People living with HIV decreasing, but more needs to be done: survey

Young women are at risk of HIV infections as socioeconomic problems such as the “blesser” phenomena remain a factor.

The Human Sciences Research Council (HSRC) released its sixth South African National HIV prevalence, incidence and behaviour survey (SABSSM VI) on Monday.

Dhirisha Naidoo, BroadReach Health Development chief of party for the US President's Emergency Plan for Aids Relief-funded USAID APACE programme, said teenage girls and young women face the highest risk of contracting HIV in South Africa because of their socioeconomic circumstances.

“The latest UNAids statistics show adolescent girls and young women accounted for 77% of new infections among young people (aged 15-24) in Sub-Saharan Africa in 2022.

“Some of the reasons they are at greater risk of contracting HIV include engaging in sex at a young age, not having the power to negotiate condom use and having multiple sexual partners,” Naidoo said.

Young women were also often repressed by patriarchal culture and gender-based violence and, because of the difficult economic environment, might have transactional relationships with sexual partners.”

The importance of preventive HIV medication cannot be overstated. Preventative medications include pre-exposure prophylaxis (PrEP) — a highly effective oral medication taken to prevent HIV infection — and post-exposure prophylaxis (PEP) for cases where young women may have been exposed to HIV through unprotected sex or rape.

“PEP should be taken within 72 hours of HIV exposure. Multi-scripts are also available for these preventive medications,” Naidoo added.

Dr Jean Bassett, Witkoppen Clinic executive director, said communities can make a significant difference by addressing the impact of “blesser and blessee” relationships.

“These complex relationships put young girls in dangerous situations. Another is addressing the issue of stigma.”

About one in five South Africans with HIV are unaware of their status, she said.

According to the survey, prevalence was nearly twice as high among women (20.3%) compared with men (11.5%).

The most pronounced differences in HIV prevalence by sex were seen in younger populations. It also found people infected with HIV are living longer than they were in 2017.

The survey showed South Africa has made significant progress in decreasing the percentage of people living with HIV. Of those aged 15 and older in 2022, 90% were aware of their status.

SABSSM VI found the percentage of people living with HIV has decreased from 14% in 2017 to 12.7% in 2022. This translates to about 7.8-million people living with HIV in 2022 compared with 7.9-million in 2017.

Prof Khangelani Zuma, divisional executive of the public health, societies and belonging division of the HSRC, said factors that contribute to the prevalence include fewer people getting infected, more children born HIV-negative, Aids-related mortality and people ageing and dying from natural causes.

“The increase in the population (birth of HIV-negative babies) would also increase the denominator of HIV-negative people in the country. The epidemic curve also shows an ageing population of people living with HIV living longer as the epidemic stabilises,” Zuma added.

SABSSM VI showed that among people aged 15 years and older living with HIV in 2022, 90% were aware of their status, 91% of those were on antiretroviral treatment (ART) and 94% of those on ART were virally suppressed.

It recorded 81% of people aged 15 years and older living with HIV were virally suppressed in 2022 compared with 62% in 2017. Viral suppression was higher among women when compared to men and lower among younger people aged 15—24.

The lowest percentage of viral load suppression was among men aged 25—34.

“The most pronounced differences in HIV prevalence by sex were seen among younger populations which calls for focused interventions. Compared with males of the same age groups, HIV prevalence was about two-fold in females aged 15—19 and 20—24 and three-fold higher in females aged 25—29,” said Zuma.

According to the survey, half of young men aged 15—24 were medically circumcised compared with 43% in 2017. This is an important achievement as studies have shown male circumcision can reduce the risk of heterosexual HIV transmission by about 60%.

HIV prevalence varied geographically, ranging from 8% in the Western Cape to 22% in KwaZulu-Natal. By race, HIV prevalence was highest among black Africans (20%), followed by coloureds (5%) and lowest among whites and Indian/Asian people (1% each).

Dr John Blandford, US Centers for Disease Control and Prevention South Africa country director, said the 2022 survey documents the remarkable accomplishments of the national HIV response and highlights the gaps and challenges that remain in addressing the disproportionate burden of HIV among populations, including women, young people and black South Africans.

Healthcare organisation Right to Care said there is a need to ensure HIV-positive people stay on treatment so they become virally suppressed. 

In 2023 there are still new HIV infections and deaths from HIV because people living with HIV have not started treatment, started treatment too late or not stayed on their treatment. This includes children.

“For example, seasonal workers who work in one area and then move away or go home to countries beyond South Africa's borders are often lost to healthcare follow-up despite efforts such as dispensing medication for more than one month, providing referral forms for them to hand in at another facility and tracking and tracing initiatives.

“This interrupts their treatment, and sometimes they don't start their treatment again.”