Mahikeng, Monday, 9 September 2024
The Human Sciences Research Council (HSRC) released the key findings of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) for North West Province on Monday, 9 September 2024 at a provincial dialogue held at the Peermont Mmabatho Palms Hotel and Casino.
The survey found that compared to other provinces, North West had the fifth highest HIV prevalence at 12.3% in 2022. This translates to an estimated 465,000 people living with HIV (PLHIV) in the province.
According to the overall principal investigator of the study, the HSRC’s Professor Khangelani Zuma, the survey showed that in 2022, HIV prevalence in the province was 20.8% among those aged 25–49 years overall and more than 2-fold higher (29.0%) among females than among males (13.4%). Among adolescents and youth, HIV prevalence was 2.5-fold higher among females (8.3%) than among males (3.3%) of the same age.
The survey revealed that the HIV prevalence peaked at 31.4% among those aged 40–44 years in 2022 compared to 36.8% among those aged 45–49 years in 2017. However, there was a decrease in HIV prevalence in 2022 among those aged 30–39 and 40–49 years.
“Of great concern is the worsening situation among adolescents and youth, with HIV prevalence being worse or similar to that of 2017. The prevalence of HIV among adolescents 15 to 19 is higher (4.5%) in 2022 than in 2017 (3.2%), indicating continued infections among adolescents and youth,” Professor Zuma noted.
The data presented are for three priority districts in North West namely, Bojanala, Dr Kenneth Kaunda and Ngaka Modiri Molema, where oversampling was undertaken to enhance the precision of the HIV prevalence estimates. Data for Dr Ruth Segomotsi Mompati is not presented because this district was not oversampled to allow for reliable estimates.
By district, in 2022, HIV prevalence among all ages was highest in Bojanala (15.4%), followed by Ngaka Modiri Molema (12.1%) and Dr Kenneth Kaunda (11.9%)
Antiretroviral treatment (ART)
Antiretroviral treatment (ART) coverage in North West increased from 60.7% in 2017 to 78.9% in 2022. This translates to an estimated 324,000 people living with HIV in the province receiving treatment in 2022.
ART use among those aged 15–49 years was 76.1% overall, 81.8% among females, and 63.0% among males. ART use was 73.8% in urban areas and at or above 85% in rural informal/tribal and formal/farm areas. By district, ART use ranged from 81.5% in Bojanala to 84.9% in Dr Kenneth Kaunda.
The SABSSM VI survey, conducted between 2022 and 2023, aimed to maintain surveillance of HIV infection and behaviours in South Africa, evaluate the progress of the South African national HIV and AIDS, STI and TB Strategic Plan, and monitor HIV indicators for national and international reporting.
The survey’s key objectives included estimating HIV prevalence and incidence, viral load suppression, and exposure to HIV-related services among adults and children. It also assessed progress towards the 2030 UNAIDS 95-95-95 targets, HIV drug resistance, and the relationship between social and behavioural factors, intimate partner violence, and HIV infection.
UNAIDS 95–95–95 targets
The data reveals that, in terms of progress towards the 95-95-95 UNAIDS targets, 90.7% of people living with HIV aged 15 years and older were aware of their HIV status, 89.0% of those diagnosed were on ART and 93.0% of those on ART were virally suppressed. Nationally, 89.6% of people living with HIV aged 15 years and older were aware of their HIV status, 90.7% of those who knew their HIV status were on ART, and 93.9% of those on ART were virally suppressed.
The survey shows that the UNAIDS 95–95–95 targets among those aged 15 years and older in North West (rounded to nearest decimal) was 87–86–86 for males, 92–90–96 for females. Among people living with HIV of both sexes aged 15–49 years, target achievement was 89–87–94. Urban areas lagged on the first (89.8%), second (86.4%) and third (90.4%) targets compared to other localities. None of the districts had achieved the 95–95–95 targets.
South Africa has adopted the UNAIDS 95–95–95 treatment targets in its National Strategic Plan 2023–2028, aiming to achieve the following goals: 95% of all people living with HIV knowing their HIV status (first 95); 95% of those who know their status being on ART (second 95); and 95% of those on ART achieving viral suppression (third 95).
