The Human Sciences Research Council (HSRC) says that while fewer South Africans have HIV and more people are getting treatment, a growing proportion of the population is not using condoms, creating “a pool of people with a propensity to transmit the virus”.
Additionally, more women than men are still being infected.
The findings of its latest SA national HIV/Aids prevalence, incidence and behaviour survey raise questions about whether the government’s drive to meet the UN’s 95-95-95 targets and its push for new prevention tools – like PrEP – have shifted attention away from campaigns to promote condoms.
The 95-95-95 targets aim to ensure that by 2025, 95% of people with HIV know their status, 95% of the people diagnosed with HIV get antiretroviral treatment and 95% of those being treated achieve viral suppression, reducing the risk of transmitting the virus.
For its sixth survey in a series since 2002, the HSRC interviewed more than 71 600 adults and children between January 2022 and April 2023.
The released preliminary findings were released this week, reports BusinessLIVE.
Overall, HIV prevalence fell from 14% in 2017 to 12.7% in 2022, with the number of people with HIV falling from 7.9m to 7.8m. An estimated 90% of adults knew their HIV status, 91% of those diagnosed with HIV/Aids were on antiretroviral treatment, and 94% of those on treatment were virally suppressed.
But self-reported condom usage at last sexual encounter among people who said they had multiple partners was just 43.5% among women between 15 and 25-years-old, and 50.6% among men of the same age. The figures were even lower among people aged 25 to 49, at 40.9% for women and 44% for men.
There has been a steady decline in the proportion of people using condoms since the 2008 survey, which found 66.5% of young women and 85.2% of young men had used condoms the last time they had sex.
“That is a concern,” said the HSRC’s Khangelani Zuma, one of the study’s principal investigators. “We have a lot more work to do, especially among people who have multiple partners.”
Zuma is the executive director of the Public Health, Societies and Belonging (PHSB) research division and head of biostatistics at the HSRC.
Fellow principal investigator and HSRC researcher Leickness Simbayi said low condom use among young people suggests high HIV transmission rates among this age group.
Worryingly, more than 40 years into the epidemic, young women are still among the most vulnerable to new HIV infections, bearing the brunt of the epidemic, writes Ndivhuwo Mukwevho for Health-e News.
“The most pronounced differences in HIV prevalence by sex – 20% of women as opposed to 12% among men – were seen among younger populations, calling for focused interventions,” said Zuma.
South Africa’s situation mirrors the global picture. The most recent figures released by UNAIDS this week show that 46% of all new HIV infections were among women and girls in 2022. In sub-Saharan Africa, this group accounts for more than 77% of new infections among adolescents and young adults.
Dr Logandran Naidoo, national medical director for Aids Healthcare Foundation (AHF) in South Africa, said South Africa still needs to do more work to achieve the 95-95-95 target.
“More must be done to identify people with HIV, especially using targeting testing which is offering HIV tests to people deemed to be at a higher risk of HIV infection – like key populations,” he said. “We also need to work on viral load suppression to undetectable levels.”
Viral load suppression is an indicator of how well ART is working. A person with an undetectable viral load can’t transmit the virus to their sexual partners.
“We seem to be losing several patients from care. This linkage and retention of patients and returning lost patients and ensuring adherence to their medication is important,” added Naidoo.
National health department spokesperson Foster Mohale said the survey results show that the country is on the right track to achieve the ambitious 95-95-95 targets.
“The reduction in the percentage of people with HIV can be attributed to collaborative efforts by various stakeholders and interventions introduced to curb the rate of transmission and treatment adherence,” he said.
Data on HIV incidence – or the the rate of new infections – were not released with the preliminary findings, and are only expected when the final report is released in 2024.
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