South Africa's latest HIV survey finds boys having sex earlier, plummeting condom use and that unmarried couples living together are more at risk of HIV than married or single people.
These are some of the findings of the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, released yesterday by the Human Sciences Research Council (HSRC).
Based on a representative national sample of almost 29 000 people, the report found that 12,2 % of the population was HIV-positive - almost 2 % more since the last survey in 2008.
HIV infection was highest in women aged 30 to 34 years old (36%) and men aged 35 to 39 years old (31,6%).
HSRC head Professor Olive Shisana said the increase in HIV prevalence was both because of new infections and because antiretroviral treatment was keeping people with HIV alive longer.
Those most at risk of HIV were African women aged 20 to 34 years living in KwaZulu-Natal informal settlements.
"We have made considerable ground in terms of treatment, but we have some way to go with prevention," Science and Technology Minister Derek Hanekom told Health-e.
About 469 000 people were infected with HIV in 2012, but there was a "steady decline" of new infections in young people aged 15 to 24 years, said Shisana.
In addition, the HIV rate in babies infected by their mothers has been slashed. A decade ago, about 70 000 babies a year were infected but this was down to about 8 600, according to Health Minister Aaron Motsoaledi.
Condom use plunges, could "Choice" be uncool?
The rate of infections in young women between the ages of 15 and 24 years of age was over four times higher than young men (2,5% new infections in 2012).
This is despite the fact that young men were far more likely to have started having sex at an early age and to have multiple partners.
In 2008, about one in ten boys had sex before the age of 15, whereas by 2012 this had jumped to 16,7%. Boys were three times more likely to have had sex before 15 than girls, with boys from the Eastern Cape most likely to lose their virginity early.
Shisana said relatively high condom use among young men was likely to be curbing their infection rates.
However, condom use has plunged since 2008. Less than 68% of young men aged 15 to 24 used condoms at last sex in comparison to 85% four years previously. A dismal 36% of men aged 25 to 49 used condoms (down from 44% in 2008).
Acknowledging that the government's Choice condoms "may no longer be cool", Motsoaledi said the health department was about to launch condoms that were "flavoured, coloured and are smelling very nice" at universities and FET colleges.
The rate of men reporting multiple partners has more than doubled in a decade, with close to one-fifth (23%) of men reporting multiple partners.
Putting a ring on it
People living with sexual partners who were not married were more than five times more likely to get HIV than married people, with 3% of those in "vat en sit" relationships becoming HIV-positive in 2012 as opposed to 2,3% of single people and 0,5% of married people.
"Married people were less likely to have multiple partners," said Shisana, adding that there were significant racial differences in marriage trends. Only a quarter of African people of marriageable age were married while over 70% of whites were married.
On a positive note, the blood samples revealed that almost one-third of people with HIV had been exposed to antiretroviral treatment.
Welcoming the report, Health Minister Aaron Motsoaledi said it "confirmed the good news about the scale-up of antiretroviral treatment" and that "people with HIV were living longer, mothers could spend more time with their children and there was a decline in orphans."
But Motsoaledi said it also identified "worrying trends - the increase in multiple sexual partners, decreased condom use and decreased knowledge about HIV transmission."
Dr Fareed Abdullah, head of the SA National AIDS Council (SANAC), said the report's findings supported SANAC's decision to target HIV in young women, particularly those living in informal settlements.
- Health-e News Service