The percentage of people living with HIV in South Africa has barely changed in the last six years, but new data released on Tuesday revealed that between 2002 and 2008 there were many changes in HIV knowledge, risk behaviour and testing habits.
The third national HIV prevalence, incidence and communication survey, conducted in 2008 by the Human Sciences Research Council (HSRC), in conjunction with the Medical Research Council (MRC) and the Centre for AIDS Development, Research and Evaluation (CADRE), has given researchers the first real opportunity to study trends in HIV prevalence and risk behaviour. Previous surveys were conducted in 2002 and 2005.
The findings, based on interviews with about 21,000 individuals, 15,000 of whom agreed to anonymous HIV tests, give a fairly detailed picture of South Africa's mixed success in fighting the largest HIV epidemic in the world.
Prevalence appears to have stabilized at about 11 percent, and infection rates among children and teenagers have decreased, but have increased slightly in adults over the age of 25.
Olive Shisana, CEO of the HSRC and one of the survey's principal investigators, noted that African women aged 20 to 34, remained the group most at risk with a stubbornly high HIV prevalence of nearly 33 percent; men aged between 25 and 49, with an infection rate of 24 percent, have the second highest risk profile.
HIV infection in the country's nine provinces still varies widely. KwaZulu-Natal, which has consistently carried the highest burden, now has a prevalence of 26 percent in the 15 to 49 age group, up from 22 percent in 2005; in Western Cape, levels increased slightly from 3 percent in 2005 to 5 percent in 2008, but are still the lowest in the country.
The 2008 study provides the first national prevalence figures for high-risk groups such as heavy drinkers, drug users and men who have sex with men; of these, people with disabilities and heavy drinkers were found to be most at risk, with both groups having a prevalence of about 14 percent.
Professor Thomas Rehle of the HSRC, another of the study's principal investigators, noted that the figures could be "masking some success stories", as the country's growing antiretroviral (ARV) treatment programme may have reduced AIDS-related deaths, thereby increasing the total number of people living with HIV.
This will become clearer when data on new HIV infections, or incidence of the disease, become available later in the year, but the estimated incidence among young people, based on prevalence, showed a substantial drop since 2005, particularly among teenagers.
In recent years, researchers have identified intergenerational sex, particularly between younger women and older men, and having multiple sexual partners at the same time, as major drivers of the HIV epidemic in southern Africa.
|Young men have made a decision that they're going to run around, but that they're going to use a condom|
The HSRC survey found that prevention efforts in South Africa were having little or no impact on either of these risky behaviours: the percentage of girls aged 15 to 19 who had had a partner at least five years older rose steeply from 18.5 percent in 2005 to nearly 28 percent in 2008; the number of men aged 15 to 24 who reported having more than one sexual partner in the last 12 months increased from 27 to 31 percent.
Worryingly, since 2005 accurate knowledge about how HIV is transmitted had decreased significantly in all age groups. One researcher noted that "There seemed to be an acceptance of multiple partners, especially among the youth," and that respondents found it hard to grasp the link between multiple partners and increased HIV risk.
Shisana said these disturbing trends were somewhat offset by a significant uptake in condom use, particularly among young men, 87 percent of whom reported using a condom at last sex. "I think young men have made a decision that they're going to run around, but that they're going to use a condom," she said.
Other encouraging findings were that more South Africans had been tested for HIV (about half of all respondents in 2008 compared to 30 percent in 2005) and that national HIV communication programmes had achieved a broader reach.
The researchers recommended targeted interventions to address intergenerational sex and multiple partners, particularly in hard-hit provinces, and that routine HIV testing, with the option of refusal, should be made available at all health care facilities currently offering voluntary counselling and testing.
"As a country, we can do much better," commented the new health minister, Aaron Motsoaledi. "We have spent a lot of time fighting each other," he said, referring to the history of conflict between government and civil society on HIV/AIDS during former President Thabo Mbeki's tenure. "I'm quite sure that time is over now and instead we're going to fight this disease."