Over two million people in South Africa were on antiretroviral treatment (ART) by mid-2012, suggesting that the country is on its way to achieve universal access to HIV treatment.

This was one the key findings of the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey Report, released on Tuesday.

The report, launched at the Human Sciences Research Council (HSRC) by the Ministers of Science and Technology Derek Hanekom and Health Dr Aaron Motsoaledi, found that the significant increase of ART exposure in the country has had a major impact on the survival of people living with HIV.

Overall prevalence of HIV increased from 10.6% in 2008 to 12.2% in 2012. This, according to the report, is largely due to the combined effects of new infections and a successfully expanded ART programme.

“The availability and use of ART has increased survival among HIV-infected individuals,” the report noted.

HIV prevalence in the 15-49 year age group was 18.8%, but was significantly higher in females (23.2%) than in males (14.5%). A slight decline of HIV prevalence was also noted among youth aged 15-24 years, from 8.7% in 2008 to 7.3% in 2012.

As a result of the country’s successful Prevention of Mother to Child Transmission (PMTCT) programme, HIV infection levels further decreased in infants 12 months and younger, from 2% in 2008 to 1.3% in 2012.

However, HIV incidence rates among female youth aged 15-24 years was over four times higher than for males in the same age group (2.5% vs. 0.6%).

Black African females aged 20-34 years had the highest incidence of HIV among the analysed population groups, with an HIV incidence rate of 4.5%.

A decline in condom use was also picked up 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.
“The respondents aged 15 years and older believed that they were at low risk of acquiring HIV infection. The overall knowledge about how HIV is transmitted and prevented also declined from 30.3% in 2008 compared to 26.8% in 2012,” the report said.

On the upside, attitudes of South Africans towards people living with HIV, have improved considerably since 2008.

“This could partly be the result 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.”

Curbing new infections

Minister Hanekom said the report brought to light the worrying realities of HIV infection in South Africa, while emphasising the human and social dimensions of the epidemic.

He said information from the report could be used to improve social and behavioural change campaigns, and help to identify structural aspects that deserve special attention.

“The report alerts us to the continuing need to be vigilant in addressing this epidemic, to monitor the impact of our programmes, and to constantly find new and better ways of reaching especially those most at risk through both prevention and treatment interventions.

“This requires that we double our efforts to prevent new infections. The high incidence among young women aged 15-24 years is particularly troubling and calls us to address the associated social determinants,” Minister Hanekom said.

He added that a renewed focus on creating awareness about risky behaviour and measures to strengthen the HIV testing campaign must be taken. However, this would require sociological knowledge on how communities understand and react to interventions, and adapt their behaviour according to new awareness.

Minister Motsoaledi said officials suspected that young people saw the government-issue condoms as “staid and boring”, hence they are to be replaced with a "new type of condom that will bring excitement".
The new versions, to be distributed at universities and further education and training colleges, will be flavoured and coloured.

HSRC CEO Professor Olive Shisana said she was pleased to see that more people with HIV were living longer because of the hugely expanded treatment programme launched by government.

She, however, noted that the disproportionately high HIV prevalence levels among females in the country, and the high HIV prevalence among unmarried, cohabiting people required a rethinking of conventional approaches of HIV prevention towards strategies that address the underlying socio-cultural norms in the affected communities.