By Lerato Mpembe
The Western Cape, known for its rich cultural heritage and scenic beauty, has achieved a remarkable milestone in the battle against HIV. According to the Sixth South African HIV Prevalence, Incidence and Behaviour Survey (SABSSM VI), conducted by the Human Sciences Research Council (HSRC), the province reported the lowest HIV prevalence in the country at 7.4% in 2022. This is a decline from 8.6% in 2017, a testament to the ongoing efforts to reduce the impact of HIV within the province.
This achievement translates to an estimated 540,000 people living with HIV (PLHIV) in the Western Cape, marking a decrease from 560,000 PLHIV in 2017. While this progress is commendable, there remain areas of concern that must be addressed to ensure the province continues on its path of combating HIV effectively.
Key Findings from the SABSSM VI Survey
The SABSSM VI survey, released by the HSRC, paints a comprehensive picture of the HIV landscape in the Western Cape. According to Professor Khangelani Zuma, the overall principal investigator of the study, the province has shown both areas of improvement and areas of concern when it comes to managing HIV prevalence, treatment, and prevention.
HIV Prevalence in the Western Cape
In 2022, the HIV prevalence in the Western Cape was notably higher among individuals aged 25 to 49, standing at 10.8% for both males and females. This breaks down into 14.6% for females and 5.8% for males, a significant gender disparity that highlights the need for targeted interventions for women.
The survey also revealed that HIV prevalence among individuals aged 35 to 39 was 12.9% in 2022, down from a staggering 23.4% in 2017. Despite the decrease in prevalence in several age groups, there was a concerning rise in prevalence among those younger than 24 years, pointing to new infections, particularly through horizontal (sexual) and vertical (mother-to-child) transmissions.
Moreover, the prevalence among females (9%) was higher than males (5.6%), underscoring the need for increased focus on women’s health in the province’s HIV response.
The Rise in HIV Prevalence Among Adolescents and Youth
One of the most alarming trends in the Western Cape is the rising HIV prevalence among adolescents and youth under 24 years old. This rise signals the persistence of new infections in the younger population, which could potentially reverse the overall gains made in reducing HIV prevalence in the province. As Professor Zuma expressed, “The worsening prevalence among those younger than 24 years is deeply concerning, as it shows continued new infections from both horizontal and vertical transmissions.”
This calls for urgent attention, particularly in promoting HIV awareness, prevention strategies, and access to healthcare services tailored to young people.
Antiretroviral Treatment (ART) Coverage: A Mixed Picture
ART coverage in the Western Cape has seen significant improvement over the years. In 2022, ART coverage reached 76.8%, a considerable increase from 54.4% in 2017. This translates to an estimated 360,000 PLHIV in the province receiving life-saving treatment.
However, there are still disparities in ART use across different age groups and genders. ART coverage among those aged 15 to 49 was slightly lower at 76.5% compared to other age groups. Furthermore, males (75.3%) were less likely to be on ART than females (77.1%).
The geographic distribution of ART coverage also showed discrepancies, with coverage in urban areas at 76.2% and slightly higher in the City of Cape Town at 81.4%. These figures demonstrate the importance of ensuring equitable access to ART services across different demographics and regions in the province.
Viral Load Suppression (VLS): Progress with Room for Improvement
Another crucial indicator of the success of HIV treatment is viral load suppression (VLS), which refers to reducing the viral load in PLHIV to undetectable levels. In the Western Cape, the proportion of PLHIV with VLS increased to 78.4% in 2022, up from 54.6% in 2017.
Despite this improvement, there remain notable gaps, especially among older individuals. VLS was lower among those aged 50 and older (69.4%) compared to younger age groups. Additionally, males (76%) had a lower VLS rate compared to females (79.7%).
These gaps indicate that while the province is making strides in managing HIV, more targeted efforts are required to ensure all PLHIV achieve viral suppression.
Knowledge of HIV Status: An Ongoing Challenge
One of the ongoing challenges in the Western Cape’s fight against HIV is ensuring that all PLHIV are aware of their status and receive appropriate treatment. The SABSSM VI survey revealed that individuals aged 25 to 49 accounted for the majority of PLHIV who were unaware of their status (59.1%).
Moreover, 64.7% of individuals in this age group who were aware of their status were not on ART, and 66.7% of those on ART had not achieved viral suppression. These figures highlight significant gaps in both diagnosis and treatment adherence, particularly in the critical age group of 25 to 49.
Adolescents and youth aged 15 to 24 also contribute disproportionately to these gaps in treatment, accounting for just 9.5% of all PLHIV but showing high rates of disengagement from care.
Key Drivers of the HIV Epidemic: Early Sexual Debut and Multiple Sexual Partners
The survey identified several key drivers of the HIV epidemic in the Western Cape, including early sexual debut and multiple sexual partners.
The proportion of adolescents and youth aged 15 to 24 who reported having sex before the age of 15 increased from 14% in 2017 to 16.3% in 2022. Males (21.5%) were more likely to report early sexual debut compared to females (11.3%).
Additionally, 6.7% of individuals aged 15 and older reported having two or more sexual partners in 2022, compared to 7.6% in 2017. This behavior was more prevalent among males (8.9%) than females (4.4%) and was particularly high among those aged 15 to 24 (19.1%).
Declining Condom Use: A Cause for Concern
Condom use, a key preventive measure against HIV transmission, has declined in the Western Cape. In 2022, only 22.1% of individuals reported using a condom with their most recent sexual partner, compared to 26.6% in 2017. This represents a 4.5% decline in condom use.
Condom use was highest among youth aged 15 to 24 (39.9%) and slightly higher in urban areas (22.5%). However, the survey revealed that 81.4% of individuals had either never or only sometimes used a condom with their most recent sexual partner, indicating inconsistent condom use across the population.
The decline in condom use poses a significant challenge to the province’s efforts to prevent new HIV infections, particularly among young people and those engaging in high-risk sexual behaviors.
Addressing the Gaps: Recommendations for the Way Forward
While the Western Cape has made notable progress in reducing HIV prevalence and improving treatment coverage, the SABSSM VI survey highlights several areas that require urgent attention. The province must address the rising HIV prevalence among young people, improve access to ART for those unaware of their status, and promote consistent condom use to prevent new infections.
Targeted interventions for young people, particularly those under 24, are critical. This could include comprehensive sexual education programs, improved access to youth-friendly health services, and increased HIV testing and counseling services in schools and communities.
Moreover, the province should focus on closing the gender gap in both ART coverage and viral load suppression. Addressing the unique challenges faced by men, such as stigma and reluctance to seek healthcare, will be essential in ensuring equal access to treatment for all.
In light of the survey’s findings, the Western Cape government must continue its efforts to improve HIV prevention and treatment services. This includes scaling up community-based interventions, strengthening healthcare infrastructure, and fostering partnerships with civil society organizations to reach underserved populations.
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