Rampant Aids Epidemic Confirmed in New Study

The first national household survey on HIV/Aids prevalence and behavioral risk in South Africa has brought welcome new data to reflect on.

The findings of the Nelson Mandela/HSRC Aids study presents important areas of divergence from what was previously assumed to be the profile of HIV infection in the country, but "confirms the picture of of a rampant epidemic", says Dr Kevin Kelly of the Rhodes university-based Centre for Aids Development Research and Evaluation (Cadre). He is a member of the team that conducted the study.

Until now HIV/Aids prevalence figures in South Africa were based on an annual survey at antenal clinics of the Department of Health and included only women between 15 and 49 years old. For the first time a systematic, national household survey was conducted which included more than 8 000 children, women, men and the elderly, representing province, type of settlement and race. One of the most significant findings of the survey was that 17.7% of the female population between the ages of 15 and 49 was HIV positive compared to 24.8% of women attending antenatal clinics as measured by the Department of Health in 2001. The finding for the general population was that 11.4% of the entire South African population is HIV-positive.

Another surprising result was that the Eastern Cape showed the lowest number of HIV infections of 6,6% while the highest was in the Free State at 14,9%.

In comparing the results with the annual antenatal survey Dr Kelly said that the only province where HIV prevalence had been under-estimated by the Department of Health was in the Western Cape. In all other provinces the department's findings are higher than the findings of the HSRC study. An area "begging for more investigation" was informal, urban settlements where the infection rate was the highest, at 28.4%.

In age group prevalence the survey showed that infection was highest among 25 to 29-year-olds at 28% followed by 30 to 34-year-olds at 24%.

Dr Kelly said a "good news story" was the low prevalence figure of 6% among 15 to 19-year-olds.

However, he noted that whereas in the case of Uganda and some other countries the age of first sexual intercourse has been raised by about two years as a direct outcome of HIV/Aids prevention campaigns, there is no evidence of such a trend in South Africa. The trend goes the other way, with people having sex at younger ages. He said the survey showed that "there is much still to be learned" about patterns of sexuality among youth. There are some encouraging signs that young people are responding to HIV prevention messages. In the 15 to 24-year-old age group 57.1% of men and 46% of women had used a condom the last time they had sex. Also 70% of youths 15 to 24 years said they had sex four times or less times per month while 29% were not having sex at all, showing that the image that all young people are rampantly sexually active may need to be rethought.

The researchers were surprised by the finding that 6% of the population between two and 14 years are HIV positive. Dr Kelly said this finding is open to a number of interpretations including possible transmission via medical procedures and child abuse. A further study is being planned to more closely examine this finding. Another surprising finding was the relatively high infection rate of 7% among people older than 50 years. The survey found that increased household socio-economic status is associated with a decrease in HIV/Aids prevalence . However, Dr Kelly noted that "all stratas of society are at risk of contracting HIV and there can be no doubt that we are dealing with a generalised epidemic with alarmingly high HIV prevalence in all sectors of society and population groups". He said the report was fairly inconclusive about the association between cultural practices, including circumcision and HIV status, but further investigation of this and other other cultural issues was underway. In general participants in the survey had a good knowledge of HIV/Aids although there were also areas of knowledge deficit in some sections of society, especially poorly educated groups, children and older people. There were high levels of uncertainly -- 23% among 12 to 14-year olds and 8.3% among 15 to 24s -- about the so-called 'virgin cure' for Aids.

An alarming 24.3% of respondents older than 15 years answered incorrectly or with uncertainly when asked whether HIV caused Aids.

Respondents felt they needed more information on 'condom negotiation' and better access to free HIV-testing. Dr Kelly said people have changing needs for information and education as the impact of AIDS begins to show its full force.