UNFPA South Africa

HIV

Date: 14/05/2013

HIV Prevention

Background

With an HIV prevalence rate of 16.6 per cent amongst South Africans aged between 15 – 49 years, South Africa has the largest HIV epidemic in the world1.

· It is estimated that 316 900 adult South Africans and 63 600 South African children were newly infected with HIV during 20111. This equates to an incidence of 1042 new HIV infections per day1.

· Within 14 years, HIV prevalence amongst pregnant women more than doubled from 14.2 per cent in 1996 to 30.2 per cent in 20102

· National mortality has strikingly increased by more than 86 per cent between 1997 and 2011 and HIV has been a significant contributor1,3.

· By 2011, the country had an estimated 2.01 million orphaned children as a result of AIDS1.

In spite of the statistics above, the UNAIDS World AIDS Day 2012 Report4 shows that South Africa’s HIV and AIDS response is producing results;

· There has been a 41 per cent reduction in the rate of new HIV infections since 20014.

· South Africa has scaled up HIV treatment by 75 per cent in the last two years—ensuring 1.9 million people have access to the lifesaving treatment4, and

· New HIV infections in children have decreased by 48 per cent in the last two years4.

The South African Government funds over 80 per cent of its AIDS budget from domestic resources, and has increased domestic investments on HIV/AIDS to US$ 1.9 billion, the greatest investment by any low and middle income country within this same period4.

Situational Analysis

The main route of HIV transmission in South Africa is through heterosexual sex. HIV prevalence in young women is much higher than in young men, especially in the 20–24 year age group1. In 2008, HIV prevalence was more than four times higher in women aged 20–24 years (21.1 per cent HIV prevalence) compared with men of the same age (5.1 per cent HIV prevalence)1. In adult women aged 15+, HIV prevalence is estimated at 19.4 per cent1. This means that 1 out of 5 women of reproductive age are infected with the virus1. Evidence suggests that HIV prevalence in females increases rapidly after their 20th birthday1. National HIV prevalence for adults over 15 years is estimated at 16.6 per cent1. Apart from the differences in HIV prevalence according to gender and age, differences are also found amongst the country’s nine provinces, with greater than 15 per cent of the general population of KwaZulu – Natal and Mpumalanga infected with the virus5. In contrast, a 2008 report estimated HIV prevalence for the general South African population at 10.6 per cent5.

Services to Prevent Mother-To-Child Transmission (PMTCT) have been rolled out to great success enabling 98.8 per cent of pregnant women attending antenatal care to receive HIV testing and 91.7 per cent of HIV-positive pregnant women to receive either antiretroviral (ARV) treatment or PMTCT prophylaxis6. Expansion of programmes to eliminate mother-to-child transmission (EMTCT) has reduced the rate of HIV transmission in newborns to 3.5 per cent at six weeks 6. New HIV infections in children younger than 15 years have decreased sharply from 56500 in 2009 to 29100 in 20114.

Key Challenges:

· 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 transmission5.

· 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.

Key Opportunities:

· 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 20167. The plan has set bold targets such as;

o Having 80 per cent of South Africans know their HIV status7,

o Having 3 million people on ART in 20167,

o Reducing MTCT to less than 2 per cent (at six weeks after birth)7,

o Distributing one billion condoms each year7, and

o Providing medical circumcision to 4.3 million men7.

· 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 in South Africa:

· 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:

o Promoting delay in the onset of sexual relations for young people

o Abstinence from penetrative sex

o Reduction in the number of sexual partners

o Providing and promoting correct and consistent use of male and female condoms

o Providing HIV testing and counselling services; and

o 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.

HIV Fact Sheet (PDF)

References

1. Statistics South Africa. Mid year population estimates 2011. Accessed 3/01/2012. Available at: http://www.statssa.gov.za/Publications/statsdownload.asp?PPN=P0302

2. South Africa. National Department of Health. The National Antenatal Sentinel HIV and Syphilis Prevalence Survey, 2010. Accessed 4/01/2012. Available at: www.doh.gov.za/docs/reports/2011/hiv_aids_survey.pdf

3. Statistics South Africa. Statistical release: Mortality and Causes of Death in South Africa, 2008: Findings from Death Notification. Accessed 4/01/2012. Available at: www.statssa.gov.za/publications/P03093/P030932008.pdf

4. UNAIDS World AIDS Day Report 2012. Accessed 4/01/2013. Available at: www.unaids.org ›Home › Resources ›Campaigns

5. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Pillay-van-Wyk V, Mbelle N, Van Zyl J, Parker W, Zungu NP, Pezi S & the SABSSM III Implementation Team (2009) South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers? Cape Town: HSRC Press. Accessed 3/01/2013. Available at: www.mrc.ac.za/pressreleases/2009/sanat.pdf

6. 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 Accessed 4/01/2013. Available at: www.doh.gov.za/docs/reports/2012/pmtcteffectiveness.pdf

National Strategic Plan on HIV, STIs and TB, 2012 – 2016. Accessed 9/01/2013. Available at: www.info.gov.za/view/DownloadFileAction?id=155622