Kimberley, Monday, 30 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 the Northern Cape Province on Monday, 30 September 2024, at a provincial dialogue held at Kalahari Lodge, Kimberley.
The survey found that, compared to other provinces, the Northern Cape had the second-lowest HIV prevalence at 8.9% in 2022. This translates to an estimated 120,000 people living with HIV (PLHIV) in the province, which is 21,000 more PLHIV compared to 2017.
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 3.3% among those aged 15–24 years overall, and higher among females (5.0%) than males (1.8%) in this age category. Among those aged 25–49 years, HIV prevalence was 12.6% overall, and higher in females (14.9%) than males (9.6%). HIV prevalence was also higher among those residing in urban areas (9.6%) and lower among those residing in rural informal or tribal areas (7.6%) and rural formal or farms (6.2%).
“HIV prevalence peaked at 25.7% among those aged 35–39 years in 2022 compared to 26.1% in 2017 among those aged 40–44 years. HIV prevalence increased from 24.3% among 30–34-year-olds in 2017 to 25.7% among those aged 35–39 in 2022. There was a notable downward shift in the epidemic curve in 2022 among the age categories between 20–34 years,” Professor Zuma said.
As per the study protocol, data were presented for priority districts. For the Northern Cape, this was for Frances Baard district only. Data for the John Taolo Gaetsewe, Namakwa, Pixley ka Seme, and Z.F. Mgcawu districts were not presented because these districts had not been oversampled to allow for reliable estimates.
Antiretroviral treatment (ART)
Antiretroviral treatment (ART) coverage in the Northern Cape increased from 54.9% in 2017 to 86.2% in 2022. This translates to an estimated 103,440 PLHIV in the province receiving ART in 2022.
In 2022, ART use among all PLHIV in the province was 82.6% among those aged 25–49 years. Data for youth and adolescents aged 15–24 years and among males aged 25–49 years could not be analysed owing to a small sample size.
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 reveal that, in terms of progress towards the 95-95-95 UNAIDS targets, in the Northern Cape, 91.5% of PLHIV aged 15 years and older were aware of their HIV status, 94.7% of those who knew their status were on ART and 97.4% of those on ART were virally suppressed.
The survey shows that among those aged 15 years and older, the 95-95-95 target cascade was less than 90% on the first 95 target for males (86.6) and near or above 90% on all indicators for females (93.9-92.1-97.4). Among adults aged 25–49 years, the target cascade was greater than 90% (90. 9-92.0-97.3). By demographic characteristics, the Northern Cape managed to achieve the third 95 target (97.4%) and lagged behind on the first (91.5%) and second UNAIDS 95–95–95 targets (94.7%). Among all groups, the province also lagged behind in achieving the first and second 95 targets (<95%), except for those aged 50 years and older on the second 95 target (100.0%).
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 PLHIV 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 Northern Cape had the sixth-highest proportion of PLHIV with VLS (78.6%), having increased from 2017 (52.2%). VLS was 75.4% among PLHIV aged 15–49 years, and slightly similar among males (74.6%) and females (75.8%) in this age group.
Knowledge of HIV status
Professor Zuma expressed concern that PLHIV aged 25–49 years accounted for the majority of PLHIV in Northern Cape who were unaware of their HIV status (62.4%), those who were aware of their HIV status but not on ART (72.7%) and those who were on ART with no VLS (73.1%). However, adolescents and youth aged 15–24 years contribute disproportionally to gaps in treatment, accounting for just 8.1% of all PLHIV, but 11.8% of those unaware of their status, 9.1% of those aware but not on ART and 7.7% of those on ART but not virally suppressed.
People residing in urban areas accounted for majority of PLHIV and the majority of those gaps along the clinical cascade. PLHIV in urban areas were also over-represented in each gap along the clinical cascade, particularly ART. Whereas PLHIV in urban areas accounted for about 82% of all PLHIV, they accounted for 100% of those not on ART. A similar pattern was observed for both urban females and urban males.
