HIV in SA improving slowly

The 2009 HIV gauge reveals that progress
is being made, especially among South
Africa’s youth, but more needs to be done.
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Janine Erasmus

National youth HIV prevention programme loveLife, which celebrated its 10-year anniversary in October 2009, has released its second annual publication on the status of HIV in South Africa.

The publication shows that in some areas there has been marked improvement, but a lot more needs to be done to control the spread of the epidemic and save lives.

The 2009 Gauge of HIV Prevention in South Africa is written by Dr David Harrison, former loveLife CEO, and freelance researcher Ruth Scott. Harrison now heads the national youth empowerment programme Connected! – a loveLife initiative.

“The publication will give us a sense of where progress is, and is not being made,” said Harrison, speaking at the launch on 2 November 2009.

“We’re finding that data such as that from national antenatal surveys are becoming less and less useful – we would prefer that the money be used to better understand the dynamics of the epidemic.”

LoveLife CEO Grace Mathlape concurred, saying that the gauge would inform people about what has been and can still be achieved in preventing the spread of HIV and Aids.

The publication was funded by the UK Department for International Development, which manages UK aid to poor countries, working to eradicate destitution. It may also be accessed online.

Comprehensive information

Drawing on a wide range of published sources, the publication collates all current data about HIV and Aids from both national and regional studies, and presents it in one comprehensive document.

The gauge has a threefold aim. Firstly, it reports on the status of the HIV epidemic in South Africa and identifies trends that will assist in halting the spread of the disease. Secondly, it aims to identify areas where knowledge is lacking, and thirdly it makes recommendations that could influence the direction of future policies and programmes.

The report noted a number of positive developments. The HIV epidemic has peaked, according to the publication, but the prevalence will not drop for at least five years even if the incidence, or rate of new infections, is slashed in half. This is because antiretroviral drugs help to prolong life, and therefore there are more people living with HIV and Aids.

More precise measurements must be implemented to overcome this situation and deliver accurate results, said Harrison. In fact, he added, if the prevalence goes down too soon it could mean that treatment is failing and that too many people are dying.

Another significant statistic reveals that in the past five years the prevalence of HIV among 15- to 24-year-olds has dropped, indicating that the rate of new infection has also decreased sharply.

Research did show, however, that there is a sharp jump in new infections among people in their mid-20s and early 30s. This means that children in school are relatively protected, but once out of school their lifestyle changes, the future is no longer so certain, and they are more willing to take risks.

The report recommends more support structures for new school leavers, and immediate opportunities for personal growth and development.

The number of people who have been tested and now know their status has also increased over the past few years, from less than 33% of the population, to about 50%.

Preventing infection

There are a number of areas where firm action could save thousands of lives.

Mother-to-child transmission is a key area that could result in fewer new infections. According to the report, every year about 30 000 babies are needlessly infected with HIV in this way, when prevention is possible. Although this number has decreased in the past few years it is still unacceptably high – there should be no more than 4 000 of this type of infection per year.

The strategy for preventing mother-to-child transmission (PMTCT) does not reach all babies. When successful, the programme reduces transmission to less than 5%, but the report revealed that for various reasons, at most only about 66% of infants who need PMTCT actually benefit from it. The main reason is that testing doesn’t extend to all pregnant women, and many of those who are tested, and found to be HIV-positive, are later neglected by the health system.

Testing also falls short with regard to tuberculosis, as incidence of the two diseases are closely related and more than 50% of tuberculosis patients also have HIV. The successful detection of tuberculosis in HIV-positive people must increase.

For every two pregnancies in South Africa, there is one HIV infection. This is largely as a result of higher risk in the social environment, since young girls often drop out of school during this time and become insecure about their financial situation. There is also a greater physiological vulnerability to infection.

The report recommends a focus on the prevention of teen pregnancy, but failing this, there must be a greater use of condoms during pregnancy as well as the return of new, young mothers to the school system as soon as possible.

While condom use has increased among young men between the ages of 15 and 24, the same cannot be said of women in the same age group. Furthermore, not enough condoms are distributed, as seen in the high incidence of HIV in KwaZulu-Natal, Mpumalanga and the Free State – the provinces where condom distribution is lowest. Female condoms are expensive and not readily available.

Some of the most vulnerable groups, such as prisoners, are not protected by easy access to condoms. This is especially dangerous because each year 25% of all prisoners are released back into society. “We must flood prisons with condoms,” said Harrison.

Disabled people, Aids orphans, and commercial sex workers are also at particular risk of contracting HIV. The group most at risk of infection are those living in informal settlements, whether urban or rural. Most-at-risk groups are neglected in general, and this is an area that needs urgent attention.

Taking action

Another strategy that could drastically reduce the infection rate is the introduction of a national male circumcision programme, as this medical procedure has been proven to reduce HIV incidence – when performed properly.

Behaviour change and the reduction of risk tolerance must also be addressed. Such programmes do not address all age groups and there is too little focus on high-risk groups.

The report recommends that healthcare be improved generally, as well in specific areas relating to most-at-risk groups, men and those with sexually transmitted infections.

More funding is needed. Although currently about R1-billion (US$130.6-million) is spent on HIV prevention, the gauge reported that the investment of another billion into a comprehensive national programme will result in three times that amount in annual savings within a decade.

Finally, government needs to be firm and clear on how it is tackling the spread of HIV and tuberculosis, and it must form joint partnerships with the civil and corporate sectors to strengthen its work.