Viral load suppression (VLS)
The survey further revealed that North West was among the two provinces with the lowest proportion of all people living with HIV with VLS (77.0%) despite having increased significantly from 58.7% in 2017. VLS was 77% among all ages, and markedly lower among males (62.5%) compared to females (84.9%). By locality, VLS among females ranged from 53.2% in rural formal/farms to 91.6% in rural informal/tribal areas. The range among rural localities among males was narrower, from 61.9% in rural formal/farms areas to 64.4% in rural informal/tribal areas. VLS by district ranged from 78.8% in Bojanala to 82.5% in Dr Kenneth Kaunda and 82.6% in Ngaka Modiri Molema.
Knowledge of HIV status
Professor Zuma expressed concern that people living with HIV aged 25–49 years accounted for the majority of people living with HIV in North West who were unaware of their HIV status (68.4%), aware but not on ART (70.1%), and on ART but not virally suppressed (71.3%). However, adolescents and youth aged 15–24 years contributed disproportionately to gaps in treatment, accounting for just 6.4% of all people living with HIV, but 15.8% of those unaware of their status, 15.6% of those aware but not on ART and 12.9% of those on ART but no VLS.
People residing in urban areas accounted for approximately one-half of all people living with HIV, with the balance from rural informal/tribal (21.9%) and rural forma/farms (26.0%) areas. A similar pattern is observed for both urban females and males.
The survey also revealed that for most districts, the proportional contribution to all people living with HIV in the province and all people living with HIV within each of the gaps in the clinical cascade are similar, except for Bojanala. Bojanala accounted for 41.1% of all people living with HIV but 48.6% of all people living with HIV who are unaware of their HIV status.
KEY DRIVERS OF THE HIV EPIDEMIC
Sexual debut before the age of 15 years
Regarding the key drivers of the HIV pandemic, Professor Zuma noted that in North West, the proportion of adolescents and youth aged 15–24 years who reported having sex before the age of 15 years declined from 12.0% in 2017 to 8.8% in 2022.
In 2022, sexual debut before the age of 15 years among adolescents and youth aged 15–24 years was 4-fold higher among males (14.0%) than females (3.5%). By district, early sexual debut ranged from 8.0% in Ngaka Modiri Molema to 13.0% in Dr Kenneth Kaunda.
Multiple sexual partners
The survey revealed that in North West, 9.5% of people aged 15 years and older reported having two or more sexual partners in 2022 compared to 11.1% in 2017. The proportion of people aged 15 years and older who reported having two or more sexual partners was higher among males (33.7%), compared to females (30.6%), and those aged 15–24 years (50.1%) compared to other age groups. The proportion who reported having two or more sexual partners was highest in rural informal or tribal areas (34.8%) and in Bojanala district (12.7%).
Condom use with the most recent sexual partner
Regarding condom use, the survey revealed that in North West, 32.2% of respondents reported using a condom with their most recent sexual partner in 2022, a 12.5% decline from the 44.7% reported in 2017. Condom use with their most recent sexual partner among people aged 15 years and older was similar among both females (30.6%) and males (33.7%), and higher among youth aged 15–24 years (50.1%) than adults aged 15–49 years (30.6%).
Condom use with their most recent sexual partner ranged from 26.4% in rural formal or farm areas to 34.8% in rural informal/tribal areas and was similar across districts. In North West, 50.7% reported that they never used a condom with their most recent sexual partner. Only 3.6% reported that they used a condom almost every time.
Consistency of condom use with the most recent sexual partner among people aged 15 years and older in the province ranged from 14.3% among those aged 50 years and older to 36.8% among those aged 15–24 years. Nearly 60% of youth reported using a condom sometimes or never. Consistency of condom use with the most recent sexual partner among people aged 15 years and older was similar among districts.
Nationally, more than 70% of individuals aged 15 years and older had never or sometimes used a condom with their most recent sexual partner.
Male circumcision
In North West, self-reported circumcision increased from 50.9% in 2017 to 60.8% in 2022. In 2022, self-reported male circumcision among males aged 15 years and above in the province was 58.7% overall, 74.6% among those aged 15–24 years, and 66.7% among those aged 25–34 years. By locality type, circumcision ranged from 44.8% in rural formal/farm areas to 66.5% in rural informal/tribal areas.
By district, self-reported circumcision among males aged 15–24 years ranged from 63.0% in Dr Kenneth Kaunda to 74.7% in Bojanala, and among those aged 25–34 years, from 68.9% in Ngaka Modiri Molema to 73.2% in Dr Kenneth Kaunda.
