Health Systems

HSRC Report on HIV Prevalence, Incidence, Behaviour and Communication Survey 2008

On 9 June 2009, staff from TAC’s Policy Communications and Research Department attended the Human Sciences Research Council’s (HSRC) presentation on the HIV Prevalence, Incidence, Behaviour and Communications Survey 2008. The report highlighted that African females ages 20 – 34 are the most at risk population for contracting HIV and the percentage of women with older sexual partners is increasing. At the same time the rates of men between 15 and 49 with multiple sexual partners is increasing.

TAC welcomes the news of reduction in prevalence of HIV for youth and children emphasized in the survey results, but continues tirelessly for the achievement if the NSP targets. The HSRC survey highlighted that the NSP target of reducing transmission by 50% by 2011 is a distant ideal. To achieve this target government will have increase access to evidence based methods of prevention such as condoms.

On 9 June 2009, staff from TAC’s Policy, Communications and Research Department attended the Human Sciences Research Council’s (HSRC) presentation on the HIV Prevalence, Incidence, Behaviour and Communication Survey in 2008.

The objective of this study was to gather information necessary to monitoring and evaluating progress of HIV prevention and treatment targets and interventions in South Africa. This is the third survey done by the HSRC on Prevalence, Incidence, Behaviour and Communications. The 2008 data is compared to data from the 2002 and 2005 surveys. Dr. Olive Shishana presented the findings of the survey, after which the report was presented to Health Minister Aaron Motsoaledi. It is important to note that Minister Motsoaledi stated during during his response to the survey that the fight between government and civil society is over, and that it is now time for us to all fight together to end the HIV/AIDS epidemic.

Key findings from the report:

• HIV prevalence from 2002 to 2008 has varied across the provinces. The biggest decline in prevalence was seen in the Western Cape (from around 11% to around 4%). The biggest increase in prevalence was seen in Kwazulu-Natal (from just under 12% to around 16%).

• HIV prevalence shows that African females ages 20- 34 are the most at risk population with an HIV prevalence of 32.7%. The percentage of women with sexual partners who are more than 5 years older has increased from 18.5% in 2005 to 27.6% in 2008. This is an extremely alarming increase which highlights the unequal status of women, particularly young women, in society. The fact that more young women are engaging in transactional sex with older men suggests that education and employment opportunities are severely lacking. Intergenerational sex with older men (‘sugar daddies’) was identified as a significant risk factor which increase vulnerability to HIV infection. Multiple concurrent partners were also identified as a risk factor, but this was not adequately measured by the survey as participants were only asked if they had more than one sexual partner in the past twelve months. This is not indicative of multiple current or overlapping partners. HIV prevalence for women in this age group has remained very high at around 33% in the 2002, 2005 and 2008 HSRC surveys.

• A major factor identified for a young woman having older sexual partners is the financial benefit this accrues for herself and her family. A woman’s family can pressure her into the partnership with the older man. Female HIV prevalence peaks between the ages of 25 and 29 and male HIV prevalence peaks between 30 and 34. Having sex with older men puts women at greater risk for contracting HIV.

• African males ages 25-49 are the second most at risk population with a prevalence of 23.7%. According to the HSRC’s sampling method, the percentage of males who have multiple sexual partners increased between 2002 to 2005, and rose further between 2005 to 2008. This shows that it is increasingly socially acceptable and common for men to have numerous sexual relationships at the same time (described by Shisana as men ‘running around the place’),

• The most at risk population for having multiple sexual partners are high-risk drinkers and recreational drug users. Interventions must be targeted at these groups.

• Prevalence among older men and women is rising, which is evidence that prevention mechanisms and awareness programmes are not reaching these populations. Prevalence for men and women between 50 and 54 was 10.4% and 10.2% respectively.

• The survey found that each age group over the age of 15 has increased its condom usage. Condom usage is measured by the proportion of the surveyed population that reported using a condom during last sexual act. According to this measure, condom usage has increased in every province in South Africa, but the Western Cape falls below the national average. TAC’s research in six districts has shown that stock-outs of condoms in clinics are widespread, and the Khayelitsha office reports ongoing shortages and interruptions in its condom supply from the Department of Health.

• Measuring condom usage from the last sexual act risks over-estimating its usage as people are more likely to use condoms in a one time sexual encounter than during long term concurrent relationships, during which HIV transmission rates are high.

• Testing initiatives have increased with the total number of people reporting being tested at 50.8% in 2008, up from 21.4% in 2002. It is likely that more people have tested because they are AIDS sick, and because ART availability may provide a positive incentive to test.

• While HIV prevalence among adults is rising, there has been a modest decline in HIV prevalence among children and youth. From 2002 to 2008 there has been a 3.1% decline in HIV prevalence among children. This was likely a result of the PMTCT rollout. From 2005 to 2008 there has been a modest decline in the HIV prevalence among youth of just below 2%.

• The most positive outcome from the report was that, while HIV incidence rose from 2002 to 2005 among 15 to 20 years olds, there has been a decline in incidence from 2005 to 2008. The decline has been on average 0.72% from 2005 to 2008. This indicates that there is a decline in the risky behaviour of teenagers. This statistic was emphasized in the title of the report (‘A turning tide among teenagers?’). While it is encouraging that there has been a decline in incidence among teenagers, the emphasis on this decline must not distract from the fact that prevalence rates among women aged 25 – 29 and men aged 30 – 34 for men are extremely high, and that the targets of the National Strategic Plan (2007-2011) are not being met.

• A disturbing finding from the survey was that, in all the age groups over 15 and for both males and female, there has been a decline in accurate knowledge about HIV and HIV prevention from 2005 to 2008. Treatment literacy plays an important role in prevention. Inaccurate data about HIV will lead to more infections as well as increased stigma and discrimination.

• Communications programmes on HIV have reached a growing proportion of the population from 2005 to 2008. However, government’s very expensive communication programme, Khomanani, has been far less effective in communicating its HIV messages than other non governmental programmes including loveLife and Soul City.
Minister Motsoaledi said that government would work with NGOs including SANAC to improve the efficacy of its HIV communications.

• The NSP target on prevention, to reduce transmission by 50% by 2011, is a distant ideal. During the meeting, Minister Motsoaledi asked the HSRC what message we should be sending to children about whether they should abstain or use condoms and whether condoms should be available in schools. Dr. Shishana responded that government should promote abstinence but also make condoms available for teenagers who are sexually active. Minister Motsoaledi asked if he should be making more funds available for condoms, and the audience applauded.

• The executive summary of the HSRC report states that ‘The present report allows for an understanding of the progress and potential impact of the HIV&AIDS and STI Strategic Plan for South Africa (NSP) 2007-2011 (DOH 2007) close to the midpoint of its implementation.’ However the report does not include a number of key indicators including data on how many people are receiving ART. The survey did take and test blood from its participants, but the number of people found to be on ART was not addressed in either the report or the presentation. What is urgently needed is more detailed information on how far we have come in reaching targets of the NSP. TAC welcomes the news of a reduction in prevalence of HIV for youth and children, but we continue to work tirelessly for the achievement of the NSP targets, the eradication of ART waiting lists, and the availability of dual protocols for PMTCT.