HIV/Aids: things we should know
1 December 2005
A major new study on HIV/Aids makes a number of findings that South Africans should know about. These include findings on how pregnancy, breastfeeding and male circumcision can affect HIV transmission, and on the importance of periodic HIV testing.
But the key finding is this: if you think that you, or your children, are not at risk of contracting HIV, the chances are you're wrong.
The study, which estimates that 10.8% of South Africans are HIV-positive, found that young South African women, and people in poorer communities, are particularly vulnerable to HIV/Aids - but that South Africans in general fail to appreciate the risks posed by the epidemic.
Key findings of the report, all of which have implications for HIV/Aids communication campaigns in South Africa, include the following:
- South Africans suffer from a "false sense of security" regarding HIV/Aids.
- The stigma attached to HIV/Aids is becoming less of a factor in South Africa.
- There is an increased risk of contracting HIV during pregnancy.
- Periodic HIV testing is crucial to HIV/Aids prevention and treatment.
- HIV prevalance among children is significant, and affected both by prolonged breastfeeding of infants and poor supervision of children.
- Sex at a young age, high partner turnover and concurrent sexual partnerships are significant factors in HIV transmission in South Africa.
- Safe male circumcision offers significant, but not complete, protection.
Half of the respondents in the study who were found to be HIV-positive - over two million people - did not think they were at risk of HIV infection, and hence were unaware of their risk of infecting others.
The study recommends that HIV/Aids campaigns and programmes address "this false sense of security in the general population, with a particular emphasis on encouraging people to go for voluntary testing and counselling".
Aids stigma on the decrease
The survey found that an overwhelming majority of South African are willing to care for an Aids patient, and that nearly half of South Africans of 15 years and older do not think it is wrong to marry a person with HIV.
"These results suggest that South Africans are accepting HIV/Aids as a reality in South Africa, and that stigmatisation in society is becoming less of a factor, especially in urban areas." The study recommends that service providers capitalise on this by encouraging people to undergo counselling and testing, and to disclose their HIV status to their partners.
Increased risk during pregnancy
The study confirmed recent findings from other studies that suggest an increased risk of HIV acquisition during pregnancy, and recommends that awareness campaigns aimed at pregnant women and would-be parents be undertaken on a national scale.
These campaigns, the report said, should encourage people to plan their pregnancy, to get tested for HIV before trying to conceive, and to disclose their results to their partners.
Periodic HIV testing crucial
Despite a well-established voluntary counselling and testing service in South Africa, and despite the fact that most respondents in the survey knew of a place to be tested, many of those found to be HIV-positive had not been tested.
"Knowledge of HIV status is a critical aspect of prevention as it is linked to motivation to prevent HIV infection of others," the report said. "It also serves as an entrée into seeking treatment for opportunistic infections and receiving antiretrovirals in the case of advanced HIV infection."
The study recommends encouraging periodic HIV testing for men and women in stable partnerships. It adds that, given the extremely high HIV incidence among South African women aged 15–24, Aids campaigns and programmes "should sensitise this young female group to the fact that the risk of HIV is real".
While the survey recorded a substantially lower HIV prevalence among children aged 2-14 (3.3% in 2005 compared to 5.6% in 2002), the epidemic remains "significant" among South African children, with an estimated 5.1% of children aged 2-4 and 4.4% of children aged 5-9 living with HIV.
Most of the HIV-positive children aged 2-4 years are likely to have been infected "through mother-to-child transmission or during prolonged breastfeeding," the HSRC said.
However, the study also found that 6% of all recent HIV infections in South Africa occurred in children aged 2-14, with 3.3% occurring in children aged 5-9. "These infections cannot be clearly linked to mother-to-child transmission, and could include child sexual abuse or infection through the healthcare system.
"Other findings suggest that many South African children are left unsupervised for much of the time, including going to and from school and being sent on errands alone - practices which could expose children to sexual abuse."
The study recommends that HIV prevention campaigns include messages on increasing supervision of children. It also recommends that the government review its "baby friendly" breastfeeding policy, encouraging HIV-positive women not to breastfeed their children but to supply them with a breast milk substitute instead.
Sexual lifestyle issues
A high number of sexual partners, regular turnover of sexual partners, and concurrent sexual partnerships pose significant risks for HIV infection. Over a quarter of South African men aged 15-24 had more than one partner in the past 12 months, the study found.
The study also found that young South African women are more likely to have male partners who are at least five years older. "Older men have a higher HIV prevalence than younger men, and therefore young women with older male partners increase their chances of getting HIV."
The study recommends that prevention campaigns and programmes emphasise these aspects of risk, and that sexually active people should:
- Avoid engaging in unprotected sex with anyone whose HIV status they do not know.
- Access and consistently use condoms to protect themselves in every sexual encounter with non-regular partners.
- Avoid frequent partner turnover and concurrent sexual partnerships.
A high HIV prevalence among South Africans aged 50 years and older (5.8%) calls for the development of targeted interventions for this age group, the study finds, "as they are considerably less aware of national HIV/Aids campaigns and programmes and have generally poorer knowledge of key aspects of HIV prevention and other aspects of HIV/Aids".
Safe male circumcision
A recent study in Orange Farm in Gauteng found that safe male circumcision can offer males at least 60% protection from HIV infection.
The HSRC study recommends that safe male circumcision be encouraged by the public health sector, medical insurance schemes and women as one effective way of slowing the spread of HIV infection.
At the same time, the study warns that male circumcision does not completely prevent HIV acquisition, and that it remains crucial for circumcised men to practise safe sex.