New HIV infection rates decline in SA

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JOHANNESBURG - According to a newly-released study, about 60% of South Africans living with HIV are taking anti-retrovirals (ARVs).

The same data shows approximately 7.9 million South Africans were living with the virus in 2017.

This decreasing trend is consistent with the previous estimates of HIV incidence.

This is one of the main findings of the South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017, officially launched this week by the Minister of Health, Dr Aaron Motsoaledi at the National Department of Health in Pretoria.

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The launch of the survey was chaired by Human Sciences Research Council (HSRC) CEO Prof Crain Soudien and Co-Chair Professor Helen Rees, the Executive Director of the Wits Reproductive Health and HIV Institute (Wits RHI) of the University of the Witwatersrand, who was the Chair of the Review Panel of the survey report.

The 2017 survey is the fifth wave of a series of cross-sectional studies conducted by a consortium of scientists led by the HSRC, including the South African Medical Research Council, National Institute of Communicable Diseases and research agencies.

Previous studies were done in 2002, 2005, 2008 and 2012. HSRC’s Deputy CEO of Research Professor Leickness Simbayi who is the Overall Principal Investigator (PI) of the survey says: “HSRC has a long history of undertaking population-based surveys on HIV/AIDS in the country.”

Data was collected on not only the HIV status of individuals but also information on socio-demographic and behavioural factors that greatly enhanced the analysis and interpretation of the observed trends in HIV prevalence (the proportion of people living with HIV in the country) and HIV incidence (new HIV infections in a given year).

The data from the 2017 survey serves as critical benchmark figures for the evaluation of the National Strategic Plan (NSP) 2012-2016 and also the baseline for the current one.

The population-based cross-sectional survey of households in South Africa was conducted between January and December 2017.

Over 33 000 people were interviewed and almost 24 000 agreed to be tested for HIV.

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The survey found that there has been a significant decline in the HIV incidence rate of 0.48%. This translated to an estimated 231,100 new HIV infections in the country in 2017. Although still high, this was a decline of 44%  from an incidence rate of 0.85%  reported in the 2012 survey.

The HIV incidence rate was generally higher among females aged 15 to 24 years old where the number of new infections was three-times that of their male counterparts. 

The survey found that over 60% or an estimated 4.4 million people living with HIV (PLHIV) were on antiretroviral treatment (ART). It was also found that viral suppression was 87.3% among PLHIV who were on ART, with females generally being more likely to be virally suppressed than males among those aged 15-64 years.

“This suggests that progress is being made in increasing ART coverage, however, more needs to be done to link those who test HIV positive to care as soon as they are tested, in line with the current policy of test and treat” said Dr Sizulu Moyo of the HIV/AIDS, STIs and TB (HAST) Research Programme in the HSRC Research Programme.

Furthermore, although viral suppression is high among those on ART, not everyone who is living with HIV is on treatment, and consequently, only 62.3% of all PLHIV irrespective of treatment were found to be virally suppressed.

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The study found that South Africa had made some progress in addressing the HIV epidemic as reflected by some key HIV indicators.

In terms of the UNAIDS 90-90-90  targets, the study found that 85% of PLHIV aged 15 to 64-year-olds have tested for HIV and know their HIV positive status, 71% of this sub-group are on ART, and  86% of the group on ART are virally suppressed. “This shows that the country has made significant progress towards reaching the 90-90-90 targets,” says Dr Edmore Marinda of the Research use and Impact Assessment (RIA) Unit in HSRC, one of the Co-PIs of the survey.

As expected there is an upward trend in HIV prevalence which is explained by the reduction in HIV and AIDS-related deaths and additions of new infections that are still occurring. Approximately 7.9 million South Africans were living with HIV in 2017.

The study found that females had higher rates of HIV prevalence than males. HIV prevalence among adults aged 15 to 49 years in South Africa is 20.6%, 26.3% among females and 14.8% among males. The disparity in HIV prevalence by sex was more pronounced among young adults aged 20 to 24 years and was three times higher among females than males. 

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The study also found that HIV prevalence peaked at 35 to 39 years of age for females and 45 to 49 years of age for males. HIV has risen sharply for women 60 years and older compared to males, where the figures have remained constant.

According to Professor Khangelani Zuma the Executive Director of the HAST Research Programme in the HSRC “This shows the overall ageing profile of PLHIV, which is mainly as a result of the successful implementation of ART programme, resulting in fewer deaths and therefore PLHIV living longer.” 

However, high infection levels (7.9%) among youth aged 15 to 24 years is still concerning.

The top three provinces with the highest HIV prevalence were KwaZulu-Natal, followed by the Free State and the Eastern Cape.

The bottom three affected provinces were Limpopo, Northern Cape and Western Cape being the least affected. However, compared to 2012 substantial increases in HIV prevalence were observed in the EC and WC.

The study also found an increase in the number of men who are medically circumcised,  rising from 18.6% in 2012 to 30.8% in 2017.

Prof Simbayi says “Although this is encouraging, this finding highlights a need to continue promoting and creating demand for voluntary medical male circumcision with an immediate target among males in the 15-34 year-old age group.”

In terms of risk behaviours, the study found that consistent condom use was low, early sexual debut (sex before the age of 15 years) especially among males increased compared to 2012 and over a third of young women had sexual relationships with older men.  “It is concerning to find very little behaviour change seems to have occurred since 2012. 

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This suggests that most of the reduction in new infections was likely due to the impact of the expanded ARV treatment programme” says Dr Mpumi Zungu also of the HSRC’s HAST Research Programme and a co-PI of the survey.