15 June 2009
The latest survey by the Human Sciences Research Council finds that South Africa’s HIV/Aids epidemic is stabilising, with signs of declining prevalence among the country’s children and teenagers.
According to the National HIV Prevalence, Incidence and Communication Survey conducted in 2008, the prevalence of HIV/Aids in the country has levelled off at 10.9% for people aged two and older.
There were an estimated 5.2-million people living with HIV in the country in 2008, according to the survey, which was conducted between June 2008 and March 2009. It is the third in a series of national population-based surveys conducted to help monitor the country’s response to the epidemic.
South Africa is currently implementing the largest antiretroviral treatment programme in the world.
The research revealed that HIV prevalence among adults aged 15 to 49 has declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape percent and the Free State, with the largest decline being by 7.9% in the Western Cape.
The survey also revealed that the percentage of South Africans aged between 15 and 49 who reported awareness of their HIV status has almost doubled, from 21.4% in 2002 to 50.8% in 2008.
The report attributed this to improved communication and awareness programmes, coupled with and a substantial increase in the availability of voluntary counselling and testing services.
The study also showed a reduction in new infections among teenagers aged 15 to 19 years, with new infections among South Africans under 20 declining from two percent in 2002 to 1.7% in 2008.
Change in behaviour
Speaking to BuaNews, HSRC research specialist Nompumelelo Zungu said the change in behaviour among the country’s teenagers was encouraging.
She noted that an increased number of people reported to have tested for HIV, meaning that up to half of the population was aware of their status.
“This is good news, as it says that those campaigns that promote HIV testing are beginning to make progress,” Zungu said. “However, there is room for improvement, in that we still have those that do not know their status, and we recommend that the country implement provider-initiated routine HIV testing in all health care facilities.”
HIV prevalence by sex and age remains high within the age group 25 to 29, at 15.7% of males and 32.7% of females. The prevalence also remains high within the 35 to 39 age group, at 18.5% of males and 24.8% of females.
However, HIV prevalence has declined among children aged between 2 and 14, from 5.6% in 2002 to 2.5% in 2008.
Interventions that could have contributed to this include efforts to address HIV in early childhood, and programmes to prevent mother-to-child transmission in areas such as the Western Cape, where the largest decline, of six percent, was recorded.
Zungu pointed out that the country had various HIV interventions that were reaching different target groups, and thus one could not attribute the success to one particular intervention.
Increased condom usage
The report also found that the proportion of the population who reported using a condom during their last sexual encounter was particularly high among youngsters aged 15 and 24 years, increasing among males from 57% in 2002 to 87% in 2008, and among females from 46% to 73%.
According to the report, there was a substantial increase in condom use among people aged 25 to 49 years, with condom use by males increasing from 26.7% in 2002 to 56.4% in 2008, while female use increased from 19.7% in 2002 to 58.1% in 2008.
Among people aged 50 years and above, condom use by males increased from 8.2% in 2002 to 39.9% in 2008 and from 5.3% to 25.9% in females.
Zungu said the increase in condom use, especially among the 15- to 24-year group, indicated that young people were beginning to heed the messages of programmes promoting condom use.
“It also says that condoms are available to young people and they are using them,” she said.
Targeted communication programmes
There was also an increase in the population reached by at least one national HIV communication programme between 2005 and 2008, with 90% of youngsters reporting that they had been reached by at least one programme, as compared to 74% in 2005.
However, the report noted several challenges, including the continued rise in HIV prevalence among adults in KwaZulu-Natal and the Eastern Cape as a result of a decline in HIV prevention knowledge, and the low reach of the Khomanani campaign as compared to other Aids awareness programmes.
Zungu suggested a review of the programme to identify strengths and weakness and then come up with a clearer targeting of different population and risk groups using research evidence to support the interventions or communication content and strategy.
“Most of the interventions have targeted the youth and because of this many older people believe that they are not at risk of HIV because until recently the statistics suggested that HIV prevalence was high among youth,” she said.
“There should be focussed interventions to increase awareness in this age group 50 and above, interventions for the above 50 group should be comprehensive and socio-culturally relevant to ensure that the interventions implemented address the risks faced by this group in a relevant manner. For example, in this age group, one is likely to find widows and divorcees.”
She emphasised that it might be important to equip people who have not been dating for a long time with skills to negotiate safe sex using a condom and also address the issue of “sugar daddies” and “sugar mummies” in the younger age group.
The report also noted inter-generational sex and multi concurrent sexual partners as a challenge, with a persistent high level of HIV prevalence among females, aged 25 and 29, over the period of three surveys and an increase of inter-generational sex among female teenagers aged 15 and 19 increased from 9.6% to 14.5%.
According to the report, HIV prevalence in males aged 15 and 49 having more than one sexual partner in the past year increased from 9.4% in 2002 to 19.3% in 2008, while with females the increase was from 1.6% to 3.7%.
Zungu said this was even more so for women who are poor and dependant on males for financial support. “Power dynamics and gender dynamics remain at the core of our epidemic, intergenerational sex and age mixing remains an important social determinant of HIV infection,” she explained.
She noted that ways to protect women from being infected by HIV/Aids because they wanted to have children, needed to be found.
She also noted that there has been an increase in the number of people who report to have multiple partners, especially among 15 to 24-year-old males.
“To protect women, we need to spend more time addressing our social values and begin to be vocal about the dangers inherent in multiple sexual relationships.
“Data shows that having a partner who is much younger than you may expose you to a higher risk for HIV in that the younger person belongs to a different age group and HIV prevalence in that group might be higher.
“We need to discourage inter-generational sex or age mixing and especially multiple sexual partnerships,” Zungu said.
The report recommended a need to target intervention programmes, particularly in KwaZulu-Natal and the Eastern Cape; a need for programmes to help people have children without risking HIV infection and programmes to address high sexual partner turnover and intergenerational sex by changing community norms.
The report also recommended the implementation of anti-multiple and inter-generational sexual partnerships and the implementation of provider-initiated routine HIV testing in all health care facilities.