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By Lerato Mpembe
The Human Sciences Research Council (HSRC) has released a concerning report highlighting the state of HIV prevalence in South Africa’s North West province. According to the key findings from the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI), North West had the fifth-highest HIV prevalence rate in the country in 2022, with 12.3% of its population living with HIV.
Of greater concern is the higher HIV prevalence among individuals aged 25 to 49, which stood at a significant 20.8%. The survey also noted that women were disproportionately affected, with HIV prevalence among females more than double that of their male counterparts. Females in this age group had a prevalence of 29%, compared to 13.4% among males, indicating a gender disparity that demands urgent attention. The findings also show a notable gap between young males and females, with adolescent girls facing much higher infection rates than their male peers.
Decline in Overall Prevalence but Rising Youth Infections
While there was a slight decline in the overall prevalence among adults aged 30 to 49, this decrease is overshadowed by the worrying increase in infections among adolescents and youth. HIV prevalence among those aged 15 to 19 rose to 4.5% in 2022, up from 3.2% in 2017, showing that younger populations remain highly vulnerable to new infections.
The data also reveals that HIV prevalence peaked among individuals aged 40 to 44, reaching 31.4%. This marked a slight reduction compared to previous figures from 2017 when the prevalence for those aged 45 to 49 stood at 36.8%. Although the decline in some age groups may indicate progress, the report emphasizes the ongoing need to address gaps in treatment and prevention efforts, particularly among young people.
Key Districts: Bojanala Leads in Prevalence
By district, Bojanala recorded the highest HIV prevalence in North West, with 15.4% of the population infected. Ngaka Modiri Molema followed at 12.1%, and Dr Kenneth Kaunda district recorded a prevalence of 11.9%. These districts were oversampled to ensure the precision of the estimates, allowing for a detailed understanding of the provincial HIV burden.
In terms of antiretroviral treatment (ART), coverage has significantly improved across the province, increasing from 60.7% in 2017 to 78.9% in 2022. Despite this improvement, many gaps remain in the treatment cascade, especially for younger individuals who often struggle with accessing and adhering to ART. Approximately 324,000 people in the province were receiving ART in 2022, with women showing higher treatment uptake (81.8%) than men (63%).
Treatment Gaps and Viral Load Suppression
The SABSSM VI findings also highlight several troubling gaps in treatment. Nearly 68.4% of people living with HIV in North West who are unaware of their status are between the ages of 25 and 49. Moreover, even among those aware of their status, 70.1% were not receiving treatment, and 71.3% were not virally suppressed, increasing the risk of onward transmission. Adolescents and youth, in particular, disproportionately contribute to these gaps in treatment, despite accounting for only 6.4% of all HIV-positive individuals in the province.
Sexual Behaviour and Condom Use
The study also delved into the sexual behaviours contributing to the ongoing HIV transmission in the province. One key driver is the decrease in condom use. In 2022, only 32.2% of respondents reported using a condom with their most recent sexual partner, a sharp decline from 44.7% in 2017. Youth aged 15 to 24, however, reported higher condom use (50.1%) than adults aged 25 and older.
In terms of sexual debut, the survey indicated a positive trend, with fewer adolescents reporting sexual activity before the age of 15. However, early sexual initiation remained more common among males than females. The proportion of young males reporting sex before age 15 was four times higher than that of their female counterparts.
Additionally, the study found that the number of individuals reporting multiple sexual partners had also declined since 2017, though men and rural communities still exhibited higher rates of this behaviour.
Recommendations for the Future
The HSRC has issued several recommendations based on these findings. The council underscores the need for a long-term strategy to care for individuals in an ageing HIV epidemic and tailored interventions for vulnerable populations, including adolescents and youth. Among the key prevention measures highlighted are increased access to medical male circumcision, the promotion of regular HIV testing, and broader access to pre-exposure prophylaxis (PrEP) for at-risk individuals.
The findings also suggest that a focused effort is needed to improve ART coverage and viral load suppression, particularly among men and younger people. In addition, there is a call to reduce social stigma around HIV, which continues to be a significant barrier to treatment and prevention efforts.
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