HIV prevalence down from 14% to 12.7%, females still twice as likely to test positive

The 25th International Aids Conference heard that while the prevalence of HIV has decreased in South Africa since 2017, females are still disproportionately affected by the disease.

The Human Sciences Research Council (HSRC) released the key findings of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey at the conference in Munich, Germany, on Wednesday.

They said the survey shows encouraging trends in prevalence, prevention and treatment, following on from earlier reports at the conference that medical authorities and government were on track to have Aids “completely under control” by 2030.

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Incidence rate consistently higher in females

The survey found that HIV prevalence (percentage of people living with HIV) for all ages decreased from 14.0% in 2017 to 12.7% in 2022 translating to a decline from 7.9 million to 7.8 million people living with HIV.

However, the data shows that females have a prevalence of 16.4% compared to males at 8.8% of all ages. Prevalence peaks at 34.2% for females aged 35–39 years, whereas prevalence peaks at 27.1% for males aged 45–49 years.

HIV incidence (estimated number of new infections) in people aged two years and older in 2022 was 0.44%, translating to 232,400 new HIV infections in South Africa.

HIV incidence was 0.60% among adults 15 years and older translating to 227 400; 0.39% among youth and young adults aged 15–24; and 0.72% among adults aged 15–49 years. In 2022, the HIV incidence rate was consistently higher in females than males in all age categories.

In terms of treatment, South Africa recorded an increase in antiretroviral treatment (ART) coverage, from 63.7% in 2017 to 80.9% in 2022. This translates to an estimated 5 700 000 people living with HIV receiving ART, an increase from 4 500 000 in 2017. A greater proportion of females, 83.2% than males, 76.2% were on ART. HIV viral load suppression stands at 81.4% for all ages.

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SA on track despite stigma

The 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. It also assessed progress towards the 2030 UNAIDS 95-95-95 targets, HIV drug resistance, and the relationship between social and behavioural factors, intimate partner violence, and HIV infection.

Progress towards the 95-95-95 targets improved, with 89.6% of people living with HIV knowing their status, and of those knowing their status, 90.7% are on treatment, with 93.9% of those who knew their status and being on treatment being virally suppressed. Improvement across the 95-95-95 indicators was more pronounced in males compared to females. Overall, the survey found that 81.4% of all people living with HIV were virally suppressed.

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However, it is concerning that the survey further reveals that gaps remain in knowledge of HIV status among youth aged 15-24 (73.1%). Early sexual debut, age-disparate relationships, multiple sexual partners, and low condom use persist as key drivers of HIV. Awareness and uptake of pre-exposure prophylaxis (PrEP) are increasing.

According to the overall Principal Investigator of the study, HSRC’s Prof Khangelani Zuma, HIV-related stigma remains a significant issue among people aged 15 years and older.

“Addressing stigma is essential to improving the quality of life and well-being of people living with HIV. However, of the six questions related to HIV-related stigma, the majority yielded results that indicated that most people held positive attitudes toward people living with HIV,” said Zuma.

Read the full survey below.