8-million people living with HIV in SA, according to latest estimates

The number of people living with HIV in South Africa continues to rise, surpassing 8-million in 2024. This is according to recently released estimates from the Thembisa Project, the leading mathematical model of HIV and TB in the country. The 8-million 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. The increasing numbers thus show 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 time about 105,000 people with HIV died, 53,000 due to HIV-related causes and 52,000 for reasons not related to HIV.

The estimates of new HIV infections are slightly higher than in last year’s Thembisa publications. According to Dr Leigh Johnson, of the University of Cape Town and the key developer of the Thembisa model, this is mainly due to the model factoring in new evidence that condom use is declining.

Of the 8-million people living with HIV, about 6.2-million, or 78%, were taking antiretroviral treatment in 2024. About one in five people living with the virus were thus not on treatment. Treatment is recommended for everyone living with HIV.

On the UNAIDS 95-95-95 targets, endorsed in SA’s National Strategic Plan for HIV, TB and STIs 2023–2028, the middle target, or helping people start and stay on treatment, continues to be the main area of underperformance. About 95% of people living with HIV in SA knew their status in 2024, and about 81.5% of these were on antiretroviral treatment. Of those on treatment, about 92% had viral suppression. 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 SA’s HIV epidemic. There are many more women living with HIV than men, with 5.2-million women compared to 2.6-million men as of mid-2024. Slightly more men died of HIV-related causes than women in 2023/2024, with 27,100 men dying compared to 24,200 women.

One ongoing area of concern is that many people only start treatment once their immune systems have been severely compromised. In 2023/2024, about 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. CD4 cells are a type of white blood cell that is vital to the functioning of the immune system. 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, an estimated 714,000 people restarted antiretroviral treatment after previously having stopped for at least a month. Of these, about 326,000 had CD4 counts below 200 cells/mm3.

This article was first published in Spotlight