proportion of the population who reported using a condom at their last sexual encounter was particularly high among young people aged 15-24 years: from 57% in 2002 to 87% in 2008 among young males, and from 46% to 73% among young females. This trend was also obvious in condom use among people in the 25-49 age group, where condom use among males aged 25-49 at last sex has nearly doubled, while among females in the same age group it has tripled. This may indicate a shift in power relations between males and females, but also an understanding of the value of condoms as in important prevention measure.
    •    There was an increase in the population reached by at least one national HIV communication programme between 2005 and 2008. This trend is in an upwards direction, and is particularly clear among youth where 90% reported that they have been reached by at least one programme. Although reach of the main national HIV/AIDS communication programmes increased over time, the government’s Khomanani Programme had the lowest reach in comparison to other programmes. Reach of all programmes was low for people aged 50 years and older, with 37.8% of people in this age group not being reached by any programme.

Communication programmes are not reaching all sectors of the population,” said Dr Warren Parker, a co-investigator on the study. “The lack of reach into older age groups has been raised repeatedly in previous studies, yet nearly four out of ten people aged 50 years and older are not reached by any programme.”

The challenges

Dr Shisana stressed that there are still major challenges that would need coordinated, concerted and intensive effort to complement and sustain the achievements to date. “Our efforts in the coming period need to focus on key drivers of the epidemic,” said Shisana.
Professor Leickness Simbayi, the study’s co-principal investigator, added that there is a need for a clear and unambiguous emphasis on teenagers having older partners, and on all sexually active people limiting the number of sexual partners that they have.

“Interventions need to be targeted to the particular issues in each province, and communication programmes need to focus on expanding their reach and intensifying their messages.”

The challenges include:

    •    The high level of HIV prevalence among females aged 25-29 is persistent, and has been at a level of 33% over the period of three surveys.
    •    Intergenerational sex has increased substantively among female teenagers aged 15-19, which exposes them to a group of older males with a higher HIV prevalence.
    •    Having many sexual partners increases risk of exposure to HIV, and this high risk practice has increased markedly between 2002 and 2008. Among males aged 15-49, having more than one sexual partner in the past year increased from 9.4% in 2002 to 19.3% in 2008, whilst among females the increase was from 1.6% to 3.7%.
    •    HIV prevalence levels among adults aged 15-49 has increased between 2002 and 2008 among the large populations of KwaZulu-Natal (by 10.1%) and in the Eastern Cape (by 5.0%). Smaller increases were noted in North West, Mpumalanga, and Limpopo.
    •    HIV prevention knowledge has declined among the population 15-49 years at national level, from 64.4% in 2005 to 44.8% in 2008, and has also declined in the Eastern Cape, KwaZulu-Natal, North West, Gauteng, Mpumalanga, and Limpopo.

Shisana said “for the first time, the report provides information on high-risk groups, defined in this study as people who drink excessively, those who take drugs, men who have sex with men and people with disabilities as well as women aged 20-34 and men aged 25-49. More attention should be paid to these categories in the NSP”.

The report recommends that HIV testing be routinely offered to all patients at health facilities, and that options for safe child bearing be expanded for people in the 20-34 year age group.

Download the survey report

 Full report: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008 A Turning Tide Among Teenagers?

Download the presentation

This is a copy of the presentation delivered by HSRC CEO Dr Olive Shisana at the launch on 9 June 2009,  before handing the report to the Minister of Health Dr Aaron Motsoaledi in Cape Town.

 Presentation: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008


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