The number of South Africans with HIV continues to rise, passing 8m in 2024, according to recently released estimates from Thembisa, the leading mathematical model of HIV and TB in the country. The 8m amounts to 12.8% of the population.
The continued rise is because there are more people becoming newly infected with HIV than there are people with HIV who are dying, writes Spotlight’s Marcus Low.
The increasing numbers are thus a reflection of the fact that antiretroviral medicines are keeping people alive who would otherwise have died.
There were an estimated 178 000 new HIV infections in 2023/2024 (mid-2023 to mid-2024). Over the same period, around 105 000 people with HIV died – 53 000 due to HIV-related causes and 52 000 for unrelated reasons.
The estimates of new infections are slightly higher than last year, said Dr Leigh Johnson of the University of Cape Town and the key developer of the Thembisa model, mainly due to the model factoring in new evidence that condom usage is declining.
Treatment coverage of 78%
Of the 8m people with HIV, around 6.2m, or 78%, were taking antiretroviral treatment in 2024. Around one in five were thus not on treatment.
On the UNAIDS 95-95-95 targets, also endorsed in South Africa, the middle target, helping people start and stay on treatment, continues to be the main area of under-performance.
Around 95% of people with HIV in South Africa knew their status in 2024, around 81.5% of these were on antiretroviral treatment, and of those on treatment, around 92% had viral suppression. (Note that the 78% treatment coverage figure is the product of multiplying the performance on the first two 95 targets.)
There continues to be stark gender disparities in this country’s HIV epidemic. On the one hand, there are many more infected women than men – 5.2m compared with 2.6m as of mid-2024. On the other hand, slightly more men died of HIV-related causes than women in 2023/2024 – 27 100 men compared with 24 200 women.
Worrying trends
One ongoing area of concern is that many people only start treatment once their immune systems have been severely compromised. In 2023/2024, around 54 000 adults started treatment for the first time with CD4 counts below 200 cells/mm3. A CD4 count above 500 cells/mm3 is generally considered to be healthy.
People who start treatment with low CD4 counts tend to have worse long-term outcomes.
The latest Thembisa outputs also contain worrying findings on the extent to which people drop in and out of care. In 2023/2024, 714 000 people restarted antiretroviral treatment after previously having stopped for at least a month – of these, around 326 000 had CD4 counts below 200 cells/mm3.
On a more positive note, the latest Thembisa outputs continue to show a rise in life expectancy in South Africa. Life expectancy declined severely round the turn of the century, largely due to people dying of Aids, but then increased over time as ARV therapy started keeping people with HIV alive.
A blip in 2020 and 2021 was due to the Covid-19 pandemic.
Note: This article is based on outputs from Thembisa version 4.8 – published in late March 2025. We have quoted 2023/2024 figures since they are based on more data, and thus more reliable than the estimates for 2024/2025. We have rounded some numbers to make the text more accessible.
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