For immediate release
Polokwane, Tuesday, 27 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 Limpopo Province on Tuesday, 27 August 2024 at a provincial dialogue held at Meropa Hotel, Polokwane.
The survey found that Limpopo had one of the lowest HIV prevalence levels among all provinces in 2022, at 8.9%, down from 10.1% in 2017. This translates to an estimated 570,000 people living with HIV (PLHIV) in Limpopo, a 2.0% decrease from the 580,000 reported in 2017.
The findings also showed that in 2022, HIV prevalence in the province was disproportionately higher among the 25–49 age group, with females recording a prevalence of 22.3% and males 17.0%. Moreover, HIV prevalence was high, 7.4% among individuals living in rural formal or farm areas. Notably, females consistently showed a higher HIV prevalence across all selected demographic variables compared to their male counterparts.
According to the overall principal investigator of the study, the HSRC’s Prof Khangelani Zuma, the survey reveals that the HIV epidemic profile peaked at an HIV prevalence of 29.4% among individuals aged 50–54 years in 2022, down from a peak of 36.9% in 2017 among those aged 40–44 years. “There was a decrease in HIV prevalence in 2022, except among those aged 0–14 years, 35–39 years, and 50–54 years, compared to 2017,” Prof Zuma noted.
The data presented are for three Limpopo districts, namely Vhembe, Capricorn, and Mopani, as per the study protocol. Data for the Waterberg and Greater Sekhukhune districts are not presented here because these districts were not oversampled, which is necessary for representative and reliable estimates. Among the three districts, the highest HIV prevalence was in Mopani (9.0%).
Antiretroviral treatment (ART)
Limpopo’s antiretroviral treatment (ART) coverage estimates closely mirror the national estimates, increasing to 80.8% in 2022 from 62.8% in 2017. This translates to an estimated 430,000 people living with HIV in the province receiving treatment in 2022, up from 290,000 in 2017.
ART use among all people living with HIV in the province was 80.8%, with males (73.1%) having lower coverage than females (84.0%). Additionally, ART coverage was lower among those residing in urban areas (79.7%) than in other localities. The lowest ART use was reported in Vhembe (76.4%), followed by Capricorn (80.8%).
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, 88.6% of people living with HIV in Limpopo, aged 15 years and older, were aware of their HIV status. Of those, 90.5% were on ART, and 90.9% of those on ART were virally suppressed. Nationally, the 2022 survey estimated that 89.6% of people living with HIV, aged 15 years and older, were aware of their HIV status. Of those, 90.7% were on ART, and 93.9% of those on ART were virally suppressed.
The survey shows that Limpopo is lagging on all UNAIDS 95–95–95 targets and also marginally less than the national average, with percentages of 88.6%, 90.5%, and 90.9%, respectively, by demographic characteristics. However, two groups exceeded the third 95 target: those aged 50 years and older (97.2%) and those residing in urban areas (97.1%).
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, Limpopo had one of the lowest proportions of people living with HIV who achieved viral load suppression (VLS) at 77.0%, up from 60.8% in 2017. Notably, VLS was slightly lower among females (76.6%) than males (77.8%), with a more significant disparity in rural informal or tribal areas, where females achieved VLS at a rate of 75.2% compared to males at 83.9%. Low levels of VLS are concerning in that there is a high risk of HIV transmission during unprotected sexual acts with a person who is virally unsuppressed.
Knowledge of HIV status
Prof Zuma expressed concern that people living with HIV aged 25–49 years make up the majority of those in Limpopo Province who are unaware of their HIV status (65.0%), aware but not on ART (63.3%), and on ART but not virally suppressed (65.9%). However, he noted that adolescents and youth aged 15–24 years disproportionately contribute to gaps in treatment, comprising only 4.8% of all people living with HIV, yet accounting for 15.0% of those unaware of their status, 13.3% of those aware but not on ART, and 11.4% of those on ART but not virally suppressed.
A similar pattern exists among males and females. Among females, those aged 15–24 years account for a minority of female people living with HIV (4.0%). Yet, they make up a disproportionate percentage of those who do not know their status (13.3%), are not on ART (8.7%), or are not virally suppressed (9.4%). Similarly, males aged 15–24 years account for just 6.9% of all males living with HIV, but a significant percentage of those who are unaware of their HIV status (20.0%), aware but not on ART (28.6%), and on ART but not virally suppressed (16.7%).
The survey also revealed that people residing in rural informal areas comprise the majority of people living with HIV (49.5%). However, people living with HIV in urban areas make up the majority of those who are unaware of their status (47.8%) and those who are aware but not on ART (45.5%). In contrast, people residing in rural informal areas account for the majority of those who are on ART but not virally suppressed (46.4%). A similar pattern was observed among females.
The survey further revealed that, among all districts, Mopani has the largest proportion of people living with HIV (28.0%). However, Capricorn has the highest proportion of people living with HIV who are unaware of their HIV status (30.4%), those who are aware but not on ART (33.3%), and those on ART but not virally suppressed (27.7%).
KEY DRIVERS OF THE HIV EPIDEMIC
Sexual debut before the age of 15 years
Regarding the key drivers of the HIV pandemic, Prof Zuma noted that in Limpopo, the proportion of adolescents and youth aged 15–24 years who reported having sex before the age of 15 years decreased to 8.7% in 2022 from 13.5% in 2017.
