Sunday Times (Johannesburg) - June 13, 2009
Claire Keeton

This is according to Dr Francois Venter, president of the HIV Clinicians' Society of Southern Africa, who based his comments on the third national HIV survey released this week.

The survey found that 5.2 million South Africans - or 10.9% of the population - are infected, a similar figure to the last survey, in 2005.

But, said Venter, "the data suggests that new infections are actually going down - especially as we have, since the last survey, kept half a million South Africans alive by using antiretrovirals".

The new study - conducted among 23369 people from June 2008 to March this year by the Human Sciences Research Council and three collaborators - provides the best information on South Africa's HIV epidemic.

But Mark Heywood, deputy chairman of the SA National Aids Council, said the latest results were no cause for celebration.

"With the scale of the epidemic, its visibility and high levels of death, it would be surprising if there were no levelling off," he said.

Of concern is that the new study shows that "sugar daddies" and multiple sexual partners are still driving HIV infection - and women in their 20s are twice as likely to be HIV positive than men of that age.

Heywood, director of the Aids Law Project, said: "This shows a failure to properly tackle inter-generational sex and the inequality affecting women."

Besides the gender imbalance, HIV levels among provinces are uneven, with infection rates in KwaZulu-Natal (16%), Free State (13%) and Mpumalanga (15%) higher than the national average.

Heywood ascribed this to a "poorer, more chaotic and thinner state of government" in some provinces.

The survey results are a mix of good, bad and ugly.

The good news is that new infections are lower among teenagers, and child and teenage prevalence rates are down. Condom use and HIV testing are up.

The report's title, A Turning Tide Among Teenagers? highlights the most promising finding.

Venter said: "This (decline) is despite no change in age at sexual debut.

"Unfortunately, as has been shown in other countries like Uganda and which we can see in this survey, new infections continue to hit the older groups."

The Treatment Action Campaign policy unit said of the report: "The (declining incidence) must not distract from the fact that prevalence rates among women aged 25-29 and men aged 30-34 are extremely high, and that the targets of the National Strategic Plan (2007-2011) are not being met."

The plan calls for a 50% reduction in new infections by 2011.

The roll-out of the strategy aimed to prevent mother-to-child transmission of the virus seems to be working, with a reduction in prevalence among children.

But, said Denise Hunt, director of the Aids Consortium, a network of about 1000 organisations, "it could be so much better. We look forward to the accelerated plan (on mother-child transmission)."

Teenagers also reported a steep increase in condom use, which rose among all age groups.

HSRC CEO Dr Olive Shisana attributed this to "highly successful condom promotion and distribution by government. The second reason is the empowerment of women."

The TAC, the Clinicians' Society and the Aids Consortium all expressed concern at supplies of government condoms running out.

TAC research in six districts has "shown that stock-outs of condoms in clinics are widespread", the organisation said.

Venter said: "It makes the stock-out of condoms we've seen several times within the country that much more outrageous. . .

"It also suggests the Department of Education should really reassess its ridiculous policy of not making condoms available in schools."

Another positive finding is that HIV testing has risen sharply since the last survey.

Shisana said: "The availability of HIV testing sites, including mobile clinics, promotion of HIV testing (through campaigns), all play a role in increasing interest in HIV testing."

The TAC indicated that the increased availability of antiretroviral drugs and people in the community being seen to get sick from Aids might have boosted testing figures.

The bad news from the survey isn't new, but it is grave.

The incidence of inter-generational sex (at least a five-year age gap between partners) and the number of sexual partners - both known to spread HIV - are rising and the "most at-risk populations" are not being reached by prevention programmes.

Shisana said that poverty fuelled "age mixing" and "running around" with multiple partners.

She said: " Young women often have older partners to get financial security . . . which often supports the family."

Multiple sexual partnerships are also linked to age mixing and material gain, she said.

The most at risk are heavy drinkers and recreational drug users.

A major concern is that HIV-prevention efforts are not reaching the most vulnerable groups.

"It is a disturbing finding that, in all the age groups over 15, there has been a decline in accurate knowledge about HIV and HIV prevention," said the TAC.

Shisana said: "People living in rural areas are unlikely to be reached by these programmes. People with disabilities are also difficult to reach."

The Department of Health's expensive Khomanani programme reaches only about half of its audience, and has proved to be the weakest of the four national prevention programmes (Soul City, Soul Buddyz and loveLife), said the report.

Heywood called for an investigation into Khomanani, which is soon to award its next tender.

The TAC said the report had a gap - in failing to report on how many people are receiving ARVs.

The National Strategic Plan aims to provide treatment care and support to 80% of HIV-positive people by 2011, and this was not measured.

At the launch of the report this week, minister of health Aaron Motsoaledi promised that the government would work with NGOs, including the Aids Council, to improve its HIV communications.

Statistical portrait of an epidemic

-- HIV prevalence: 10.9% compared with 10.8% in 2005;

-- Provinces differ: highest is KwaZulu-Natal (with 15.8% prevalence) and lowest, Western Cape (3.8%);

-- Reduced incidence in teenagers 15-19 years old (according to a mathematical calculation);

-- Reduced HIV prevalence among children two to 14 years old: 2.5% compared with 5.6% in 2002;

-- HIV testing rose in the 15-49 age group: 50.8% vs 30.5% in 2005;

-- Condom use grew in the 15-49 group: 62.4% vs 35.4% in 2005;

-- High level of HIV prevalence among women 25-29 years old: one in three ;

-- Inter-generational sex increased among teenage girls aged 15-19: 27.6% vs 18.5% in 2005;

-- Multiple sexual partners increased among men: 30.8% vs 23% in 2002; and

-- HIV prevention knowledge declined among 15-49-year-olds: 44.8% vs 64.4% in 2005.

090613
ST090602

Always watch for outdated information. This article first appeared in 2009. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2009. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .