14 June 2017

South Africa: Are Fewer Than 6,000 Babies Born HIV+ Every Year in SA, As Zuma Said?

South Africa's President Jacob Zuma highlighted the success of his administration's HIV policies in parliament recently. Does official data back up his claim that fewer than 6,000 babies are born HIV+ every year?

South Africa is respected for its achievements in fighting HIV and AIDS since he took office, President Jacob Zuma told parliamentarians recently.

As part of the presidency's budget vote speech, Zuma specifically lauded government's programme to prevent pregnant women from passing on the virus to their babies. About 70,000 babies were born HIV+ in 2004, Zuma said.

"Due to our very successful prevention of mother-to-child transmission programme, the figure has dramatically dropped to below 6,000," he added.

Approximately 1.1% of babies tested positive at birth

Zuma's spokesman, Dr Bongani Ngqulunga, told Africa Check that the figure Zuma used was sourced from the national department of health.

The department's deputy director-general in charge of HIV, maternal and child health, Dr Yogan Pillay, said the figure is from a 2012 survey by the Medical Research Council, but Africa Check was unable to trace it.

In addition to infection in the uterus, an HIV+ woman can transmit the virus to her child during birth or breastfeeding. Without any intervention, between 15% to 45% of the babies born to HIV+ women can get infected, according to the World Health Organisation. This is drastically reduced when both the mother and baby are treated with antiretroviral drugs.

Mother-to-child transmission is usually reported as a rate - that is, the share of babies born to HIV+ mothers who end up with the virus. The latest available figure reported by the department of health shows that an estimated 1.5% of babies born to HIV+ women tested positive for the virus within the first 10 weeks of their lives.

Nearly a third of pregnant women HIV+

Pillay pointed out that the number of pregnant women testing positive for HIV has remained stable over the years.

In 2013, 29.7% of pregnant women were HIV+ according to a nationally representative sample of public health facilities. This rate is much the same as in 2004 when it stood at 30%.

(Note: Pillay told Africa Check that data is not collected from private health facilities as the department believes that transmission rates are negligible.)

Performance indicators from the health department's 2017 budget vote show that 169,656 babies were born to HIV+ women in the 2015/16 reporting year. At a transmission rate of 1.5%, this means that 2,495 babies got the virus from their mothers by 10 weeks of age.

Transmission rate almost triples in first 18 months

However, a scientist at the South African Medical Research Council, Professor Ameena Goga, warns that the rate of mother to child transmission of HIV will vary depending on when it is measured. Goga is a paediatrician and has done extensive research on mother-to-child transmission of HIV.

"For example, prevention of mother-to-child transmission can be measured using infant HIV results at birth, 6 weeks, 10 weeks or 18 weeks and 18 months," she told Africa Check.

Data from 2014 - which are the most recently available - estimated that 4.3% of HIV-exposed babies tested positive for the virus by the time they reached 18 months. Children can become infected when their HIV+ mothers don't remain on treatment, especially while breastfeeding.

If we apply the 4.3% infection rate to the number of live births to HIV+ women in 2015/16, it would mean that 7,295 children will ultimately test positive for the virus at 18 months of age.

Pillay has previously told health journalism centre Bhekisisa that the department aims to bring down the 18 month infection rate to less than 1% by 2022.

Conclusion: Zuma's number an understatement

During the presidency's budget vote, President Jacob Zuma said that the number of babies born with HIV in South Africa has "dramatically dropped to below 6,000".

The most recent data shows that 1.5% of the babies of HIV+ women were estimated to be infected with the virus by 10 weeks of age. This translates to 2,495 babies born during the 2015/16 reporting year.

However, it is crucial that HIV-exposed babies be kept virus-free since the mother-to-child transmission rate almost triples in the first 18 months of a baby's life. In 2014, this rate stood at 4.3%.

Edited by Anim van Wyk

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