/ MEDIA STATEMENT / The content on this page is not written by Polity.org.za, but is supplied by third parties. This content does not constitute news reporting by Polity.org.za.

The Human Sciences Research Council (HSRC) released the key findings of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) for the Western Cape Province on Thursday, 26 September 2024, at a provincial dialogue held at The Capital 15 On Orange Hotel, Cape Town.

The survey found that compared to other provinces, the Western Cape had the lowest HIV prevalence (7.4%) in 2022 and second lowest in 2017 (8.6%).  This translates to 540,000 people living with HIV (PLHIV) in Western Cape, which was a decline from 560,000 PLHIV in 2017.

According to the overall principal investigator of the study, the HSRC’s Professor Khangelani Zuma, the survey showed that, in 2022, HIV prevalence in the province was higher among those aged 25–49 years (10.8%), for both females (14.6%), and males (5.8%). HIV prevalence was also higher among those residing in rural formal or farm areas (8.5%). In addition, HIV prevalence was higher among females (9.0%) compared to males (5.6%).

“HIV prevalence peaked at 12.9% amongst those aged 35–39 years in 2022 from 23.4% in 2017 within the same age group. There was a decrease in HIV prevalence in 2022 among all age groups younger than 30–34 years compared to 2017, apart from the age groups 0–14, 15–19, and those 50 years and older. The worsening prevalence among those younger than 24 years is deeply concerning as it shows continued new infections from both horizontal and vertical transmissions,” Professor Zuma said. 

As per the study protocol, data are presented for priority districts. For the Western Cape, this is the City of Cape Town district. 

Antiretroviral treatment (ART)

Antiretroviral treatment (ART) coverage in the Western Cape increased to 76.8% in 2022, from 54.4% in 2017. This translates to an estimated 360,000 PLHIV in the province receiving ART in 2022.

In 2022, ART use among all PLHIV in the province was lower among those aged 15–49 years (76.5%) compared to other age groups. ART use was also lower among males (75.3%) compared to females (77.1%). In addition, ART use was 76.2% amongst respondents who reside in urban areas and 81.4% in the City of Cape Town. 

The SABSSM VI survey, conducted between 2022 and 2023, aimed to maintain surveillance of HIV infection and behaviours in South Africa, evaluate the progress of the South African national HIV and AIDS, STI and TB Strategic Plan, and monitor HIV indicators for national and international reporting.

The survey's key objectives included estimating HIV prevalence and incidence, viral load suppression, and exposure to HIV-related services among adults and children. It also assessed progress towards the 2030 UNAIDS 95-95-95 targets, HIV drug resistance, and the relationship between social and behavioural factors, intimate partner violence, and HIV infection.

UNAIDS 95–95–95 targets

The data reveal that, in terms of progress towards the 95-95-95 UNAIDS targets, in the Western Cape, 85.6% of PLHIV aged 15 years and older were aware of their HIV status. Of this group, 91.0% were on ART, and of those on ART,  92.0% were virally suppressed. 

The survey shows that by demographic characteristics, the Western Cape is on track towards achieving the second and the third 95. The awareness of HIV status was lower amongst males (79.0%). However, females had a consistently lower proportion in the second 95 (88.5%) and third 95 (91.7%) compared to males. 

South Africa has adopted the UNAIDS 95–95–95 treatment targets in its National Strategic Plan 2023–2028, aiming to achieve the following goals: 95% of all PLHIV knowing their HIV status (first 95); 95% of those who know their status being on ART (second 95); and 95% of those on ART achieving viral suppression (third 95).

Viral load suppression (VLS)

The survey further revealed that, in 2022, among all provinces, Western Cape had the seventh highest proportion of PLHIV with VLS (78.4%), having increased from 2017 (54.6%).

Overall, VLS was also lower among males (76.0%) compared to females (79.7%). VLS was also lower among those aged 50 years and older (69.4%) compared to other age groups. VLS was 79.2% for those residing in urban areas and 80.4% in the City of Cape Town.

Knowledge of HIV status

Professor Zuma expressed concern that PLHIV aged 25–49 years accounted for the majority of PLHIV in the Western Cape who were unaware of HIV status (59.1%), aware but not on ART (64.7%), and on ART but not VLS (66.7%). However, adolescents and youth aged 15–24 years contributed disproportionally to gaps in treatment, accounting for just 9.5% of all PLHIV, but 18.2% of those unaware of their HIV status, 14.7% of those aware but not on ART and 11.1% of those on ART but not virally suppressed.

People residing in urban areas account for the majority of PLHIV in the Western Cape who were unaware of HIV status (84.6%), aware but not on ART (89.5%), and on ART but not VLS (92.0%). When stratifying by sex, the survey found that females residing in urban areas accounted for the majority of PLHIV and are either not on ART or not VLS.

