By Karabo Marifi
KwaZulu-Natal has recorded a decrease in HIV prevalence from 18% in 2017 to 16% in 2022, making it the province with the second-highest rate of HIV in South Africa, following Mpumalanga. According to the Human Sciences Research Council (HSRC), this translates to approximately 1.98 million people living with HIV (PLHIV) in the province, slightly down from 1.99 million in 2017.
This data is based on findings from the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI), which highlights key trends in HIV infection across the country. One of the alarming statistics from the study is the higher prevalence of HIV among people aged between 25 and 49, with 31.1% in this age group, particularly impacting females (38.4%) and males (21.5%).
Rural Areas and Vulnerable Groups
The study found that rural formal or farm areas saw higher prevalence rates of around 20%, indicating the continued impact of the epidemic in these communities. A particularly concerning trend is that HIV prevalence continues to increase among older adults, particularly those aged 45 to 49, with the figure rising to 44.5% in 2022. This is indicative of ongoing infections among older age groups, even as infections among those younger than 40 years have decreased.
Antiretroviral Treatment (ART) Coverage and Viral Load Suppression
One positive outcome is the significant increase in antiretroviral treatment (ART) coverage in KwaZulu-Natal, which has grown from 71.2% in 2017 to 87.3% in 2022. This increase means that an estimated 1.61 million PLHIV in the province are receiving treatment. However, ART use remains notably lower among adolescents and youth aged 15 to 24, where only 62.8% are receiving treatment, with similarly lower rates for males (58.8%) and females (64%).
Viral load suppression (VLS) has also seen improvement, with KwaZulu-Natal boasting the highest proportion of PLHIV with VLS at 86.8% in 2022, up from 67.8% in 2017. This is a critical factor in controlling the spread of HIV as people with suppressed viral loads are less likely to transmit the virus to others.
Challenges and Recommendations
Despite these improvements, gaps remain in the clinical cascade, particularly among adolescents and youth, as well as people unaware of their HIV status. Among the age group 15 to 24, nearly 28.4% were unaware of their status, and a concerning number of those on ART are not virally suppressed. Moreover, the survey points to rising risky sexual behaviour, with an increase in the proportion of people reporting multiple sexual partners and a decline in condom use. This is especially true among males, with 18.6% reporting multiple partners, compared to 3.5% of females.
The SABSSM VI survey also revealed a troubling decrease in consistent condom use, with only 32.8% of people reporting that they used a condom during their most recent sexual encounter in 2022, compared to 44.9% in 2017. Among adolescents and youth, about 60% reported using condoms inconsistently or not at all.
To address these gaps, Professor Khangelani Zuma, the principal investigator, recommended increasing ART coverage among youth, expanding HIV prevention measures like PrEP, and enhancing awareness around regular HIV testing and safe sexual practices. Additionally, he highlighted the need for a long-term strategy to care for an ageing population living with HIV.
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