UNFPA South Africa
It is estimated that 12.2% of the South African population (6.4 million persons) are HIV positive. This is 1.2 million more People Living with HIV than in 2008 (10.6%, or 5.2 million). The main route of HIV transmission is through heterosexual sex1.
HIV incidence among youth aged 15-24 years, has declined steadily from 2.8% in 2002-2005 to 2.3% in 2005-2008 to 1.5% in 2008-2012. An encouraging finding was the decline in incidence among young females aged 15-24 years, from 5.3% in 2002-2005 to 2.1% in the period 2008-2012, a statistically significant reduction of 60% in HIV incidence1.
HIV prevalence in young women 20 - 24 is at 17.4% which is three times higher than in men of the same age, 5.1%. Within the 25 - 29 year age group HIV prevalence amongst women is 28.4% whilst in men of the same age group it is 17.3%1.
Although the epidemic in South Africa is generalized, there are specific groups that have HIV prevalence above the national average which are classified as key populations with higher risk of HIV exposure i.e. African females aged 20-34 years (HIV prevalence of 31.6%), people co-habiting (30.9%), black African males aged 25-49 years (25.7%), disabled persons 15 years and older (16.7%), high-risk alcohol drinkers 15 years and older (14.3%), and recreational drug users (12.7%)1.
Between 2008 and 2012, there has been a shift presumably as a result of the effects of increased ART coverage. Peak HIV prevalence for females has shifted from the 25-29 year age group in 2008 to the 30-34 year age group in 2012, while for males it has shifted from the 30-34 year age group in 2008 to the 35-39 year age group in 2012. With respect to children aged 2-14 years, prevalence remained the same between 2008 and 2012, likely the result of the effects of both reduced mother-to-child transmissions and increased survival among HIV-infected children due to improved access to ART. For example 98% of health facilities, offer Prevention of Mother to Child Transmission services.
Out of the total estimated number of 6,422,000 people living with HIV in the country, 2,002,000 (31.2%) were on ART. In fact the UNAIDS, 2012 South Africa Progress Report, confirms that 2,150,880 people were on ART and that 87% of eligible women were receiving ART.
Determinants of HIV
- Early sexual debut; (10.7%) of those aged 15-24 years reported having had sex for the first time before the age of 15 years. Broken down by gender 16.7% males and 5.0% females reported to have had sex before the age of 15.
- 19.9% of respondents aged 15-19 years (19.9%) were involved in age-disparate relationships involving a sexual partner who was more than five years older than they were. More interestingly, there was a significant sex difference: one-third (33.7%) of all female adolescents aged 15-19 years reported having had a partner more than five years their senior, compared to only 4.1% of their male counterparts.
- Multiple sexual partners; 12.6% of the respondents aged 15 years and older reported had more than one sexual partner in the last 12 months. More males (20.1%) than females had multiple partners and rates were highest for the younger people aged 15-24 years at (22.4%) than the other age groups. Overall it is concerning that there is an increase from 11.5% in 2002 to 18.3% in 2012. This is also the same in the key populations identified to be at higher risk of HIV exposure i.e. recreational drug users aged 15 years and older (32.0%), high-risk (alcohol) drinkers aged 15 years and older (32.9%), black African males aged 25-49 years (21.1%), and the disabled aged 15 years and older (15.9%).
- Condom use, over one-third (36.2%) of all respondents aged 15 years and older who were sexually active during the previous 12 months indicated that they had used a condom at last sex act. Significant sex differences were found, with a higher percentage of males (38.6%) reporting that they had used a condom than females (33.6%). Additional analyses also revealed that: youth aged 15-24 years had a significantly higher percentage (58.4%) of condom use than the other age groups. Of major concern is the down the downward trend in condom use reported in 2012 compared 2008 rates at 67.5% for males and 47.5% for females.
- Male circumcision, almost half (46.4%) of the male respondents aged 15 years and older reported that they were circumcised.
- The 65.5% indicated that they had been tested for HIV, (66.2%) had done so in the 12 months and testing rates amongst females were highest at 71.5%. A total of 55.0% of HIV-positive females and 45.0% of HIV-negative females were aware of their HIV status, compared to 37.8% and 35.6% respectively (HIV positive and HIV negative) of their male counterparts. Conversely, 62.2% of HIV-positive males and 45.0% of HIV-positive females were not aware of their sero- status.
•Only 43.5 per cent of male youth (aged 15-24 years) and 40.6 per cent of females of the same age group can correctly identify ways to prevent sexual transmission of HIV and reject major misconceptions about HIV transmission2.
•Women (especially young women and girls) face increased risks of HIV infection, this calls for more effective enabling interventions. Risk-enhancing factors include alcohol abuse, violence against women and socioeconomic insecurity there are many people accessing ARVs which has a huge impact on available domestic resources. There is an urgent need to scale up evidence-informed HIV prevention efforts as any response to treatment and care will not succeed unless the number of new infections is reduced significantly. This will also contribute to financial sustainability of the ARV programme.
•The South African National Strategic Plan guides national efforts towards the elimination of new HIV infections through its main goal to reduce national HIV incidence by 50 per cent by 2016 . The plan has set bold targets such as;
o Having 80 per cent of South Africans know their HIV status3,
o Having 3 million people on ART in 20163,
o Reducing MTCT to less than 2 per cent (at six weeks after birth)3,
o Distributing one billion condoms each year3, and
o Providing medical circumcision to 4.3 million men3.
•The opportunity to capitalise on the world's largest HIV testing initiative to strengthen health systems and service delivery points for Universal Access, foster public-private partnerships and to ensure harmonisation of reporting systems across sectors.
•Increased opportunity to position dual methods prevention within the context of increasing condom use.
UNFPA promotes protection and respect for human rights, including gender equality and freedom from stigma and discrimination, especially for the most vulnerable and most-at-risk populations. UNFPA advocates for an evidence-informed, comprehensive approach to HIV prevention that is tailored to local epidemics Elements of a comprehensive approach include:
- Promoting delay in the onset of sexual relations for young people
- Abstinence from penetrative sex
- Reduction in the number of sexual partners
- Providing and promoting correct and consistent use of male and female condoms
- Providing HIV testing and counselling services; and
- Providing services for the treatment of sexually transmitted infections.
UNFPA supports the South African National AIDS Council in implementing comprehensive prevention programmes. UNFPA also forges effective partnerships that engage and are led by the sectors i.e. the youth, women and sex workers sectors, local NGOs and development partners.
UNFPA supports capacity building of health care workers on integrated SRH/HIV prevention for young people and key populations.
UNFPA supports implementation of comprehensive prevention packages for young people and key populations including development of national and provincial social behaviour change programmes promoting combination prevention.
1. Shisana, O, Rehle, T, Simbayi LC, Zuma, K, Jooste, S, Zungu N, Labadarios, D, Onoya, D et al. (2014) South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town, HSRC Press.
2. Goga AE, Dinh TH, Jackson DJ for the SAPMTCTE study group. Evaluation of the Effectiveness of the National Prevention of Mother-to-Child Transmission (PMTCT) Programme Measured at Six Weeks Postpartum in South Africa, 2010. South African Medical Research Council, National Department of Health of South Africa and PEPFAR/US Centers for Disease Control and Prevention. 2012 Available at: www.doh.gov.za/docs/reports/2012/pmtcteffectiveness.pdf
3. National Strategic Plan on HIV, STIs and TB, 2012 - 2016. Available at: www.info.gov.za/view/DownloadFileAction?id=155622