Compared to other provinces, Gauteng had the third-lowest HIV prevalence at 11.9% in 2022 which is slightly lower than the 12.1% reported in 2017.
This translates to an estimated 1 720 000 people living with HIV (PLHIV) in Gauteng in 2022, representing an insignificant 0.2% decline from the 1 780 000 reported in 2017.
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 Gauteng on Thursday.
The findings also showed that, in 2022, HIV prevalence in the province was disproportionately higher among those aged 25 to 49 (20.0%), for females (24.9%) and males (14.1%).
HIV prevalence was also higher among those residing in rural formal or farm areas (12.7%).
According to the overall principal investigator of the study, the HSRC’s Professor Khangelani Zuma, the HIV prevalence peaked at 32.2% among those who are 50 to 54 years old in 2022.
In 2017, the prevalence peak was in a younger age group, at 31.9% among those aged 35 to 39.
“There was a decrease in HIV prevalence in 2022 among all age groups younger than 40 years compared to 2017. It is, however, concerning that even though the epidemic is ageing, there seems to be a possibility of new infections still happening in the older age groups,” Zuma noted.
The data presented are for five priority districts of Gauteng, namely the City of Tshwane, the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand.
Among the five districts, the highest HIV prevalence was found in Sedibeng (13.2%).
The SABSSM VI survey, conducted between 2022 and 2023, aimed to maintain surveillance of HIV infection and behaviours in South Africa, evaluate the progress of the South African national HIV and AIDS, STI and TB Strategic Plan, and monitor HIV indicators for national and international reporting.
The survey’s key objectives included estimating HIV prevalence and incidence, viral load suppression, and exposure to HIV-related services among adults and children.
Antiretroviral treatment
The data also shows that Gauteng’s antiretroviral treatment (ART) coverage increased to 73.4% in 2022 from 56% in 2017.
The ART coverage translates to an estimated 1 210 000 PLHIV in the province receiving treatment in 2022.
ART use among all PLHIV in the province was lowest among those aged 15 to 49 (72.4%) compared to other age groups.
“ART use in Gauteng was consistently lower among males compared to females in all the age groups, however, it was lowest in the West Rand (73.4%) and Ekurhuleni (73.6%) districts.”
Knowledge of HIV status
Zuma expressed concern that PLHIV aged between 25 and 49, which accounts for most PLHIV in Gauteng who are unaware of their HIV status (61.8%), are aware of their HIV status but not on ART (64.6%), and ART but not virally suppressed (64.6%).
He also noted that adolescents and youth aged from 15 to 24 contribute disproportionally to gaps in treatment, accounting for just 6.8% of all PLHIV.
However, 20% of those unaware of their HIV status, 13.4% of those aware of their HIV status but not on ART, and 12.1% of those on ART but not virally suppressed.
According to the study, females aged 15 to 24 account for the minority of all females living with HIV (6.4%), but a relatively larger proportion of those who do not know their status (15.2%), not on ART (13.4%), and ART but not virally suppressed (12.1%).
Males aged 15 to 24 years account for just 7.8% of all males living with HIV, but 27.3% of those unaware of their HIV status, 19.4% of those who are aware but not on ART, and 18.9% of those who are on ART but not virally suppressed.
The survey further revealed that, among all districts, Ekurhuleni accounts for just 30.6% of all PLHIV, but 47.4% of all PLHIV do not know their status.
Sexual debut
Regarding the key drivers of the HIV pandemic, Zuma noted that there was a change in the proportion of Gauteng adolescents and youth aged 15 to 24 who reported having sex before the age of 15 in 2017 (14.8%) compared to 2022 (13.2%).
In 2022, the percentage of adolescents and youth aged 15 to 24 who had their sexual debut before the age of 15 was higher among males (17.8%) than females (7.9%).
The prevalence was lowest in Ekurhuleni (9.5%) and highest in West Rand (18.1%), followed by the City of Johannesburg (14.1%).
Multiple sexual partners
The survey revealed that in Gauteng, 7.8% of people 15 years and older reported having multiple sexual partners in 2022 compared to 12.8% in 2017.
The proportion of people aged 15 years and older who reported having multiple sexual partners was four-fold higher among males (12.3%) compared to females (3.1%), and two-fold higher among those aged 15 to 24 (17.1%) compared to those aged 15 to 49 (8.6%).
The proportion who reported having multiple sexual partners was highest in the City of Tshwane (13.7%) and lowest in West Rand (2.9%).
Condom use
Regarding condom use, the survey found that, in Gauteng, 30.3% reported using a condom with the most recent sexual partner in 2022 compared to 36.3% in 2017, representing a decline of six percentage points.
Condom use with the most recent sexual partner among people 15 years and older was lower among those aged between 25 and 49 years (29.6%) compared to other age groups, females compared to males (27.6% versus 32.9%), and those residing in rural formal, or farm areas (18.9%) compared to other localities.
Condom use with the most recent sexual partner among people aged 15 years and older ranged from 24.7% in the City of Tshwane to 37.9% in West Rand.
In Gauteng, a higher proportion (53.8%) also reported that they never used a condom with their most recent sexual partner. Only 4.7% reported that they used a condom almost every time.
Consistent condom use with the most recent sexual partner among people 15 years in the province was higher among adolescents and youth aged 15 to 24 (32.1%) compared to those aged 25 to 49 (19.3%).
However, over 70% of those aged 25 to 49 years reported only using a condom sometimes or never.
Consistent condom use with the most recent sexual partner among people aged 15 and older was highest in Sedibeng (23.4%) and lowest in the City of Tshwane (17%).
“We also recommend enhancing prevention efforts targeted at groups that are disproportionately affected by the drivers of HIV infection, such as women and young people,” concluded Professor Zuma. – SAnews.gov.za