In North West, 66% of circumcised males reported having a medical circumcision. Among circumcised males, self-reported medical circumcision was 86.0% among those aged 15–24 years, and 62.6% among those aged 25–49 years. By locality, medical circumcision ranged from 45.4% in rural formal/farm areas to 70.0% in urban areas. By district, medical circumcision ranged from 58.1% in Bojanala to 77.1% in Ngaka Modiri Molema.
Male circumcision among children aged 14 years and younger in the province increased with age from 1.1% among those aged 0–4 years to 43.6% among boys 12–14 years. Male circumcision among children aged 14 years and younger was lowest in Dr Kenneth Kaunda (6.6%) and highest in Bojanala (18.0%).
Awareness of HIV testing sites
Awareness of HIV testing sites is critical for accessing HIV testing services. In 2022, awareness of HIV testing sites by selected demographic variables among people aged 15 years and older in the province was generally high (above 90%).
Access to HIV testing sites is important for scaling up the utilisation of HIV testing services. In the province, most people aged 15 years and older accessed public clinics or doctors (66.3%) or public hospitals (11.0%) for HIV testing.
Furthermore, HIV testing is a gateway to counseling on HIV prevention and linkage to care among people diagnosed with HIV. The survey shows that among female adolescents and youth (15–24 years), 19.7% never tested for HIV and 1.7% tested more than three years ago. Among all districts, approximately one-quarter of all females aged 15 years and above had never tested for HIV. A large proportion of males aged 15 years and above in Ngaka Modiri Molema (41.3%) and Bojanala (37%) had never tested for HIV, and less than one-half had been tested in the past three years.
Awareness and uptake of pre-exposure prophylaxis (PrEP)
Overall, in 2022, 30.0% of sexually active adults aged 15+ years in North West had ever heard of PrEP, of whom 5.1% had ever taken PrEP. Of those who had ever heard of PrEP, 1.6% were taking PrEP at the time of the survey. Of those who had ever heard of PrEP, 79.5% were willing to take it to prevent HIV. Awareness of PrEP was higher in urban (35.0%) areas as compared to rural formal/farm areas (6.1%)
Key recommendations
The survey recommends key actions to address the HIV epidemic as a public health threat in South Africa by 2030. These include targeted interventions for age groups most affected by HIV, particularly adolescent girls and young women, who require intensified prevention efforts.
Professor Zuma recommends a long-term strategy to care for individuals in an aging HIV epidemic as well as tailored interventions to address gaps in the clinical cascade by district, locality and subpopulation.
“We also recommend a continued focus on increasing coverage and demand for medical male circumcision among males aged 15 years and older. We must also enhance public awareness and uptake of effective HIV prevention measures, such as regular HIV testing, condoms and PrEP,” concluded Professor Zuma.
The HSRC conducted the survey in partnership with the US Centers for Disease Control and Prevention (CDC), the South African Medical Research Council (SAMRC), the University of Cape Town (UCT), and the National Institute for Communicable Diseases (NICD).
The council has launched a provincial results dissemination roadshow, dubbed the Provincial Dialogue, which has already been successfully completed in the Eastern Cape, Limpopo, and Gauteng provinces. The next provinces in line for this initiative are Mpumalanga, Free State, KwaZulu-Natal, Western Cape, and Northern Cape.
Click on the link below to download the full provincial report, presentation, and a 20-year SABSSM anniversary video:
Ends.
For media enquiries:
| Dr Lucky Ditaunyane Cell: +27 83 227 6074 Email: lditaunyane@hsrc.ac.za | Adziliwi Nematandani Cell: +27 82 765 9191 Email: anematandani@hsrc.ac.za |
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Notes to the editor
About the Human Sciences Research Council (HSRC)
The HSRC was established in 1968 as South Africa’s statutory research agency and has grown to become the largest dedicated research institute in the social sciences and humanities on the African continent, doing cutting-edge public research in areas that are crucial to development.
Our mandate is to inform the effective formulation and monitoring of government policy; to evaluate policy implementation; to stimulate public debate through the effective dissemination of research-based data and fact-based research results; to foster research collaboration; and to help build research capacity and infrastructure for the human sciences.
The Council conducts large-scale, policy-relevant, social-scientific research for public sector users, non-governmental organisations and international development agencies. Its research activities and structures are closely aligned with South Africa’s national development priorities.