The issue of cross-border influence on the prevalence of HIV in the country has come under the spotlight in an investigation conducted by the Human Sciences Research Council (HSRC).
The HSRC, along with its partners, is expected to publish these results in the Sixth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM VI) in April 2024.
Dr Musawenkosi Mabaso, chief research specialist in the HIV/Aids, STIs and TB (HAST) programme at HSRC, revealed that they had been looking into the issue and the results would be published in due time.
Though non-committal on the possibility of cross-border influence on HIV, he indicated that previous studies have shown it to be a factor.
“I don’t want to pre-empt the paper that we’re working on, but I think there is an indication that a certain proportion, especially the undocumented migrants, don’t have access to public health care,” he said.
“In terms of HIV we’re getting an indication ... the majority of the people that we find in this migrant pool are from Sadc countries, where the HIV prevalence is high. This was a 2017 survey, so it would be interesting now, with all the changes that have taken place, to look at this question again.”
He was speaking at the Edward hotel in Durban on Wednesday during the KZN presentation of the preliminary results of the SABSSM VI.
It showed that people living in KwaZulu-Natal were the least likely to transmit HIV, despite the province having the highest concentration of people living with the virus.
This is because it leads the way in terms of the viral load suppression (VLS) intake among people living with HIV in the province, which reduces the risk of transmitting the virus.
The survey showed a pattern of mostly rural provinces having the highest populations of people living with the virus, with KZN (21.8%) closely followed by Mpumalanga (20.8%), Free State (19.1%) and the Eastern Cape (18.8).
Prof Khangelani Zuma, divisional executive of the public health, societies and belonging division of the HSRC, said this was a historical fact since they started monitoring HIV in 2002, largely caused by migration work where the virus is transmitted from urban to rural areas, among other factors.
Zuma said this was a positive sign because it shows that the people who were found with the virus over the years were still alive.
“If, for example, the next survey we do finds that there’s very few people living with HIV, the next question would be, what happened? Where are these people?”
So we have this group of few people living with HIV but they are not virally suppressed so they are most likely to transmit the virus. That is what we need to deal with.
— Prof Khangelani Zuma
However, Zuma said the numbers must be viewed in the context of the exposure of those people living with the virus to ARVs and viral suppressions.
A province that has a high rate of VLS among people living with HIV will have a lower risk of transmitting the virus compared with others.
In KZN 86.7% of people living with HIV are on VLS, followed by Mpumalanga (82.2), Free State (81.2) and Eastern Cape (80.2).
“What we have now is a pool of people that have been living with HIV for a number of years, with KZN being the highest, but this pool of people are now maintaining their lives because they are taking treatment.”
Provinces like the Western Cape (8.2%), Northern Cape (10%) and Limpopo (11.9%) have fewer people living with HIV, but few of those people are virally suppressed.
“So we have this group of few people living with HIV, but they are not virally suppressed, so they are most likely to transmit the virus. That is what we need to deal with.”
The survey, conducted between January 2022 and April 2023, shows that there are about 7.8 million people living with HIV in the country, with 7.4 million being adults of 15 years and older.
That is 107,000 fewer people than the 7.9 million from 2017.
He also addressed media reports that said the survey had showed that African women didn’t want condoms.
“I don’t know where that comes from because it has nothing to do with this paper. It has not been part of this information or any statement by the researchers involved in this study.”
He said what they found was that among youth (15-24 years) who reported having multiple sexual partners, 43.5% of females and 50.6 males said they used condoms in their last sexual encounter.
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