Decline in SA's HIV prevalence, survey shows
This translates, according to the latest data, to about 7.8 million people living with HIV in South Africa in 2022 compared to 7.9 million in 2017.
This key finding is contained in the sixth South African National HIV Prevalence, Incidence, and Behaviour (SABSSM VI) survey released on Monday, 27 November by the Human Sciences Research Council (HSRC).
The survey highlights the progress toward ending HIV in South Africa, which remains the epicentre of the HIV endemic in the world.
The HSRC’s divisional executive of the public health, societies, and belonging division, Khangelani Zuma, said several factors contribute to HIV prevalence.
“These factors include fewer people getting infected with HIV, more children born HIV-negative, Aids-related mortality, and people aging and dying from natural causes,” Zuma said.
He is also the survey’s principal investigator.
In addition, he said the increase in the population of the birth of HIV-negative babies would also increase the denominator of HIV-negative people in the country.
“The epidemic curve also shows an aging population of people living with HIV who are living longer as the epidemic stabilises,” he added.
In addition, the 2022 survey shows significant progress toward the Joint United Nations Programme on HIV and Aids (UNAids) 95-95-95 targets.
UNAids envisions that by 2025, 95% of all people living with HIV have to be aware of their HIV status, 95% of those aware of their status to be on antiretroviral treatment (Art), and 95% of those on treatment to achieve viral-load suppression.
HIV awareness and treatment advancements
Meanwhile, the survey indicated that among those aged 15 and older living with HIV in South Africa in 2022, 90% were aware of their status, 91% of those aware of their status were on Art and 94% of those on Art were virally suppressed.
“This is an improvement compared to 2017 when the UNAids target was 90-90-90 but South Africa achieved 85%-71%-87%.”
This is attributed to the change in treatment guidelines in 2016, which made provision for treatment to be given to everyone requiring HIV treatment immediately regardless of their clinical status, which previously needed to include a CD4 count below 500 cells/mm3.
The data also revealed that 81% of people aged 15 and older living with HIV were virally suppressed in 2022 compared to 62% in 2017.
Viral suppression, the HSRC noted, was higher (83%) among women when compared to men (79%) and lower (70%) among younger adults aged 15 to 24.
The lowest percentage of viral-load suppression (66%) was among men aged between 25 and 34.
According to the survey, half of all young men aged between 15 and 24 were medically circumcised compared to 43% in 2017.
“This is an important achievement as studies have shown that male circumcision can reduce the risk of heterosexual HIV transmission by approximately 60%.”
Addressing gaps
While the research indicates that progress has been made, the survey also shows gaps that remain in addressing the HIV epidemic in South Africa.
The impact of the HIV epidemic in South Africa is unequal across geographic regions and populations, particularly affecting black Africans, women, and young people.
HIV prevalence varied geographically, ranging from 8% in the Western Cape to 22% in KwaZulu-Natal among the 15-year-olds and older.
Furthermore, HIV prevalence was nearly twice as high among women (20%) compared to men (12%).
By race, HIV prevalence was the highest among black Africans (20%), followed by Coloureds (5%), and lowest among Whites and Indians/Asians (1% each).
“The most pronounced differences in HIV prevalence by sex were seen among younger populations, which calls for focused interventions,” Zuma explained.
Among females, HIV prevalence was highest in ages 35 to 39 years at 34.2%, whereas among males, HIV prevalence was highest in ages 45 to 49 years at 27.1%.
Compared to males, HIV prevalence was approximately two-fold higher in females aged 15 to 19 (5.7% versus 3.1%), and 20 to 24 years (8% versus 4%), and three-fold higher in females aged 25 to 29 (19.5% versus 6.3%).
SABSSM VI is a large cross-sectional, population-based household survey conducted from January 2022 to April 2023.
The survey marks 20 years, with the first survey commissioned and funded by former president Nelson Mandela through his foundation in 2001.
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