Independent On-Line, 06 December 2002, SA's HIV/Aids rate lower than expected

After months of speculation, the first independent and nationally representative study of HIV and Aids in
South Africa released in Johannesburg on Thursday revealed several shock findings.

The good news is that the overall infection rate in the country is 11,4 percent, lower than the previously estimated 19 percent.

This means that about 4,5 million South Africans are living with HIV and Aids.

The bad news for white South Africans is that their infection rate is 6,2 percent, 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 percent and among Indians prevalence was 1,6 percent.

HIV prevalence among Africans was highest at 12,9 percent 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 report found.

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 participants.

Further surprising news is that HIV prevalence was highest in the Free State - 14,9 percent - followed by Gauteng with 14,7 percent and Mpumalanga with 14,1 percent.

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 percent.

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 settlements.

But
KwaZulu-Natal is a populous province and as a result has the second highest number of people living with HIV and Aids after Gauteng.

The infection rate in the
Western Cape was 10,7 percent, higher than the antenatal survey that ranked the province as the lowest with 8,6 percent with regard to prevalence rate.

The
Eastern Cape has the lowest infection rate at 6,6 percent. An unexpected finding was the high prevalence rate, 5,6 percent, 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 percent, followed by formal urban areas with 12,1 percent.

Tribal areas had a rate of 8,7 percent and farms 7,9 percent.

"The mobility and transient nature of life in informal settlements, 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 percent of men living in informal settlements reported more than one sexual partner in the past year, in comparison to 19,2 percent in tribal areas, 10,2 percent in urban formal areas and 8,2 percent in rural areas.

Youth aged between 15-24 in informal settlements also showed a significantly higher rate of sexual experience - 74 percent - 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 support."

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