For immediate release
East London, Thursday, 15 August 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 the Eastern Cape province on 15 August 2024 at a provincial dialogue held at the East London Premier Hotel ICC.
The survey found that HIV prevalence in the Eastern Cape between 2017 and 2022 seems to have stabilised from 15.9% in 2017 to 13.7% in 2022. This translates to approximately 980,000 people living with HIV in the province, down from 1,000,000 in 2017.
The findings revealed that in 2022, HIV prevalence in the province was highest among individuals aged 25–49 years (27.7%), with females (35.4%) and males (17.1%) in the same age group being disproportionately affected. Among males, HIV prevalence was highest in urban areas (8.7%), while among females, it was highest in rural informal or tribal areas (19.8%).
According to the overall principal investigator of the study, the HSRC’s Prof Khangelani Zuma, the survey shows that the HIV prevalence peaked at 34.8% among those aged 40-44 years in 2022, down from a peak of 39.8% in 2017 among those aged 35-39 years. “This indicates a decline in HIV prevalence in 2022 across the following age groups: 0-35 years and 45-59 years, with the exception of the peak among those aged 40-44 years and 60 years and older.”
The data also presented results for six priority districts within the province: Alfred Nzo, Amathole, Buffalo City, Chris Hani, Nelson Mandela Bay, and OR Tambo. The survey found that in 2022, HIV prevalence was highest in Chris Hani (14.4%), followed by Amathole (14.1%), Alfred Nzo (13.9%), and Nelson Mandela Bay (9.7%). The HIV prevalence data for Joe Gqabi and Sarah Baartman were not reported due to insufficient data.
Nationally, current use of antiretroviral treatment (ART) among all people living with HIV increased to 80.9% in 2022 from 63.7% in 2017. The Eastern Cape recorded an increase in ART coverage, from 67.8% in 2017 to 83.5% in 2022. This translates to an estimated 723,000 people living with HIV in the province receiving ART in 2022. The survey further shows that in 2022, ART use among all people living with HIV in the province was 70.9% among adolescents and youth aged 15–24 years, and 84.8% among those aged 25–49 years. Among females, ART coverage was substantially lower among those aged 15–24 years (68.7%) compared to those aged 25–49 years (88.2%).
In terms of districts, ART use was lowest in Nelson Mandela Bay (69.4%) and Buffalo City (79.4%), and highest in Alfred Nzo (92.0%).
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.
The data shows that, in terms of progress towards the 95-95-95 UNAIDS targets, 93.7% of people living with HIV aged 15 years and older were aware of their HIV status; of these, 88.3% were on ART, and of those on ART, 90.3% were virally suppressed. It further shows that, among those aged 15 years and older, the 95-95-95 target cascade was less than 90% across all indicators for males (89.3-87.6-85.9) and near or above 90% for females (95.1-88.4-91.5). Adolescents and youth aged 15–24 years lagged significantly behind on the first 95 target, with 81.4% aware of their status, compared to 94.8% of those aged 25–49 years. In the districts, progress towards the 95-95-95 targets ranged from 79.5-84.3-78.6 in Nelson Mandela Bay to 98.4-93.7-91.6 in Alfred Nzo.
Nationally, progress towards the 95-95-95 targets improved, with 89.6% of people living with HIV knowing their status. Of those who knew their status, 90.7% were on treatment, and of those on treatment, 93.9% were virally suppressed. Improvement across the 95-95-95 indicators was more pronounced in males than in females.
The survey further found that in the Eastern Cape, the proportion of people living with HIV with Viral Load Suppression (VLS), was 79.3% in 2022, which was an increase from 66.3% in 2017. However, VLS was 61.4% among children aged 0–14 years. Among people living with HIV aged 15-49 years, VLS was 78.6%, but substantially lower among males (65.4%) compared to females (83.9%) in this age group. Nationally, the survey found that 81.4% of all people living with HIV were virally suppressed.
Prof Zuma said it is concerning that people living with HIV aged 25–49 years account for the majority of people living with HIV in the Eastern Cape who are unaware of their HIV status (61.2%), aware but not on ART (63.3%), and on ART with no VLS (65.6%). “However, adolescents and youth aged 15–24 years contribute disproportionately to gaps in treatment, accounting for just 9.6% of all people living with HIV, but 22.4% of them are unaware of their status, 18.3% are aware but not on ART, and 13.8% are on ART with no VLS,” he said.
Female adolescents and youth aged 15–24 years account for a minority of female people living with HIV (11.3%), but a relatively larger proportion of those who do not know their HIV status (31.4%), are not on ART (24.2%), or are on ART but not virally suppressed (18.7%).
Focusing on the key drivers of the HIV pandemic, Prof Zuma indicated that the Eastern Cape had the highest prevalence of early sexual debut among provinces in 2022.
“The proportion of adolescents and youth aged 15–24 years who reported having sex before the age of 15 years remained unchanged from 2017 (15.8%) to 2022 (15.3%). In 2022, sexual debut before the age of 15 years among adolescents and youth aged 15–24 years was higher among males (21.7%) than among females (9.5%),” said Prof Zuma. Among districts, early sexual debut ranged from 8.7% in Nelson Mandela Bay to 18.9% in Buffalo City.
Other key drivers included having multiple sexual partners. In the province, 11.9% of people aged 15 years and older reported having multiple sexual partners in 2022, compared to 10.9% in 2017. Among people aged 15 years and older, the proportion of males who reported having multiple sexual partners was threefold higher (17.9%) compared to females (5.5%). The proportion of people who reported having multiple sexual partners was highest in rural informal or tribal areas (13.6%). By district, the prevalence of multiple sexual partners was highest in Alfred Nzo (15.2%) and OR Tambo (15.2%), and lowest in Nelson Mandela Bay (7.0%).
With regard to condom use, in the Eastern Cape, 34.7% of respondents reported using a condom with their most recent sexual partner in 2022, compared to 38.1% in 2017. Condom use was substantially lower among those residing in rural formal or farm areas (18.0%) compared to urban areas (35.6%). However, nearly 60% of adolescents and youth reported using a condom sometimes or never. The consistency of condom use with the most recent sexual partner among people aged 15 years and older was highest in Nelson Mandela Bay (65.5%) and lowest in Amathole (38.7%).
In this province, the self-reported circumcision rate was 80.5% in 2017 and 77.2% in 2022. However, the province had the lowest proportion of medical male circumcisions in the country, at 14.3%.
Knowledge (30.9%) and use (2.5%) of HIV pre-exposure prophylaxis (PrEP) were universally low; however, willingness to take PrEP was high (70.3%).
The survey recommends key actions to address the HIV epidemic as a public health threat in South Africa by 2030. These include developing a long-term strategy to care for individuals in an aging HIV population. Professor Zuma recommends addressing health inequalities and combining prevention strategies to address specific areas of concern regarding HIV prevalence and treatment rates at the district level.
“We also recommend enhancing prevention efforts that target groups disproportionately affected by the drivers of HIV infection, such as women and young people. Furthermore, we recommend enhancing accurate public awareness of effective HIV prevention measures, including regular HIV testing, condom use, and PrEP,” concluded Prof Zuma
The survey was conducted by the HSRC 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: https://hsrc.ac.za/sabssm-vi-provincial-dialogue-eastern-cape-media-pack/
Ends.
For media enquiries:
| Dr Lucky Ditaunyane Cell: 0832276074 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. Research activities and structures are closely aligned with South Africa’s national development priorities.