KEY DRIVERS OF THE HIV EPIDEMIC

Sexual debut before the age of 15 years

Regarding the key drivers of the HIV epidemic, Professor Zuma noted that, in the Western Cape, there was an increase in the proportion of adolescents and youth aged 15–24 years who reported sex before the age of 15 years in 2017 (14.0%), compared to 2022 (16.3%). Sexual debut before the age of 15 years among adolescents and youth aged 15–24 years in 2022 was higher among males (21.5%) than females (11.3%).

Multiple sexual partners 

The survey revealed that in the Western Cape, 6.7% of people aged 15 years and older reported having two or more sexual partners in 2022 compared to 7.6% in 2017.

The proportion of people aged 15 years and older who reported having multiple sexual partners was 2-fold higher among males (8.9%), compared to females (4.4%), and higher among those aged 15–24 years (19.1%) compared to other age groups. In addition, urban residents (6.8%) had a higher prevalence of multiple sexual partners compared to other localities.

Condom use with the most recent sexual partner

Regarding condom use, the survey revealed that 22.1% reported using a condom with their most recent sexual partner in 2022 compared to 26.6% in 2017, representing a 4.5% decline. Condom use with their most recent sexual partner among people aged 15 years and older was higher among those aged 15–24 years (39.9%) and in the urban areas (22.5%) while it was similar by sex.

Nationally, more than 70% of individuals aged 15 years and older had never or sometimes used a condom with their most recent sexual partner. In the Western Cape, a higher proportion also reported that they had never or sometimes (81.4%) used a condom with their most recent sexual partner. Only 13.4% reported that they had used condoms almost every time.

Consistency of condom use with their most recent sexual partner among people aged 15 years in the province was higher among youth aged 15–24 years (24.0%). However, over 75% of those aged 25–49 reported only using a condom sometimes or never. Consistency of condom use with their most recent sexual partner was 14.4 in the city of Cape Town.

Male circumcision 

In the Western Cape, self-reported circumcision decreased from 52.0% in 2017 to 50.9% in 2022. In 2022, self-reported male circumcision in the province was lower among those aged 15–24 years (44.4%) and those residing in rural informal or farm areas (27.3%), and highest among those aged 25–34 years (58.1%). The self-reported male prevalence of having been circumcised amongst males in the City of Cape Town was low amongst those aged 15–24 years (53.1%). 

The Western Cape had the third lowest proportion of medical circumcisions in the country at 46.3%. Self-reported medical circumcision was lower among those aged 25–49 years (38.7%) and urban areas (46.1%). Medical circumcision was 45.8% in the City of Cape Town.

Male circumcision among children aged 14 years and younger in the Western Cape was lowest amongst those aged 0–4 years at 5.7%. Male circumcision among children aged 14 years and younger in the Western Cape increased with age from 5.7% among those aged 0–4 years up to 13.4% among children aged 5–11 years, decreasing to 8.4% among children aged 12–14 years. Male circumcision was 11.7% in the City of Cape Town.

HIV testing

HIV testing is a gateway to counseling on HIV prevention and linkage to care among people diagnosed with HIV. The survey shows that awareness of HIV testing sites by selected demographic variables among people aged 15 years and older in the province was generally high (89.9%). However, awareness was modestly lower among those aged 50 years and older (85.6%) compared to other age groups, and males (85.9%) compared to females.

Awareness and uptake of Pre-exposure Prophylaxis (PrEP)

Overall in 2022, 33.5% of sexually active adults aged 15 years and older had heard of PrEP, of whom 3.0% had taken PrEP. Of those who had taken PrEP 1.0% were taking PrEP at the time of the survey. More females (36.0%) compared to males (30.6%) had heard of PrEP and were willing to use PrEP to prevent HIV (59.6% versus 64.9%). Compared to other age groups, more adolescents and youth aged 15–24 years had heard of PrEP (40.1%). Of those, 2.5% were currently taking it and 53.8% were willing to take it.

Key recommendations

The survey recommends key actions to address the HIV epidemic as a public health threat in South Africa by 2030. These include targeted interventions for age groups most affected by HIV, particularly adolescent girls and young women, who require intensified prevention efforts. 

Professor Zuma recommends a long-term strategy to care for individuals in an ageing HIV epidemic as well as tailored interventions to address gaps in the clinical cascade by district, locality and subpopulation.

“We also recommend a continued focus on increasing coverage and demand for medical male circumcision among males aged 15 years and older. We must also enhance public awareness and uptake of effective HIV prevention measures, such as regular HIV testing, condoms and PrEP,” concluded Professor Zuma.

The HSRC conducted the survey in partnership with the US Centers for Disease Control and Prevention (CDC), the South African Medical Research Council (SAMRC), the University of Cape Town (UCT), and the National Institute for Communicable Diseases (NICD).

The council has launched a provincial results dissemination roadshow, dubbed the Provincial Dialogue, which has already been successfully completed in the Eastern Cape, Limpopo, Gauteng North West and Mpumalanga, Free State and KwaZulu-Natal provinces. The final dialogue will take place in the Northern Cape on 30 September.

Issued by Human Sciences Research Council