December 6, 2002
By Anso Thom
After months of speculation, the first independent and
nationally representative study of HIV/Aids in South
Africa released in Johannesburg yesterday revealed
several shock findings.
The good news is that the overall infection rate in the
country is 11.4%, lower than the previously estimated
This means that around 4.5 million South Africans are
living with HIV/Aids.
The bad news for white South Africans is that theri
infection rate is 6.2%, a considerably higher figure
than in countries with predominantly white populations
such as America, Australia and France.
Coloured prevalence was found to be 6.1% and among
Indians prevalence was 1.6%.
HIV prevalence among Africans was highest at 12.9% but
this can be explained by historical factors, such as
labour migration and relocation, as well as the fact
that more African people live in informal settlements.
"The HIV prevalence among whites and coloureds
clearly indicates that a dynamic epidemic is occurring
in these groups and they should be consciously
incorporated into HIV prevention efforts," the
The study, commissioned by the Nelson Mandela Foundation
and the Nelson Mandela Children's Fund and conducted by
the Human Sciences Research Council (HSRC) in
collaboration with the Medical Research Council (MRC)
and the Centre for Aids Development, Research and
Evaluation drew on a sample of 9 963 people countrywide,
and included anonymous saliva-based HIV tests from 8 840
Further surprising news is that HIV prevalence was
highest in the Free State - 14.9% - followed by Gauteng
with 14.7% and Mpumalanga with 14.1%. Gauteng and Free
State have the highest proportion of their residents
living in informal settlements, found to be a
significant risk factor for HIV.
KwaZulu-Natal, which according to antenatal surveys
showed the highest infection rate, ranked fourth at
11.7%. A possible explanation for the discrepancy is the
fact that the sites for KwaZulu Natal's ante-natal
survey are along major transport routes, known to be
high risk areas for HIV. In addition, a relatively small
percentage of people live in informal
But KwaZulu-Natal is a populous province and as a result
has the second highest number of people living with
HIV/Aids after Gauteng.
The infection rate in the Western Cape was 10.7%, higher
than the antenatal survey that ranked the province as
the lowest with 8.6% with regard to prevalence rate. The
Eastern Cape has the lowest infection rate at 6.6%. An
unexpected finding was the high prevalence rate, 5.6%,
for children between two and 14 years. It remains
unclear how some of these children were infected.
"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," said Dr Olive Shisana.
People living in urban informal settlements had the
highest HIV prevalence of 21.3%, followed by formal
urban areas with 12.1%.
Tribal areas had a rate of 8.7% and farms 7.9%.
"The mobility and transient nature of life in
informal settle-ments, rather than socio-economic
status, makes those living in these areas most
vulnerable to HIV," said Shisana.
This was also reflected in the finding that 23.5% of men
living in informal settlements reported more than one
sexual partner in the past year, in comparison to 19.2%
in tribal areas, 10.2% in urban formal areas and 8.2% in
farms. Youth aged between 15-24 in informal settlements
also showed a significantly higher rate of sexual
experience - 74% - than their peers in rural areas and
formal urban areas.
Dr Mark Orkin, HSRC Chief Executive Officer, said the
findings opened three windows of opportunity for
concerted interventions: "Firstly, we now have
information for different race, gender and age groups in
urban and rural areas, thus allowing programme planners
to develop targeted interventions.
"Secondly, we have a clearer understanding of the
positive relationship between communication and risk
reduction, as well as of information needs.
"Thirdly, because the findings are representative,
they will enable reliable modeling for the first time,
giving a solid basis for optimising and extending
programmes of prevention, care, treatment and
He said the HSRC was committed to repeating the study at
regular intervals. Treatment Action Campaign manager
Nathan Geffen welcomed the report as an important
addition to the body of research on HIV prevalence and
called on the HSRC to repeat the study every two years.
He cautioned them to continuously improve on the
methodology for collecting data. - Health-e News