By Phenyo Selinda
HIV prevalence in South Africa has decreased from 14% in 2017 to 12.7% in 2022, resulting in a reduction from 7.9 million people living with the virus in 2017 to 7.8 million in 2022. This is according to the sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI), released by the Human Sciences Research Council (HSRC) at the 2024 International AIDS Conference.
Decrease in HIV Prevalence
While HIV prevalence has decreased across all age groups, the data indicates that females continue to be disproportionately affected by HIV, with a prevalence of 16.4%, compared to males at 8.8% across all age groups. For females aged 35 to 39 years, prevalence peaks at 34.2%, whereas for males aged 45 to 49 years, prevalence peaks at 27.1%.
The survey also revealed that HIV incidence in individuals aged two years and older in 2022 was 0.44%, resulting in 232,400 new HIV infections in South Africa. Among adults 15 years and older, HIV incidence was at 0.60%, translating to 227,400 new infections. The incidence rate among youth and young adults aged 15 to 24 was 0.39%, and among adults aged 15 to 49 years, it was 0.72%.
Increase in Treatment Coverage
“In terms of treatment, South Africa recorded an increase in antiretroviral treatment (ART) coverage, from 63.7% in 2017 to 80.9% in 2022,” the HSRC stated. This means an estimated 5.7 million people living with HIV receive ART, an increase from 4.5 million in 2017. A greater proportion of females, 83.2%, compared to males, 76.2%, were on ART. Data shows that HIV viral load suppression stands at 81.4% for all ages.
Evaluating Progress
The SABSSM VI survey, conducted between 2022 and 2023, evaluates the progress of the South African national HIV and AIDS, STI, and TB Strategic Plan. It also monitors HIV indicators for national and international reporting, assesses progress towards the 2030 UNAIDS 95-95-95 targets, and examines HIV drug resistance and the relationship between social and behavioural factors, intimate partner violence, and HIV infection.
In December 2020, the Joint United Nations Programme on HIV/AIDS (UNAIDS) outlined a set of new targets ensuring that 95% of all individuals living with HIV are aware of their status, 95% of all individuals diagnosed with HIV infection receive continuous treatment, and 95% of all those on treatment achieve viral suppression by 2025.
Progress Towards 95-95-95 Targets
The HSRC reported significant progress towards the 95-95-95 targets, with 89.6% of people living with HIV knowing their status. Of those, 90.7% were on treatment, and 93.9% of those on treatment were virally suppressed. “Improvement across the 95-95-95 indicators was more pronounced in males compared to females,” the HSRC noted. Overall, 81.4% of all people living with HIV were virally suppressed.
However, the survey also highlighted gaps in knowledge of HIV status among youth aged 15 to 24, with only 73.1% aware of their status. Early sexual debut, age-disparate relationships, multiple sexual partners, and low condom use persist as key drivers of HIV.
Increasing Awareness and Reducing Stigma
The awareness and uptake of pre-exposure prophylaxis (PrEP) are increasing. Despite this, HIV-related stigma remains a significant issue among individuals aged 15 years and older. Professor Khangelani Zuma, the overall principal investigator of the study, emphasized, “Addressing stigma is essential to improving the quality of life and well-being of people living with HIV. However, of the six questions related to HIV-related stigma, the majority yielded results indicating that most people held positive attitudes toward people living with HIV.”
Response Rate and Recommendations
The survey achieved a household response rate of 80% and an individual interview response rate of 94.1%. A total of 47,766 participants provided blood specimens for HIV testing, resulting in a testing response rate of 62.7%. Professor Zuma stated, “The results suggest advancements in the fight against the HIV epidemic in South Africa. This is evidenced by a stabilisation of HIV prevalence, an ageing epidemic, a reduction in HIV incidence, and improvements in HIV treatment outcomes.”
The study recommended key actions to address the HIV epidemic as a public health threat in South Africa by 2030. These include continuing intensive programmes focusing on reducing new infections among adolescent girls and young women and enhancing prevention efforts targeting groups disproportionately affected by HIV.
As South Africa continues to make strides in combating HIV, the SABSSM VI survey provides valuable insights and highlights the areas that require further attention to achieve the UNAIDS 95-95-95 targets and ultimately end the HIV epidemic by 2030.
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