The Sixth South African HIV Prevalence, Incidence and Behaviour Survey (SABSSM VI) for the Eastern Cape has found that HIV prevalence in the province seems to have stabilised from 15.9% in 2017 to 13.7% in 2022.
This translates to approximately 980 000 people with HIV in the Eastern Cape, down from one million in 2017.
The data is based on the Human Sciences Research Council (HSRC), which released the key findings of the SABSSM VI for the Eastern Cape on Thursday.
The findings also revealed that in 2022, HIV prevalence in the province was highest among individuals aged 25 to 49 years (27.7%), with females (35.4%) and males (17.1%) in the same age group being disproportionately affected.
Among males, HIV prevalence was highest in urban areas (8.7%), while among females, it was highest in rural informal or tribal areas (19.8%).
According to the overall principal investigator of the study, the HSRC's Professor Khangelani Zuma, the survey shows that HIV prevalence peaked at 34.8% among those aged 40 to 44 years in 2022, down from a peak of 39.8% in 2017 among those aged 35 to 39 years.
"This indicates a decline in HIV prevalence in 2022 across the following age groups: zero to 35 years and 45 to 59 years, except the peak among those aged 40 to 44 years and 60 years and older," he explained.
The data also presented results for six priority districts within the province, including Alfred Nzo, Amathole, Buffalo City, Chris Hani, Nelson Mandela Bay, and OR Tambo.
The survey found that in 2022, HIV prevalence was highest in Chris Hani (14.4%), followed by Amathole (14.1%), Alfred Nzo (13.9%), and Nelson Mandela Bay (9.7%).
However, the HIV prevalence data for the Joe Gqabi and Sarah Baartman districts were not reported due to insufficient data.
Treatment
Nationally, the current use of antiretroviral treatment (ART) among all people with HIV increased to 80.9% in 2022 from 63.7% in 2017.
The Eastern Cape recorded an increase in ART coverage, from 67.8% in 2017 to 83.5% in 2022.
This translates to an estimated 723 000 people receiving ART in 2022.
The survey further shows that in 2022, ART use among all people with HIV in the province was 70.9% among adolescents and youth aged 15 to 24 years, and 84.8% among those aged 25 to 49 years.
ART coverage was substantially lower among females aged 15 to 24 (68.7%) compared to those aged 25 to 49 (88.2%).
In terms of districts, ART use was lowest in Nelson Mandela Bay (69.4%) and Buffalo City (79.4%), and highest in Alfred Nzo (92.0%).
Viral load
The survey further found that in the Eastern Cape, the proportion of people with Viral Load Suppression (VLS) was 79.3% in 2022, which was an increase from 66.3% in 2017.
However, VLS was 61.4% among children aged zero to 14 years. Among those aged 15 to 49 years, VLS was 78.6%, but substantially lower among males (65.4%) compared to females (83.9%) in this age group.
Nationally, the survey found that 81.4% of all people with HIV were virally suppressed.
Zuma said it was concerning that people with HIV aged between 25 and 49 years account for most people living with HIV in the Eastern Cape, who are unaware of their HIV status (61.2%), aware but not on ART (63.3%), and on ART with no VLS (65.6%).
"However, adolescents and youth aged 15 to 24 years contribute disproportionately to gaps in treatment, accounting for just 9.6% of all people living with HIV, but 22.4% of them are unaware of their status, 18.3% are aware but not on ART, and 13.8% are on ART with no VLS," he said.
Female adolescents and youth aged 15 to 24 years account for a minority of female people living with HIV (11.3%), but a relatively larger proportion of those who do not know their HIV status (31.4%), are not on ART (24.2%), or are on ART but not virally suppressed (18.7%).
Early sexual debut
Focusing on the key drivers of the HIV pandemic, Zuma indicated that the Eastern Cape had the highest prevalence of early sexual debut among provinces in 2022.
"The proportion of adolescents and youth aged 15 to 24 years who reported having sex before the age of 15 years remained unchanged from 2017 (15.8%) to 2022 (15.3%). In 2022, sexual debut before the age of 15 years among adolescents and youth aged 15 to 24 years was higher among males (21.7%) than among females (9.5%)," the Professor said.
Among districts, early sexual debut ranged from 8.7% in Nelson Mandela Bay to 18.9% in Buffalo City.
Multiple partners
Other key drivers included having multiple sexual partners. In the province, 11.9% of people aged 15 years and older reported having multiple sexual partners in 2022, compared to 10.9% in 2017.
Among people aged 15 years and older, the proportion of males who reported having multiple sexual partners was threefold higher (17.9%) compared to females (5.5%).
The proportion of people who reported having multiple sexual partners was highest in rural informal or tribal areas (13.6%).
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By district, the prevalence of multiple sexual partners was highest in Alfred Nzo (15.2%) and OR Tambo (15.2%), and lowest in Nelson Mandela Bay (7.0%).
Condoms
Regarding condom use, 34.7% of respondents in the Eastern Cape reported using a condom with their most recent sexual partner in 2022, compared to 38.1% in 2017.
Condom use was substantially lower among those residing in rural formal or farm areas (18.0%) compared to urban areas (35.6%).
However, nearly 60% of adolescents and youth reported using a condom sometimes or never.
"The consistency of condom uses with the most recent sexual partner among people aged 15 years and older was highest in Nelson Mandela Bay (65.5%) and lowest in Amathole (38.7%)."
In this province, the self-reported circumcision rate was 80.5% in 2017 and 77.2% in 2022.
However, the province had the lowest proportion of medical male circumcisions in the country, at 14.3%.
Knowledge (30.9%) and use (2.5%) of HIV pre-exposure prophylaxis (PrEP) were universally low; however, willingness to take PrEP was high (70.3%).
