Number of people living with HIV in South Africa drops to 7.8 million

The percentage of people living with HIV in South Africa has decreased from 14.0% in 2017 to 12.7% in 2022, a survey by the Human Sciences Research Council (HSRC) has revealed.

This translates to approximately 7.8 million people living with HIV in South Africa in 2022, compared to 7.9 million in 2017.

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The HSRC on Monday announced key findings from the Sixth South African National HIV Prevalence, Incidence, and Behaviour survey (SABSSM VI), which highlight progress toward ending HIV in South Africa.

According to professor Khangelani Zuma, the overall principal investigator of the survey, the decline could be as a result of fewer people getting infected with HIV, more children born HIV-negative, Aids-related mortality, and people ageing and dying from natural causes.

“The increase in the population (birth of HIV-negative babies) would also increase the denominator of HIV-negative people in the country. The epidemic curve also shows an ageing population of people living with HIV, who are living longer as the epidemic stabilises,” Zuma said.

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The 2022 survey shows South Africa has made progress toward the UNAIDS 95-95-95 targets that by 2025, 95% of all people living with HIV must be aware of their HIV status, 95% of those aware of their status to be on antiretroviral treatment (ART), and 95% of those on ART who also know that they are living with HIV to achieve viral load suppression.

Among those 15 years and older living with HIV in South Africa in 2022, 90% were aware of their status, 91% of those aware of their status were on ART, and 94% of those on ART were virally suppressed.

This is compared to 2017 when the UNAIDS target was 90-90-90, but South Africa achieved 85%-71%-87%.

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According to the survey, 81% of people aged 15 years and older were virally suppressed (less than 1000 copies /mL) in 2022 compared to 62% in 2017.

Viral suppression was higher (83%) among women when compared to men (79%) and lower (70%) among younger adults aged 15-24 years.

The lowest percentage of viral load suppression (66%) was among men aged 25-34 years old. The country also recorded an uptake of treatment, which was attributed to the changes in treatment guidelines in 2016.

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The guidelines made provision for treatment to be given to everyone requiring HIV treatment immediately regardless of their clinical status, which previously needed to include a CD4 count below 500 cells/mm3.

Gaps in HIV epidemic

The survey also shows that more needs to be done in addressing the HIV epidemic in South Africa.

This as among people aged 15 years and older, the impact of the HIV epidemic in South Africa still affects Black Africans, women, and young people.

By race, HIV prevalence was the highest among Black Africans (20%), followed by Coloureds (5%), and lowest among Whites and Indian/Asian people (1% each).

HIV prevalence was also nearly twice as high among women (20%) compared to men (12%).

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“The most pronounced differences in HIV prevalence by sex were seen among younger populations, which calls for focused interventions. Compared to males of the same age groups, HIV prevalence was approximately two-fold in females aged 15-19 years (5.6% versus 3% respectively), and 20-24 years (8% vs. 4% respectively), and three-fold higher in females aged 25-29 (20% versus 6% respectively),” said Zuma.

The survey was conducted in all nine provinces among participants of all ages from January 2022 to April 2023.