As condom use decreased, more South Africans than ever – an estimated 6.4 million – were living with HIV/AIDS in 2012.
This according to the South African National HIV Prevalence, Incidence and Behaviour Survey 2012, released this week by the Minister of Science and Technology, Derek Hanekom, and the Minister of Health, Dr Aaron Motsoaledi.
While the results shows that HIV infections continue to rise, the increased prevalence of HIV in 2012 (from 10.6% in 2008 to 12.2% in 2012) is also due to the government’s successfully expanded antiretroviral treatment (ART) programme, which means that more HIV positive people are living longer.
Over two million people were on ART by mid-2012, 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. 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,” cautioned Professor Thomas Rehle, Director & Senior Programme Advisor in the HIV/AIDS, STIs and TB (HAST) programme and Principal Investigator of the study.
Women continue to bear the brunt of the epidemic. The HIV incidence rate among female youth aged 15-24 years was over four times higher than for males in this age group (2.5% vs. 0.6%). With an HIV incidence rate of 4.5%, black African females aged 20-34 years had the highest incidence of HIV among the analysed population groups.
“The disproportionately high HIV prevalence levels among females in the country, and high HIV prevalence in unmarried cohabiting people… require a rethinking of conventional approaches of HIV prevention towards strategies that address the underlying socio-cultural norms in the affected communities,” said Principal Investigator, Prof. Olive Shisana, HSRC CEO.
Compared with 2008, there was 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.
Less than 68% of young men aged 15 to 24 used condoms in their last sexual experience compared to 85% four years previously. In the age group of 25 to 49, only 36% of men used condoms (44% in 2008).
To address fears that government supplied Choice condoms may no longer be seen as “cool,” Minister Motsoaledi said that the health department would be introducing more variety – including flavoured, coloured and better smelling condoms – at universities and colleges.
“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. 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,” said Professor Leickness Simbayi, Executive Director, HAST programme, HSRC, and a Principal Investigator on the study.
Another concerning finding is that the majority of those 15 years and older (76.5%) surveyed believed that they were at low risk of acquiring HIV infection. Unfortunately, approximately one in ten who believed they were at low risk was already infected but didn’t know it. Furthermore, the overall knowledge about how HIV is transmitted and prevented also declined from 30.3% in 2008 compared to 26.8% in 2012.
With regard to specific information or statistics about gay, bisexual and MSM (men who have sex with men), the report had little information “due too few observations to report reliably.”
The report did recommend the introduction of “targeted HIV-prevention programmes for key populations at higher risk of HIV exposure” including “MSM and sex workers.”
There was also concern that some key populations may be at higher risk of HIV exposure because of overlapping risks (e.g., MSM also involved in recreational drug use or a high-risk drinker).
According to the HSRC, “the report underscores that while the country is on the right track with the provision of ART, national HIV counselling and testing efforts, and greater access of PMTCT, more other biomedical, behavioural, social, and structural prevention interventions are needed to reduce the high rates of new HIV infections.”