Bloemfontein, Friday, 20 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 Free State Province on Friday, 20 September 2024, at a provincial dialogue held at BON Hotel Bloemfontein.
The survey found that compared to other provinces, Free State Province had the third-highest HIV prevalence at 15.6% in 2022 and 17.0% in 2017. This translates to 450,000 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 consistently higher among females as compared to males across age categories above 15 years. The most concerning observations include the unchanged prevalence of 3.9% among children aged 0–14 years in both survey years, and the considerable increase in HIV prevalence among youth aged 15–24 in 2022 compared to 2017. Prevalence more than doubled among those aged 15–19 years (from 3.2% in 2017 to 7.4% in 2022).
By age group, prevalence was highest among those aged 25–49 years (24.4%); by sex, females in this age group (33.0%) had 2-fold higher HIV prevalence compared to males (14.9%). By locality, overall HIV prevalence ranged from 14.8% in urban areas to 20.7% among those residing in rural informal/tribal areas. By district, HIV prevalence ranged from 15.3% in Thabo Mofutsanyane to 18.7% in Mangaung.
“HIV prevalence peaked at 31.3% among those aged 55–59 years in 2022, down from 42.4% among those aged 35–39 years in 2017. However, the good news is that between 2017 and 2022, there was a notable decrease in HIV prevalence among all groups between 25–54 years,” Professor Zuma noted.
The data presented are for three priority districts within Free State Province namely: Lejweleputswa, Mangaung, and Thabo Mofutsanyane, as per the study protocol. Data for Fezile Dabi and Xhariep are not presented because these districts were not oversampled to allow for reliable estimates.
Antiretroviral treatment (ART)
Antiretroviral treatment (ART) coverage in the Free State increased to 81.3% in 2022 from 64.7% in 2017. The ART coverage estimates translate to an estimated 340,000 people living with HIV receiving treatment in 2022.
In 2022, ART coverage among all people living with HIV in the province was significantly lower among adolescents and youth aged 15–24 (60.5%) compared to older age groups, and similar between males and females across all age categories. By locality, ART coverage ranged from 79.7% in urban areas to 91.3% in rural informal/tribal areas. Differences in ART coverage by locality were largely driven by females, with ART coverage in urban areas (78.0%) being significantly lower than in rural informal/tribal areas (94.1%). By district, ART use ranged from 76.4% in Mangaung to 89.4% in Lejweleputswa.
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, in Free State, 88.1% of people living with HIV aged 15 years and older were aware of their HIV status, 93.3% of those who knew their HIV status were on ART and 94.8% 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.
Rounded to the nearest decimal, the UNAIDS 95–95–95 targets in the Free State were 86–97–91 among males and 89–92–96 among females. By age group, adolescents and youth aged 15–24 years lagged behind on the first 95 (64.1%) compared to older age groups, and urban areas had the lowest first 95 (87.3%) compared to other localities. Progress towards the 95–95–95 targets by district was variable across districts.
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, in 2022, among all provinces, the Free State had the third highest proportion of people living with HIV, with VLS having increased from 66.2% in 2017 to 81.1% in 2022. VLS was lower among those aged 15–24 years (62.8%) compared to older age groups, and those residing in rural formal/farm areas (66.5%) compared to the other localities. By district, VLS ranged from 77.2% in Thabo Mofutsanyane to 81.4% in Lejweleputswa.
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 Free State who are unaware of their HIV status (50.7%), aware but not on ART (59.8%), and on ART but not VLS (64.3%). However, adolescents and youth aged 15–24 years contributed disproportionally to gaps in treatment, accounting for 10.8% of all people living with HIV, but 27.5% of those who are unaware of their HIV status, 19.6% of those aware but not on ART and 18.5% of those on ART but not VLS.
When stratified by sex, the survey found a similar pattern among males and females. Female adolescents and youth (15–24 years) accounted for a minority of female people living with HIV (11.2%) but a relatively larger proportion of those who did not know their HIV status (29.8%), were not on ART (21.3%), or not VLS (21.8%). Male adolescents and youth (15–24 years) accounted for just 9.9% of all males living with HIV, but 22.7% of those unaware of their HIV status, and 15.6% of those aware but not on ART.
People residing in urban areas accounted for the majority of people living with HIV (66.4%), and those in gaps along the clinical cascade. People living with HIV in urban areas accounted for 75.0% of those living with HIV who were unaware of their HIV status, 73.6% of those who were aware but not on ART and 65.0% of those on ART but not VLS. Of note, a larger proportion of all female people living with HIV resided in urban areas as compared to males (71.4% vs. 54.7%, respectively) and a larger proportion of male people living with HIV resided in rural formal/farm areas as compared to females (33.3% vs. 15.8%, respectively).
By district, Mangaung accounted for 20.1% of all people living with HIV in Free State but 46.3% of those unaware of their status, 34.0% of those who were aware but not on ART and 26.5% of those on ART but not virally suppressed.
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 Free State, there was a decline in the proportion of adolescents and youth aged 15–24 years who reported having sex before the age of 15 years in 2017 (13.7%) compared to 2022 (9.2%). Nationally, 13.0% of adolescents and youth aged 15–24 years in 2017 had sex before the age of 15 years compared to 11.2% in 2022.