In 2022, the percentage of adolescents and youth aged 15–24 years who had their sexual debut before the age of 15 years was higher among males (14.0%) compared to females (3.1%). This percentage varied by district, with the lowest rate in Capricorn (4.8%) and the highest rate in Vhembe (12.9%).
Multiple sexual partners
The survey revealed that in Limpopo, 11.4% of people aged 15 years and older reported having multiple sexual partners in 2022, a decrease from 12.0% in 2017. Notably, males (18.5%) were 3.7 times more likely to report having multiple sexual partners than females (5.0%). The highest proportion of multiple sexual partners was found among those aged 15–24 years (15.8%), compared to other age groups.
Urban and rural informal or tribal areas had similar proportions, at 12.0%, the highest across localities. Vhembe district had the highest proportion of people reporting multiple sexual partnerships at 14.4%. Nationally, 8.9% of people reported having multiple sexual partners in 2022, a decline from 10.8% in 2017.
Condom use with the most recent sexual partner
Regarding condom use, the survey found that in Limpopo, 29.8% of people reported using a condom with their most recent sexual partner in 2022, a decline of 11.8% from 41.6% in 2017. Condom use was lower among certain groups, including those aged 25–49 years (28.7%) and females (25.4%). Condom use varied by district, ranging from 28.3% in Mopani to 35.5% in Vhembe among people aged 15 years and older.
Nationally, more than 70.0% of individuals aged 15 years and older reported either never or sometimes using a condom with their most recent sexual partner. In Limpopo, a higher proportion (53.0%) reported never using a condom with their most recent sexual partner, while only 4.4% reported using a condom almost every time.
The consistency of condom use with the most recent sexual partner among people aged 15 years and older in the province was higher among adolescents and youth aged 15–24 years (31.7%) compared to those aged 25–49 years (19.0%). However, nearly 60% of adolescents and youth aged 15–24 years reported using condoms only sometimes or never.
The consistency of condom use every time with a partner was similar in urban and rural formal or farm areas (16.9%). The consistency of condom use every time with the most recent sexual partner among people aged 15 years and older varied by district, ranging from 17.4% in Mopani to 29.1% in Vhembe.
Male circumcision
In Limpopo, the self-reported circumcision rate increased from 81.3% in 2017 to 87.7% in 2022. However, self-reported male circumcision in the province was lower among those aged 25–49 years (85.5%) compared to other age groups. The lowest circumcision rates were found among those residing in rural formal or farm areas (72.2%) and in Mopani district (82.6%).
Regionally, self-reported circumcision rates varied by age group and district. Among males aged 15–24 years, circumcision rates ranged from 95.2% in Capricorn to 98.4% in Vhembe. For those aged 25–34 years, rates ranged from 79.6% in Mopani to 88.5% in Capricorn. Among older males aged 25–49 years, circumcision rates ranged from 72.4% in Mopani to 96.4% in Vhembe district.
In Limpopo, the proportion of medical circumcisions was less than 50%. Self-reported medical circumcision was lower among males aged 25–49 years (46.0%) compared to other age groups. It was also lower in rural formal areas (27.8%) than in other localities. The proportion of medical circumcision varied by district, ranging from 45.3% in Mopani to 60.3% in Capricorn.
Male circumcision among children aged 14 years and younger in Limpopo increased with age, from 2.4% among those aged 0–4 years to 78.0% among those aged 12–14 years. However, circumcision rates among children in this age group were lowest in the Capricorn district, at 22.4%.
Awareness of HIV testing sites
Awareness of HIV testing sites is crucial for accessing HIV testing services. According to the survey, in 2022, awareness of HIV testing sites among people aged 15 years and older in the province was generally high. However, awareness was significantly lower among adolescents and youth aged 15–24 years, at 89.6%, compared to other age groups.
Awareness and uptake of pre-exposure prophylaxis (PrEP)
In 2022, a survey found that 24.5% of sexually active adults aged 15 years and older were aware of PrEP (pre-exposure prophylaxis), with 2.2% having used it. Of those who had used PrEP, 0.8% were still taking it at the time of the survey. Notably, more females (26.5%) than males (21.6%) were aware of PrEP and willing to use PrEP to prevent HIV (65.8% versus 44.4%).
Adolescents and youth aged 15–24 showed the highest awareness of PrEP (33.1%), with 4.4% currently taking it and 70.4% willing to take it. Overall, 58.3% of respondents who knew about PrEP expressed willingness to consider taking it to prevent HIV infection. The highest current use of PrEP was reported in Vhembe District.
Access to HIV testing sites
Access to HIV testing sites is crucial for increasing the utilisation of HIV testing services. According to the survey, in Limpopo, the majority of people aged 15 years and older (59.7%) accessed public clinics or doctors for HIV testing, making it the most common entry point for testing.
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 that addressing health inequalities and targeting specific districts and localities with higher HIV prevalence, lower ART uptake coverage, and low viral suppression is crucial for effective programme planning and implementation in the province.
“We also recommend that HIV prevention and management targeted interventions, which foster a sustained reduction in HIV prevalence over time, should be continuously strengthened,” concluded Prof 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:
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 r esearch activities and structures are closely aligned with South Africa’s national development priorities.