The North West had the fifth highest HIV prevalence rate in the country at 12.3% in 2022, with HIV prevalence in the province at 20.8% among those aged 25 to 49 years old overall.
In addition, a large number of people living with HIV (PLHIV) in the province were women.
This is according to the Human Sciences Research Council (HSRC), which released the key findings of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) for the North West on Monday.
According to the overall principal investigator of the study, the HSRC's Professor Khangelani Zuma, the survey showed that in 2022, HIV prevalence in the province was 20.8% among those aged 25 to 49 overall and more than two-fold higher (29.0%) among females than among males (13.4%).
Among adolescents and youth, HIV prevalence was 2.5-fold higher among females (8.3%) than among males (3.3%) of the same age.
The survey revealed that the HIV prevalence peaked at 31.4% among those 40 to 44 years in 2022 compared to 36.8% among those 45 to 49 years in 2017.
However, there was a decrease in HIV prevalence in 2022 among those aged 30 to 39 and 40 to 49.
"Of great concern is the worsening situation among adolescents and youth, with HIV prevalence being worse or similar to that of 2017.
"The prevalence of HIV among adolescents 15 to 19 is higher (4.5%) in 2022 than in 2017 (3.2%), indicating continued infections among adolescents and youth," Zuma noted.
The data presented are for three priority districts in North West namely, Bojanala, Dr Kenneth Kaunda and Ngaka Modiri Molema, where oversampling was undertaken to enhance the precision of the HIV prevalence estimates.
By district, in 2022, HIV prevalence among all ages was highest in Bojanala (15.4%), followed by Ngaka Modiri Molema (12.1%) and Dr Kenneth Kaunda (11.9%).
Antiretroviral treatment
Antiretroviral treatment (ART) coverage in North West increased from 60.7% in 2017 to 78.9% in 2022.
This means an estimated 324 000 people living with HIV in the province received treatment in 2022.
ART use among those 15 to 49 years was 76.1% overall, 81.8% among females, and 63.0% among males.
ART use was 73.8% in urban areas and at or above 85% in rural informal and formal or farm areas.
By district, ART use ranged from 81.5% in Bojanala to 84.9% in Dr Kenneth Kaunda.
Meanwhile, Zuma expressed concern that people living with HIV aged 25 to 49 accounted for most people living with HIV in the North West who were unaware of their HIV status (68.4%), aware but not on ART (70.1%), and on ART but not virally suppressed (71.3%).
However, adolescents and youth aged 15 to 24 contributed disproportionately to gaps in treatment, accounting for just 6.4% of all people living with HIV, but 15.8% of those unaware of their status, 15.6% of those aware but not on ART and 12.9% of those on ART but no viral load suppression (VLS).
Key HIV drivers
Shifting the focus to key drivers of the HIV pandemic, Zuma noted that in the North West, the proportion of adolescents and youth aged 15 to 24 who reported having sex before 15 years declined from 12% in 2017 to 8.8% in 2022.
In 2022, sexual debut before the age of 15 years among adolescents and youth aged 15 to 24 was four-fold higher among males (14.0%) than females (3.5%).
The survey revealed that in the North West, 9.5% of people 15 years and older reported having two or more sexual partners in 2022 compared to 11.1% in 2017.
The proportion of people aged 15 and older who reported having two or more sexual partners was higher among males (33.7%), compared to females (30.6%), and those 15 to 24 years (50.1%) compared to other age groups.
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The proportion who reported having two or more sexual partners was highest in rural informal or tribal areas (34.8%) and in Bojanala district (12.7%).
Regarding condom use, the survey revealed that in North West, 32.2% of respondents reported using a condom with their most recent sexual partner in 2022, a 12.5% decline from the 44.7% reported in 2017.
Condom use with their most recent sexual partner among people aged 15 and older was similar among both females (30.6%) and males (33.7%), and higher among youth aged 15 to 24 (50.1%) than adults aged 15 to 49 (30.6%).
The professor recommended a long-term strategy to care for individuals in an ageing HIV epidemic as well as tailored interventions to address gaps in the clinical cascade by district, locality and subpopulation.
"We also recommend a continued focus on increasing coverage and demand for medical male circumcision among males aged 15 and older. We must also enhance public awareness and uptake of effective HIV prevention measures, such as regular HIV testing, condoms and PrEP," he added.