KEY DRIVERS OF THE HIV EPIDEMIC
Sexual debut before the age of 15 years
Regarding the key drivers of the HIV epidemic, Professor Zuma noted that the Northern Cape had the second-lowest prevalence of early sexual debut among provinces. The proportion of adolescents and youth aged 15–24 years who reported having sex before the age of 15 decreased from 11.4% in 2017 to 8.0% in 2022. Sexual debut before the age of 15 years among adolescents and youth aged 15–24 years in 2022 was higher among males (10.2%) than females (5.1%).
Multiple sexual partners
The survey revealed that in the Northern Cape, 11.0% of people aged 15 years and older reported having multiple sexual partners in 2022, compared to 8.4% in 2017.
The proportion of people aged 15 years and older who reported having multiple sexual partners was 2.07-fold (11.2%) higher among males compared to females (5.4%). The proportion who reported having multiple sexual partners was highest in urban areas (9.2%). The prevalence of multiple sexual partners was 10.5% in Frances Baard.
Condom use with the most recent sexual partner
Regarding condom use, the survey revealed that in the Northern Cape, 30.4% reported using a condom with their most recent sexual partner in 2022, compared to 39.9% in 2017. Condom with their most recent sexual partner among people aged 15 years and older was higher among males (34.9%) than females (25.7%) and lower among those aged 25–49 years (27.8%) compared to those aged 15–24 years (64.3%). Condom use was substantially lower among those residing in rural formal/farm areas (14.6%) compared to those living in urban areas (32.0%). Condom use with their most recent sexual partner among people aged 15 years and older was 40.2% in Frances Baard.
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 Northern Cape, a higher proportion (52.3%) also reported that they had never used a condom with their most recent sexual partner. Only 7.6% reported that they had used condoms almost every time.
Consistency of condom use with their most recent sexual partner among people aged 15 years and older in the province was lowest among those aged 25–49 years (15.0%) compared to adolescents and youth aged 15–24 years (41.2%). However, less than 50% of adolescents and youth reported using a condom sometimes or never using a condom. Consistency of condom use with the most recent sexual partner among people aged 15 years and older was 22.3% in Frances Baard.
Male circumcision
In the Northern Cape, self-reported circumcision decreased from 39.2% in 2017 to 35.6% in 2022. The survey shows that in 2022, self-reported male circumcision in the province was lower among those aged 15–24 years (37.6%) compared to other age groups and highest among those residing in rural informal/tribal areas (41.3%).
The survey further shows that among circumcised males, the majority (60.0%) reported having had a medical (performed by a healthcare provider) circumcision. The Northern Cape had the third highest proportion of medical circumcisions in the country at 71.4%. However, self-reported medical male circumcision was lower among those aged 25–49 years (74.6%). Medical male circumcision was 74.6% in the Frances Baard.
Male circumcision among children aged 14 years and younger in the Northern Cape increased with age, ranging from 1.3% among those aged 0–4 years to 24.1% among children aged 12–14 years. Male circumcision among children aged 14 years and younger was 9.7% in Frances Baard.
HIV testing
HIV testing is a gateway to counselling on HIV prevention and linkage to care among people diagnosed with HIV. The survey shows that, in 2022, awareness of HIV testing sites by selected demographic variables among people aged 15 years and older in the province was generally high. However, awareness was modestly lower among males (89.6%) as compared to females (91.5%) and lower among adolescent and youth aged 15–24 years (89.1%) compared to those aged 25–49 years (93.6%).
Awareness and uptake of Pre-exposure Prophylaxis (PrEP)
Overall, in 2022, 22.7% of sexually active adults aged 15 years and older had heard of PrEP, of whom 0.7% had taken PrEP. None of those were taking PrEP at the time of the survey (0.0%). More females (24.9%) compared to males (19.9%) had heard of PrEP, and had ever taken PrEP (1.3% of females vs. 0.0 of males). Willingness was fairly similar among males (85.4%) and females (86.9). Compared to other age groups, more of those aged 25–49 years had heard of PrEP (25.9%) and 90.2% of those who knew about it were willing to take it to prevent HIV infection. None of them (0.0%) were taking it at the time of the survey. Overall, about 86.3% 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 |
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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.