Business Day, 07 December 2002, Research offers new insights into spread of HIV/AIDS in SA

Infection rate among whites and children shown to be higher than expected

CAPE TOWN - The highest incidence of HIV infection is not found in KwaZulu-Natal as previously thought, and it is much higher than expected among whites and children, according to a new study led by the Human Sciences Research Council.

The lead partners in the study were the council and the Nelson Mandela Foundation.

It is the first of its kind in SA, and draws on a representative sample of the SA population to offer a snapshot of how the epidemic is affecting all ages and population groups.

Other studies have drawn on specific population groups, such as young pregnant women attending government antenatal clinics, to estimate the HIV prevalence rate among other population groups. The study's findings, based on the results of anonymous saliva tests from 8428 participants, offers new insights on how best to allocate resources and develop strategies to combat HIV/AIDS in the country.

It also raises questions about how the epidemic has spread, says Olive Shisana, executive director of social aspects of HIV/AIDS and health at the research council, and the study's principal investigator.

One of the most worrying findings was that the infection rate among young children aged 2-14 was at 5,6%.

Shisana said this was unlikely to be due solely to sexual abuse because the incidence of HIV among boys and girls was found to be the same, and girls were more vulnerable to sexual abuse than boys. She said further investigation was required urgently.

The study found HIV prevalence among whites was 6,2%, considerably higher than in countries with predominantly white populations such as the US, Australia and France, where its prevalence among whites is less than 1%. The survey found that among blacks, the HIV prevalence rate was 18,4%, coloureds 6,6%, and Indians 1,8%.

HIV prevalence was highest in Free State (14,9%), Gauteng (14,7%) and Mpumalanga (14,1%), with KwaZulu-Natal in fourth position at 11,7%.

The most recent antenatal clinic survey indicated KwaZuluNatal was the most badly affected province, with 33,5% of pregnant women attending government clinics in 2000 infected.

A possible reason for the discrepancy, said Shisana, was that the sites for KwaZulu-Natal's antenatal clinic survey are along major transport routes, which are high risk areas for HIV. Overall, the study found that 11,4% of the SA population, or 4,5-million people, were infected with HIV.

Of those tested in the study, 22,3% proved to be HIV positive (women 12,8% and men for 9,5%). Among young people aged 15 to 24, twice as many women (12%) were infected as males (6%). The survey also found people in urban informal settlements had the highest HIV prevalence rate (21,3%), followed by formal urban areas (12,1%), tribal areas (8,7%) and farms (7,9%).

Government spokesman Joel Netshitenzhe welcomed the study's results yesterday as a positive contribution to understanding the effect of the epidemic.

He said the study's finding that a high percentage of people in SA believe that antiretroviral medicines should be provided to society, was consistent with government's own approach.

Government believed antiretroviral medicines could help improve the condition of those infected with HIV/AIDS, but had to deal with the challenges posed by a number of constraints.

These included infrastructure, the training of medical personnel on the management of HIV/AIDS and ensuring patient compliance with the treatment regime.