Bafflement over Africa’s highest HIV prevalence in Pietermaritzburg

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Experts are baffled by the fact that uMgungundlovu municipality in KwaZulu-Natal, with Pietermaritzburg the major city, continues to experience the highest prevalence of HIV-infected people, not only in South Africa but on the continent, despite ‘good treatment’.

Director of the Centre for the Aids Programme of Research in South Africas (Caprisa) Professor Salim Abdool Karim is quoted in News24 as saying he was unable to give a definitive answer as to why this specific area experiences such a high HIV rate. This was despite ongoing research and the fact that there is “good coverage of the area in terms of treatment”.

The University of Washington recently released data on its Institute for Health Metrics and Evaluation website showing the high prevalence of HIV in adults between the ages on 15 and 49 in different parts of Africa. The report says uMgungundlovu showed a prevalence of 29,7% of HIV in people while KwaZulu-Natal as a whole presented a 24% prevalence – the highest in the country. Coming in second is the Free State with a rate of 21,3% and then Mpumalanga with a rate of 20,9%.

The report says the data for the map was collected between 2000 and 2017 and no new studies have been done at ground level, however, the figures are regarded as “very worrying”.

Karim said there is no simple answer why uMgungundlovu has such a high prevalence of HIV, but added that there were many contributing factors. He added that the study and map by the University of Washington was “not a new study and it shows us what we have known for years”.

There were four major factors contributing to HIV infection rates, he said in the report, however, none of them was unique to the uMgugundlovu area and they were an issue in other provinces and African countries as well.

The first factor is the “partnering pattern”. “Young women have the highest rate of HIV infection and are mainly being infected by men about 10 years older than them. So, this age difference is key because if young girls have sex with young boys, there is less chance of infection because the prevalence of HIV in young boys is a lot less.”

Karim said in the report that young women continued to have very high rates of HIV “and they drive the epidemic in that sense”. He said another factor is not that young girls in uMgungundlovu were having more sex than their female counterparts across the globe, but that they are having “riskier sex”, which places them at higher risk of exposure.

He said they had also come across a biological risk factor that impacts about a quarter to a third of young women. A study of the genetic codes of vaginal bacteria showed that those with an overgrowth of certain bacteria had an almost 13 times higher chance of getting HIV. According to the report, it was also found that the bacteria – called Prevotella bivia – may be increasing women’s vulnerability to HIV by inflammation in the vagina through the release of an immune system stimulant “lipopolysaccharide” – a molecule in HIV infection.

He said women with the inflammation have a higher CD4 cell count (which HIV/Aids attacks) in their vaginal tract, which makes “them sitting ducks for HIV to attack”. He added, however, that this was also not unique to the area.

The report says the third key factor is migration, and the fourth is having a sexually transmitted disease as this helps spread the infection by up to 30 or 40 times than usual risk. He said in the uMgungundlovu community it is often seen as acceptable for an older man to date a much younger woman. He said this is not a normal or acceptable social norm and contributes to the spread of HIV.

In many ways, he said, the district had a head start in the fight against Aids as treatment had started in the area in 2003, before the government rolled out antiretrovirals more widely. “There is good coverage of the area in terms of treatment and we are making progress. More people are seeking treatment and are not dying, which will increase the prevalence, but I don’t think this is the case in uMgungundlovu.

“It all just baffles me. It’s a major concern and it is not for lack of research. We do the best with what we can. It’s like trying to eat an elephant – you have to take one bite at a time.”

News24 report

 

See also:

Mapping the burden of HIV in sub-Saharan Africa

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