KwaZulu-Natal has shaken off the tag of having the highest HIV-prevalence rate after the first national survey found that it is only fourth on the list of worst-hit provinces.
All sectors of society can now start constructive interventions after the release of a breakthrough household survey to determine the HIV prevalence rates in different provinces, among races, sexes and geographical locations.
The study, commissioned by the Nelson Mandela Foundation and conducted by the Human Sciences Research Council (HSRC), was handed to Nelson Mandela on behalf of the foundation at a ceremony in Johannesburg on Thursday.
The study estimates the overall HIV prevalence in the South African population at 11,4%, or about 4,5-million people.
Provinces worst hit by the epidemic are the Free State (14,9% HIV incidence rate), Gauteng (14,7%) and Mpumalanga (14,1%).
“We as a foundation thought it is important to get scientific information on HIV/Aids … so we know what to do on the ground in order to help people with HIV/Aids,” said Mandela.
Mark Orkin, the CEO of the HSRC, says the study is the most comprehensive and systematic view yet of how HIV/Aids is affecting South Africans. It was a collaborative effort by a number of organisations including the Medical Research Council, the Centre for Aids Development Research and Evaluation, Unicef and French research agencies.
The study is far more reflective of South African society than the Department of Health’s annual antenatal survey, which samples only pregnant women, mostly African, who are generally between the ages of 15 and 49 and attend public health facilities.
The sample was made up of 1000 small units selected from around the country and trained nurses interviewed about 10 000 individuals. Of those interviewed 65,4% agreed to “spit” for an anonymous HIV test. The survey used the 8 840 specimens of saliva and the participants answered questions on behaviour, communication and socio-cultural aspects of HIV/Aids.
The prevalence rate among those aged between 15 and 49 was found to be 15,6%. But most at risk is the 25 to 29 age group with a 28% prevalence rate, followed by the 30 to 34 age group (24%).
Surprisingly high was the prevalence rate of 5,6% among children aged two to 14.
“The study draws no conclusion on how these children were infected, but states that possible factors to be investigated are sexual abuse and exposure to unsterile needles,” says Olive Shisana, principal investigator.
One of the key findings that differed from the antenatal survey is the rate of infection in provinces. KwaZulu-Natal has been labelled as having the highest prevalence rate, yet this study found it has the fourth-highest rate (11,7%).
Shisana says the reason for this finding is that in the past 10 years KwaZulu-Natal has used the same sites for its antenatal survey whereas the HSRC study included both rural and urban areas in KwaZulu-Natal and not just the clinics.
A surprising finding is that the Eastern Cape has the lowest prevalence rate (6,6%). This, Shisana says, can be attributed to the fact that urban informal areas had a higher incidence of HIV (28,4%) with rural and tribal areas showing a 12,4% prevalence rate.
“The mobility and transient nature of life in informal settlements, rather than socio-economic status, makes those living in these areas most vulnerable to HIV,” says Shisana.
The Western Cape gets a wake-up call because its HIV prevalence rate of 10,7% is higher than the 8,6% revealed by the antenatal survey.
“The Western Cape, which has higher prevalence of HIV based on household survey, also has a large percentage of its population living in informal areas, which may explain its higher ranking,” says the study.
It explains that the Free State, Gauteng and Mpumalanga have a high proportion of informal urban settlements, therefore the prevalence rates are higher than they are in KwaZulu-Natal, which consists of largely rural areas.
Although all races are at risk, Africans have the highest incidence rate with 18,4%. Whites and coloureds were around 6% and Indians 1,8%.
“Many Indians refused to participate in the study,” says Shisana.
The study contradicts the perception that poverty-stricken people are at a higher risk of HIV infection. It found no significant difference in HIV prevalence between persons who were employed (14,2%) and those who were unemployed (12,1%).
“Wealthy Africans were found to have similar levels of risk to less wealthy Africans. However, in other race groups poorer people are more vulnerable to HIV.”
The study found that there had been significant changes in behaviour, with condom usage and the number of women with no current sexual partner having increased.
“Only 55,6% of males and 57,9% aged 15 to 24 had previously had sex, and there were very low levels of partner turnover. Of sexually active youth, 84,7% reported that they had had only one partner in the past year. For adults aged 25 to 49 the rate was 93,5%,” Shisana says.
According to the survey 13% of children in households had lost one or both their parents and 3% of the households were headed by children.
Questioned about their perceptions of political leadership, 63,8% of South Africans aged 15 years and older believed that political leaders were committed to controlling HIV/Aids. “Positive perceptions were highest among Africans and lowest among whites.”
In its conclusions the study says that there are high levels of public support for provision of anti-retroviral therapy and programmes for the prevention of mother-to-child transmission.
“It is recommended that the government should roll out an anti-retroviral therapy programme for both prevention of mother-to-child transmission and for all people living with Aids as soon as possible.”