The national response to the country's HIV and AIDS epidemic by government and various stakeholders is starting to show some positive results, writes Gabi Khumalo.
A survey by the Human Sciences Research Council (HSRC) has revealed that South Africa's HIV and AIDS epidemic has stabilised and there are signs of a declining prevalence among children and teenagers.
According to the National HIV Prevalence, Incidence and Communication Survey, conducted in 2008, the HIV prevalence has levelled off at 10.9 percent for people aged two and older.
There were an estimated 5.2 million people living with HIV in the country in 2008, according to the survey conducted from June 2008 to March 2009. It is the third in a series of national population based surveys conducted to help monitor the country's response as a nation to the HIV and AIDS epidemic.
South Africa is currently implementing the largest antiretroviral treatment programme in the world.
The research revealed that HIV prevalence among adults aged 15 to 49 has declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape percent and the Free State, with the largest decline by 7.9 percentage points in the Western Cape.
The survey also revealed that the percentage of people in the age group 15 - 49, who reported awareness of their HIV status, has almost doubled from 21.4 percent in 2002 to 50.8 percent in 2008.
The report noted that this positive outcome was attributable to multi-sectoral communication and programmes that promoted knowledge of HIV status and the substantial increase in the availability of voluntary counselling and testing services (VTC) over the period.
The study also showed a reduction in new infections amongst teenagers aged 15 to 19 years. New infections in the below 20 year old group declined from 2.0 percent in 2002 to 1.7 percent in 2008.
Speaking to BuaNews, HSRC Research Specialist, Nompumelelo Zungu said change in behaviour among teenagers was encouraging news for the fight against HIV and AIDS.
She noted that an increased number of people reported to have tested for HIV, meant that half of the population was aware of their status.
"This is good news as it says that those campaigns that promote HIV testing are beginning to make progress.
"However there is room for improvement in that we still have those that do not know their status and we recommend that the country implement provider-initiated routine HIV testing in all health care facilities," Ms Zungu said.
HIV prevalence by sex and age remains high within the age group of 25 to 29, with 15.7 percent in males and 32.7 percent in females.
The prevalence also remains high within the 35 to 39 age group, 18.5 percent in males and 24.8 percent in females
HIV prevalence has also declined among children aged between 2 and 14, from 5.6 percent in 2002 to 2.5 percent in 2008.
Interventions that could have impacted on this outcome could have been efforts to address HIV in early childhood; programmes such as the prevention of mother-to-child transmission in various parts of the country such as the Western Cape, where the largest decline of 6 percentage points occurred.
Ms Zungu pointed out that the country had various HIV interventions which were reaching different target groups and thus one could not attribute the success to just one particular intervention.
Another notable success that the country was making, according to the report was that the proportion of the population who reported using a condom at their last sexual encounter was particularly high among young people aged 15 and 24 years, increasing from 57 percent in 2002 to 87 percent in 2008, among young males and from 46 percent to 73 percent among young females.
According to the report, there was a substantial increase in condom usage among youth aged 25 to 49 years. Condom use by males increased from 26.7 percent in 2002 to 56.4 in 2008, whilst the female usage increased from 19.7 in 2002 to 58.1 in 2008.
In the older population group - 50 years and above - condom use increased from 8.2 (2002) to 39.9 percent (2008) in males and 5.3 to 25.9 percent in females.
Ms Zungu said the increase in the levels of condom use in the country especially among the 15 to 24 year group, was a result of young people beginning to heed messages contained in prevention programs promoting condom use.
"It also says that condoms are available to young people and they are using them," Ms Zungu said.
There was also an increase in the population reached, by at least one national HIV communication programme between 2005 and 2008, with 90 percent youth reporting that they had been reached by at least one programme, as compared to 74 percent in 2005.
However, among the challenges noted in the report included continued rising of HIV prevalence among adults in KwaZulu-Natal (KZN) and Eastern Cape (EC), HIV prevention knowledge had declined and low reach in the Khomanani campaign compared to other programmes.
Ms Zungu suggested a review of the program to identify strengths and weakness and then come up with a clearer targeting of different population and risk groups using research evidence to support the interventions or communication content and strategy.
"Most of the interventions have targeted the youth and because of this many older people believe that they are not at risk of HIV because until recently the statistics suggested that HIV prevalence was high among youth.
"There should be focussed interventions to increase awareness in this age group 50 and above, interventions for the above 50 group should be comprehensive and socio-culturally relevant to ensure that the interventions implemented address the risks faced by this group in a relevant manner. For example, in this age group, one is likely to find widows and divorcee's," she told BuaNews.
She emphasised that it might be important to equip people who have not been dating for a long time with skills to negotiate safe sex using a condom and also address the issue of "sugar daddies" and "sugar mummies" in the younger age group.
Inter-generational sex and multi concurrent sexual partners were among the challenges noted.
The persistent high level of HIV prevalence among females, aged 25 and 29, over the period of three surveys and an increase of inter-generational sex among female teenagers aged 15 and 19 increased from 9.6 to 14.5 percent.
According to the report, with males aged 15 and 49 having more than one sexual partner in the past year increased from 9.4 percent in 2002 to 19.3 percent in 2008, while with females the increase was from 1.6 percent to 3.7 percent.
Ms Zungu said this was even more so for women who are poor and dependant on males for financial support.
"Power dynamics and gender dynamics remain at the core of our epidemic, intergenerational sex and age mixing remains an important social determinant of HIV infection," she said.
She noted that ways to protect women from being infected by HIV and AIDS because they wanted to have children, needed to be found.
She also noted that there has been an increase in the number of people who report to have multiple partners, especially among 15 to 24-year-old males.
"To protect women, we need to spend more time addressing our social values and begin to be vocal about the dangers inherent in multiple sexual relationships.
"Data shows that having a partner who is much younger than you may expose you to a higher risk for HIV in that the younger person belongs to a different age group and HIV prevalence in that group might be higher.
"We need to discourage inter-generational sex or age mixing and especially multiple sexual partnerships," Ms Zungu said.
The report recommended a need to target intervention programmes, particularly in KZN and the Eastern Cape; a need for programmes to help people have children without risking HIV infection and programmes to address high sexual partner turnover and intergenerational sex by changing community norms.
The report also recommended the implementation of anti-multiple and inter-generational sexual partnerships and the implementation of provider-initiated routine HIV testing in all health care facilities.
