Condom use has declined in the province, with only 22.1% of respondents reporting using a condom with their most recent sexual partner, down from 26.6% in 2017. (File photo)
The Western Cape has the lowest HIV prevalence in South Africa, but new infections among young people are rising, according to the latest survey by the Human Sciences Research Council (HSRC).
Released this week, the sixth South African HIV prevalence, incidence, and behaviour Survey (SABSSM VI) found a 7.4% HIV prevalence rate in the province for 2022, down from 8.6% in 2017.
But the study also highlighted worrying trends, particularly among those under 24, where the number of new infections is increasing.
The province, with an estimated 540,000 people living with HIV (PLHIV) in 2022, has seen a decline from the 560,000 reported in 2017.
Despite this, there are disparities across age groups and geographic areas.
HIV prevalence remains significantly higher among people aged 25–49 (10.8%), with a more pronounced difference between females (14.6%) and males (5.8%). Rural areas show a higher prevalence (8.5%) compared to urban counterparts.
Professor Khangelani Zuma, HSRC’s lead investigator, said that the epidemic remains concentrated among middle-aged groups.
“HIV prevalence peaked at 12.9% among those aged 35–39 years in 2022, a drop from 23.4% in 2017,” said Zuma.
However, younger groups are increasingly at risk. The report shows concerning trends among individuals aged under 24 years, particularly through new infections from both horizontal and vertical transmissions.
Antiretroviral Treatment (ART) coverage
Access to antiretroviral treatment (ART) has significantly improved. ART coverage rose to 76.8% in 2022, up from 54.4% in 2017. This translates to an estimated 360,000 PLHIV in the Western Cape receiving treatment. However, the uptake remains uneven across different groups. ART usage among those aged 15–49 years was 76.5%, and lower among males (75.3%) compared to females (77.1%).
While urban areas showed better ART coverage (76.2%) compared to rural regions, the City of Cape Town led the province with an 81.4% coverage rate.
UNAIDS 95-95-95 targets
The Western Cape is making progress toward the global UNAIDS 95-95-95 targets, which aim for 95% of all PLHIV to know their status, 95% of those diagnosed to be on ART, and 95% of those on ART to achieve viral suppression.
According to the survey, 85.6% of PLHIV aged 15 and older in the province were aware of their status in 2022. Of these, 91.0% were on ART, and 92.0% of those on ART had achieved viral suppression.
But disparities remain. Men lag behind women in knowing their status (79.0% vs. 88.5%). “We are making strides towards the 95-95-95 goals, but we need to address the gaps in awareness, particularly among men and young people,” Zuma emphasised.
Viral load suppression (VLS) also saw a notable improvement, reaching 78.4% in 2022, up from 54.6% in 2017. However, VLS rates were lower among men (76.0%) compared to women (79.7%).
Older individuals (50+ years) had the lowest VLS rate, at just 69.4%. The City of Cape Town again led in VLS rates, with 80.4% of PLHIV achieving suppression.
Key Drivers of the HIV epidemic
The survey highlighted concerning trends around key drivers of the epidemic. In particular, sexual debut before the age of 15 increased from 14.0% in 2017 to 16.3% in 2022 among adolescents and youth aged 15–24. The practice was more prevalent among males (21.5%) than females (11.3%).
Another key factor contributing to the spread of HIV is the prevalence of multiple sexual partners. In 2022, 6.7% of individuals aged 15 and older reported having two or more sexual partners, with males (8.9%) and those aged 15–24 years (19.1%) being the most affected.
Condom use has declined, with only 22.1% of respondents reporting using a condom with their most recent sexual partner, down from 26.6% in 2017. Worryingly, 81.4% of people in the Western Cape reported inconsistent condom use, with youth aged 15–24 showing the highest rates of condom use at 39.9%.
Male circumcision decline
The survey found a decrease in self-reported male circumcision in the Western Cape, from 52.0% in 2017 to 50.9% in 2022. Circumcision rates were particularly low among younger males aged 15–24 years (44.4%) and those in rural areas (27.3%). Male circumcision is a key HIV prevention strategy, and the decline in circumcision rates could pose challenges in reducing future infections.
The survey revealed high awareness of HIV testing services, with 89.9% of people aged 15 and older knowing where to get tested. However, awareness was lower among older adults (85.6%) and men (85.9%) compared to other groups.
Among sexually active adults, 33.5% had heard of pre-exposure prophylaxis (PrEP), but only 3.0% had taken the medication to prevent HIV infection. Willingness to use PrEP was higher among women (64.9%) than men (59.6%).
The HSRC made several recommendations for the province, including targeted interventions for the most affected groups, particularly adolescent girls and young women.
The council also called for a long-term strategy to support people living with HIV as the population ages, along with efforts to increase male circumcision rates and improve HIV prevention strategies like PrEP and regular testing.
Zuma stressed the importance of sustained efforts. “We recommend a continued focus on expanding HIV prevention measures such as male circumcision, regular testing, and the use of PrEP. Tailored interventions must address gaps in the treatment cascade by district, locality, and population group.”