HIV spread falls, but risky conduct persists

The spread of HIV has slowed in SA in the past five years, with HIV incidence falling by almost half, new research has found.

Scientists are worried that the gains made in the fight against HIV in SA are largely due to interventions such as the provision of antiretroviral treatment and male circumcision, rather than behavioural change.

The spread of HIV has slowed in the past five years, with HIV incidence falling by almost half, new research from the Human Sciences Research Council (HSRC) has found.

The findings are in the latest South African National HIV Prevalence, Incidence and Communication Survey released on Tuesday, and raise questions about whether the government may have expanded its HIV treatment programme at the expense of prevention efforts.

The survey is the fifth in a series that has been conducted since 2002. Led by scientists at the Human Sciences Research Council (HSRC), it was conducted between January and December 2017 and included interviews with more than 33,000 people, of whom 24,000 agreed to take an HIV test.

It found the HIV incidence rate almost halved between 2012 and 2017, dropping from 0.85% to 0.48%, as the annual number of new infections fell from 469,000 to 231,000. The proportion of men who were circumcised rose from 18.6% to 30.8%, while the number of HIV patients on treatment rose from 2.4-million to 4.4-million.

However, consistent condom use was low, early sexual debut increased (particularly among men) and more than a third of young women were in relationships with older men.

“We’ve made progress with biomedical interventions, but unfortunately we are not making progress with behavioural change,” said one of the study’s principal investigators, HSRC researcher Mpumi Zungu.

“Changing attitudes is complex — a lot of work still has to be done. We need to remind people that HIV is still infectious and that you are at risk if you are not using condoms,” she said.

Young men and women aged between 15 and 24 reported the same degree of condom use as they had in 2012, at 49.8% for women and 67.5% for men.

However, these figures are lower than those reported in 2008, which found 66.5% of females and 85.2% of males had used condoms the last time they had sex. More youths are having sex earlier, increasing their risk of HIV. The proportion of females under 15 rose from 7.6% to 19.5% between 2008 and 2017, while the figure among males rose from 11.3% to 19.5%.

Zungu said SA had made progress towards the UN’s 9090-90 goals, which aim to increase to 90% the proportion of people who know they have HIV; are on treatment; and have a suppressed viral load to eliminate the epidemic by 2030. The survey found 85% of people living with HIV knew their status, 71% were on treatment and 86% had a suppressed viral load.