Results of the 20th antenatal surveillance survey, which were released this week, show that South Africa’s HIV epidemic is not gaining nor is it slowing down. But does this mean that the country’s efforts in combating HIV are paying off?
Every year over a period of one month, pregnant women between the ages of 15 – 49 attending selected public antenatal care clinics in the country’s 52 health districts take part in an anonymous HIV testing programme. This is for the annual antenatal HIV surveillance survey which helps the Health Department project the prevalence of the epidemic in the general population, so it can develop policy and plan interventions. The survey for 2009 involved 33 000 women and shows very little difference from the previous four years, during which prevalence has hovered around 29%.
“By 2009, we have got 29.4 percentage prevalence. From 2006, nothing is changing in terms of prevalence. Actually, it has flattened out”, said Health Minister Dr Aaron Motsoaledi, announcing the results at Birchwood hotel, near the Johannesburg International Airport.
“Why is it important?” , Motsoaledi asked. “By 1990, the prevalence was only 0.7% and it kept on going high and high until it reached a peak of 30 by 2003. From 2005 or so, it started getting flat. We don’t know for how long it will stay flat, but it’s like that. There’s no change in terms of the prevalence in the general population of antenatal women”, he said.
Although the epidemic seems to be stagnant, the survey shows a difference of HIV distribution among different age groups. At a high level of 21.7%, HIV prevalence among pregnant women between the ages of 15 – 24 is unchanged from the 2008 finding. However, infection is increasing among older women. HIV prevalence levels among the 15 – 24 year age group have to drop drastically in order to show that the country’s efforts are making a dent on HIV distribution. The level of prevalence in this age group is also a marker in the Millennium Development Goal specific to reducing HIV.
“Our MDG baseline is 21.7%. By 2015, this must go to 17.3%. This is the most important group to use to provide evidence when monitoring new HIV infections incidence. The 15 – 24 year olds is a very important group to us to tell us what’s happening. These are still very young (women) who are falling pregnant for the first time. These are new entrants and what is happening to them is a good reflection of showing the changes in terms of the prevalence”, the Health Minister said.
The only group where HIV prevalence is not stagnant is the 30 – 34 year age group. “It has increased to 41.5% in 2009. This age group, which is the hardest hit is moving from 39.6%, 40.4%”, he said. The World Health Organisation’s Dr Patrick Abok interprets the finding. “We are seeing a lot of people now having access to treatment and care, which means that many people now are trying to know their status and be able to come early and have access to treatment and care. The other element is regarding the awareness… having people who know they are HIV-positive and knowing where to go and seek treatment, and in that way, it positively is affecting their lifestyle in terms of now trying to live longer. So, we are bound to see that number increasing simply because it means that the number of people who have access to treatment, very few of them will be dying. The longer they live that means the more people in that category, the more the prevalence”, said Dr Abok.
Deputy chair-person of the South African National AIDS Council (SANAC), Mark Heywood, described the results as being “fairly predictable”. Heywood said the report suggests that the country is not doing well to prevent new HIV infections. “We’re not getting on top of the HIV epidemic, at least, as far as prevention is concerned. It shows that there is still very high numbers of new HIV infections and it shows that we have a growing number of people living with HIV in this country because of the combination of new infections and people who are now living as a result of antiretroviral treatment. I wouldn’t say that it points to our failures, but it points to our short-comings and our inadequacies, and it tells the Department of Health and SANAC that they have to do more to get this thing right, and, actually, we’re not getting it right this moment in time”, Heywood said.
As usual, KwaZulu-Natal has the highest HIV prevalence, followed by Mpumalanga and the Free State. The lowest prevalence – below 20% – is in the Northern and Western Capes, while the North West, Gauteng, Limpopo and the Eastern Cape have a prevalence level of between 20 – 30%. Prevalence levels also vary within provinces, with certain districts ranking higher than others.