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By Phenyo Selinda
In 2022, the Northern Cape recorded the second-lowest HIV prevalence rate in South Africa, standing at 8.9%, according to the Human Sciences Research Council (HSRC). This figure, although lower compared to other provinces, translates into an estimated 120,000 people living with HIV (PLHIV) in the region—an increase of 21,000 individuals compared to 2017. The findings are part of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI), which provides a comprehensive overview of the status of HIV in the Northern Cape and highlights both the progress and challenges the province faces in its fight against the virus.
HIV Prevalence in Key Demographic Groups
The survey results offer detailed insights into HIV prevalence across various age groups and demographics. Among individuals aged 15 to 24, the overall HIV prevalence was reported at 3.3%. However, the data revealed stark differences based on gender, with HIV prevalence higher among young females (5%) compared to their male counterparts (1.8%) within this age group. This gender disparity is a concern, as young women continue to bear a disproportionate burden of the HIV epidemic.
For individuals aged 25 to 49, HIV prevalence was significantly higher at 12.6%, with females once again showing a higher prevalence rate (14.9%) compared to males (9.6%). These statistics suggest that HIV continues to affect women more severely in certain age brackets, reflecting broader national trends.
Urban vs. Rural Disparities in HIV Prevalence
Geographic location also plays a role in the spread of HIV in the Northern Cape. According to the HSRC survey, those living in urban areas exhibited a higher HIV prevalence (9.6%) than those residing in rural informal or tribal areas (7.6%) and rural formal or farm areas (6.2%). These findings highlight the need for targeted interventions that address the specific challenges faced by people living in different environments.
Antiretroviral Treatment (ART) Coverage
A significant area of progress for the Northern Cape is the improvement in antiretroviral treatment (ART) coverage. ART is a crucial tool in managing HIV and preventing the progression to AIDS. In 2022, ART coverage in the province increased to 86.2%, a substantial rise from 54.9% in 2017. This translates to over 103,440 PLHIV in the Northern Cape receiving treatment in 2022. While this progress is commendable, gaps in treatment remain, particularly among youth aged 15 to 24 and males aged 25 to 49, for whom data could not be fully analysed due to small sample sizes.
For the key age group of 25 to 49, ART use among all PLHIV was recorded at 82.6%, which is a positive indicator that treatment is reaching those in need. However, further efforts are necessary to ensure that all individuals in this demographic are aware of their HIV status and receive timely treatment.
Knowledge of HIV Status
Despite improvements in ART coverage, many PLHIV in the Northern Cape remain unaware of their status. This is particularly concerning among individuals aged 25 to 49, who accounted for the majority of PLHIV unaware of their status (62.4%). This group also represented a significant proportion of those aware of their HIV status but not receiving ART (72.7%), and those who were on ART but had not achieved viral load suppression (73.1%).
Zuma emphasised the need for targeted awareness campaigns and interventions to close these gaps in the HIV treatment cascade. These findings indicate that significant work is still required to ensure that individuals living with HIV are not only aware of their status but also receive continuous treatment to suppress the virus and improve health outcomes.
Early Sexual Debut and Behavioural Drivers of the Epidemic
The survey identified early sexual debut as a key driver of the HIV epidemic in the Northern Cape. Encouragingly, the proportion of adolescents and youth aged 15 to 24 who reported having sex before the age of 15 decreased from 11.4% in 2017 to 8% in 2022. However, there were gender differences, with more males (10.2%) reporting early sexual debut compared to females (5.1%).
While the decline in early sexual debut is a positive development, the increase in the proportion of individuals aged 15 and older who reported having multiple sexual partners is concerning. In 2022, 11% of respondents aged 15 years and older reported multiple sexual partners, compared to 8.4% in 2017. Males were more likely to report multiple sexual partners (11.2%) compared to females (5.4%), with the highest rates of multiple partnerships observed in urban areas (9.2%).
Condom Use Declines: A Concerning Trend
One of the most troubling findings from the SABSSM VI survey is the significant decline in condom use. In 2022, only 30.4% of individuals reported using a condom with their most recent sexual partner, compared to 39.9% in 2017. This decline was observed across all age groups and geographic locations, with males (34.9%) more likely to use condoms than females (25.7%).
The sharp drop in condom use is particularly concerning in rural formal or farm areas, where only 14.6% of respondents reported using condoms with their most recent partner. The Northern Cape’s Frances Baard district, which had the highest HIV prevalence in the province, saw a condom use rate of just 40.2%. These trends underscore the need for renewed public health campaigns that promote safe sex practices and the importance of condom use in preventing HIV transmission.
Challenges in Medical Male Circumcision (MMC)
The survey also revealed challenges in the uptake of medical male circumcision (MMC), a key HIV prevention measure. While MMC has been proven to reduce the risk of heterosexual HIV transmission, there remains a need to increase both coverage and demand for this service among males aged 15 years and older. MMC has been an important intervention in many parts of South Africa, but the Northern Cape continues to face barriers to scaling this intervention.
A Call for Continued Efforts
The Northern Cape’s relatively low HIV prevalence compared to other provinces offers a glimmer of hope. However, the findings of the SABSSM VI survey make it clear that substantial challenges remain. The rising number of PLHIV, declining condom use, and gaps in treatment for key populations call for a renewed focus on prevention, treatment, and public awareness campaigns.
In addressing the HIV epidemic, there must be a concerted effort to reach individuals who are unaware of their HIV status and link them to care. Additionally, reducing risky sexual behaviours and promoting condom use must be prioritised to prevent new infections.
The HSRC’s findings highlight both the progress and the areas where more work is needed to combat HIV in the Northern Cape. By continuing to scale up ART coverage, improving education about safe sex practices, and increasing access to prevention tools like PrEP and MMC, the province can make significant strides in curbing the epidemic and improving health outcomes for its population.
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