However, sexual debut before the age of 15 years among adolescents and youth aged 15–24 years in 2022 was 13.0% among males and 5.7% among females. By locality, early sexual debut ranged from 4.5% in rural informal/tribal areas to 10.0% in urban areas. Proportions of people reporting early sexual debut were similar among districts.
Multiple sexual partners
The survey revealed that in the Free State, 7.8% of people aged 15 years and older reported having multiple sexual partners in 2022, a decrease from 13.0% in 2017. The proportion of people aged 15 years and older who reported multiple sexual partners was 2-fold higher among males (11.2%), compared to females (4.7%). The proportion who reported having multiple sexual partners was similar across localities, and ranged from 5.9% in Mangaung to 11.1% in Thabo Mofutsanyane districts.
Condom use with the most recent sexual partner
Regarding condom use, the survey revealed that 34.8% reported using a condom with their most recent sexual partner in 2022, a decrease from 42.5% in 2017. Condom use with the most recent sexual partner among people aged 15 years and older was similar among males and females, higher among those aged 15–24 years compared to older age groups, and higher in rural informal/tribal areas (46.1%) than in urban (34.7%) and rural formal/farms (22.5%) areas. By district, condom use with the most recent sexual partner among people aged 15 years and older ranged from 59.5% in Thabo Mofutsanyane to 68.5% in Mangaung.
Nationally, more than 70% of individuals aged 15 years and older had never or sometimes used a condom with their most recent sexual partner. In the Free State, 49.0% of individuals aged 15 years and older reported that they never used a condom with their most recent sexual partner. Only 8.9% 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 Free State was lower among those aged 25–49 years (20.9%) compared to adolescents and youth aged 15–24 years (36.0%). Nearly 50% of youth reported using a condom sometimes or never. By district, the proportion of people aged 15 years and older who reported never using a condom, ranged from 37.7% in Thabo Mofutsanyane to 57.2% in Mangaung district.
Male circumcision
In Free State, self-reported circumcision was similar between 2017 (57.2%) and in 2022 (59.2%). In 2022, self-reported male circumcision in the province was comparable across different age groups. By district, self-reported circumcision ranged from 46.6% in Mangaung to 64.8% in Thabo Mofutsanyane. By locality, self-reported circumcision ranged from 44.6% in rural formal/farm areas to 64.2% in rural informal/tribal areas.
Self-reported circumcision among males aged 15–24 years ranged from 37.1% in Mangaung to 65.7% in Lejweleputswa; among those aged 25–34 years, from 51.9% in Mangaung to 75.4% in Thabo Mofutsanyane; and among those aged 25–49 years, from 52.5% in Mangaung to 69.2% in Thabo Mofutsanyane. The province had the second-highest proportion of medical circumcisions in the country at 72.4%.
Among circumcised males, self-reported medical circumcision was lower among those aged 25–49 years (72.4%) as compared to younger males aged 15–24 years (94.0%) and males residing in rural formal/farm areas (49.6%). Medical circumcision ranged from 63.4% in Mangaung to 71.4% in Lejweleputswa.
Willingness for voluntary medical male circumcision (VMMC) among uncircumcised men in the Free State was highest among adolescents and youth aged 15–24 years (49.7%). Among uncircumcised men aged 15–24 years, willingness was at 51.1% in urban areas and ranged from 46.5% in Lejweleputswa to 53.6% in Thabo Mofutsanyane.
Male circumcision among children aged 14 years and younger in Free State increased with age, from 0.1% among those aged 0–4 years to 23.3% among children aged 12–14 years. Male circumcision among children aged 14 years and younger was lowest in Mangaung (4.0%).
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%) except among those aged 15–24 years (88.6%) and people living in Mangaung district (87.3%).
Access to HIV testing sites
Access to HIV testing sites is important for scaling up the utilisation of HIV testing services. In the Free State, most people aged 15 years and older accessed public clinics or doctors (64.1%) or public hospitals (13.7%).
HIV testing
HIV testing is a gateway to counselling on HIV prevention and linkage to care among people diagnosed with HIV. Among female adolescents and youth (15–24 years), 53.1% had never tested for HIV. The survey shows that among male adolescents and youth (15–24 years), 51.0% were never tested. It also shows that in Mangaung, 56.8% of females had never been tested for HIV.
Awareness and uptake of Pre-exposure Prophylaxis (PrEP)
Overall, in 2022, 34.6% of sexually active adults aged 15 years and older had ever heard of PrEP, 4.8% had ever taken PrEP, and 1.7% were taking PrEP at the time of the survey. More females (41.9%) compared to males (27.9%) had ever heard of PrEP. More females (63.3%) compared to males (56.8%) were willing to use PrEP to prevent HIV.
Compared to other age groups, more adolescents and youth aged 15-24 years had ever heard of PrEP (48.8%), of those who ever heard of PrEP, 4.5% were currently taking PrEP and 64.7% were willing to take it to prevent HIV. Among districts, Thabo Mofutsanyane had the highest awareness of PrEP (45%), ever-use (9.0%) and current use (4.6%) of PrEP.
Overall, 60.5% of respondents who had heard of PrEP but had never taken PrEP reported they would consider taking PrEP to prevent HIV infection.
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 ageing 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).
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 |
Join the conversation:
#SABSSMVI
#HIV
#AIDS
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.