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South Africa must step up HIV prevention: report

2 April 2014

While South Africa is on the right track when it comes to HIV treatment, testing and prevention of mother-to-child transmission, the country needs to step up its prevention efforts in order to curb the high rate of new HIV infections, according to the latest report on national HIV prevalence, incidence and behaviour.

Released in Pretoria on Tuesday by Health Minister Aaron Motsoaledi and Science and Technology Minister Derek Hanekom, the South African National HIV Prevalence, Incidence and Behaviour Survey 2012 found that an estimated 6.4-million South Africans were living with HIV/Aids in 2012.

This represented an increase in the country's estimated overall prevalence of HIV from 10.6% in 2008 to 12.2% in 2012. And with over 400 000 new HIV infections occurring in 2012, South Africa ranks first for HIV incidence in the world.

The 2012 survey is the fourth in the series of national HIV household surveys conducted by a consortium of scientists led by the Human Sciences Research Council (HSRC), including the Medical Research Council, both statutory research agencies.

World's largest antiretroviral treatment programme

According to the survey, the increased prevalence of HIV is due not only to new infections, but also to successfully expanded antiretroviral treatment (ART) programme, which has had a major impact on the survival of people living with HIV. Over 2-million South Africans were on ART by mid-2012, the survey found, suggesting that the country is on its way towards universal access to treatment.

"South Africa is currently implementing the largest antiretroviral treatment programme in the world. This is a very positive development," one of the study's four principal investigators, Professor Thomas Rehle, said in a statement. "Unfortunately, with over 400 000 new HIV infections occurring in 2012, South Africa also ranks first in HIV incidence in the world. There is a need to balance treatment and prevention efforts in the country."

HSRC chief executive Olive Shisana, another principal investigator, said the disproportionately high HIV prevalence among South African women and unmarried cohabiting couples "require a rethinking of conventional approaches of HIV prevention towards strategies that address the underlying socio-cultural norms in the affected communities".

The HIV incidence rate among South African women was of particular concern, the study found. Among young women aged 15-24 years, this was over four times higher than for young men in the same age group. And with an HIV incidence rate of 4.5%, black African women aged 20-34 years had the highest HIV incidence of all the country's population groups.

Increases in some risky sexual behaviours

Compared with 2008 data, there were trends for a decline in condom use in all age groups, except for the 50 years and older group, and an increase in multiple sexual partnerships among sexually active people aged 15 years and older in 2012.

In addition, over three-quarters (76.5%) of survey respondents aged 15 years and older believed that they were at low risk of acquiring HIV infection. One in 10 of these people were already infected without knowing it. Furthermore, the overall knowledge about how HIV is transmitted and prevented had also declined, from 30.3% in 2008 to 26.8% in 2012.

"The increases in some risky sexual behaviours are disappointing, as this partly accounts for why there are so many new infections still occurring in South Africa," said principal investigator Professor Leickness Simbayi.

"We must therefore keep reminding South Africans to avoid being complacent when it comes to HIV prevention and to continue to engage in safer sex practices in order to prevent new infections. This is a must, especially in this new era of ART, if we are to benefit maximally from combination prevention involving biomedical, social and behavioural, and structural interventions."

Improved attitudes towards people living with HIV

On the positive side, there was a slight drop in HIV prevalence among young people aged 15-24 years, from 8.7% in 2008 to 7.3% in 2012. And as a result of the country's successful prevention of mother-to-child transmission programme, HIV infection levels in infants 12 months and younger fell still further, from 2.0% in 2008 to 1.3% in 2012.

The attitudes of South Africans towards people living with HIV have also improved considerably since 2008, possibly because of the wider availability of ART in the country, as well as the fact that many people have been tested and know their HIV status.

Professor Demetre Labadarios, the study's fourth principal investigator, said this finding "shows a very positive development in our national response to HIV/Aids and must be strongly commended as it contributes towards normalizing HIV/Aids as a disease".

SAinfo reporter