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By Phenyo Selinda
The Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) has revealed that HIV prevalence in the Eastern Cape has stabilised, with a decline from 15.9% in 2017 to 13.7% in 2022. This data, based on findings from the Human Sciences Research Council (HSRC), suggests a slight improvement in the province’s battle against HIV.
According to the survey, the number of people living with HIV in the Eastern Cape has decreased to approximately 980,000, down from one million in 2017. However, the burden of HIV remains significant, especially among certain age groups and demographics.
In 2022, HIV prevalence was highest among individuals aged 25 to 49 years, with a rate of 27.7%. Within this age group, females were disproportionately affected, with a prevalence of 35.4%, compared to 17.1% among males. Urban areas saw a higher prevalence of HIV among males at 8.7%, while rural informal or tribal areas had a higher rate among females at 19.8%.
Professor Khangelani Zuma, the overall principal investigator of the study from the HSRC, highlighted that HIV prevalence peaked at 34.8% among those aged 40 to 44 years in 2022. This represents a decline from a peak of 39.8% in 2017 among those aged 35 to 39 years. He noted, “This indicates a decline in HIV prevalence in 2022 across the following age groups: zero to 35 years and 45 to 59 years, except the peak among those aged 40 to 44 years and 60 years and older.”
The survey also focused on six priority districts within the province: Alfred Nzo, Amathole, Buffalo City, Chris Hani, Nelson Mandela Bay, and OR Tambo. In 2022, HIV prevalence was highest in Chris Hani (14.4%), followed by Amathole (14.1%), Alfred Nzo (13.9%), and Nelson Mandela Bay (9.7%). Unfortunately, the HIV prevalence data for the Joe Gqabi and Sarah Baartman districts were not reported due to insufficient data.
Progress in Treatment and Viral Load Suppression
On a national scale, the use of antiretroviral treatment (ART) among all people living with HIV increased to 80.9% in 2022 from 63.7% in 2017. The Eastern Cape mirrored this trend, with ART coverage rising from 67.8% in 2017 to 83.5% in 2022, translating to approximately 723,000 people receiving ART.
The survey indicated that ART use among all people with HIV in the province was 70.9% among adolescents and youth aged 15 to 24 years, and 84.8% among those aged 25 to 49 years. Notably, ART coverage was lower among females aged 15 to 24 (68.7%) compared to those aged 25 to 49 (88.2%).
District-level data showed that ART use was lowest in Nelson Mandela Bay (69.4%) and Buffalo City (79.4%), and highest in Alfred Nzo (92.0%).
In terms of Viral Load Suppression (VLS), the survey found that 79.3% of people with HIV in the Eastern Cape were virally suppressed in 2022, an improvement from 66.3% in 2017. However, VLS was only 61.4% among children aged zero to 14 years. Among those aged 15 to 49 years, VLS was 78.6%, with a notable gender disparity: 65.4% among males compared to 83.9% among females.
Nationally, 81.4% of all people with HIV were found to be virally suppressed.
Zuma expressed concern that individuals aged between 25 and 49 years account for the majority of those living with HIV in the Eastern Cape who are unaware of their status (61.2%), aware but not on ART (63.3%), or on ART with no VLS (65.6%). He noted, “However, adolescents and youth aged 15 to 24 years contribute disproportionately to gaps in treatment, accounting for just 9.6% of all people living with HIV, but 22.4% of them are unaware of their status, 18.3% are aware but not on ART, and 13.8% are on ART with no VLS.”
Female adolescents and youth aged 15 to 24 years account for a minority of females living with HIV (11.3%), but they represent a larger proportion of those who do not know their status (31.4%), are not on ART (24.2%), or are on ART but not virally suppressed (18.7%).
Key Drivers of the HIV Pandemic
The survey also explored key drivers of the HIV pandemic in the Eastern Cape, focusing on early sexual debut and multiple sexual partners.
In 2022, the Eastern Cape had the highest prevalence of early sexual debut among provinces. The proportion of adolescents and youth aged 15 to 24 years who reported having sex before the age of 15 remained relatively unchanged from 2017 (15.8%) to 2022 (15.3%). The prevalence was higher among males (21.7%) than females (9.5%).
Among districts, early sexual debut ranged from 8.7% in Nelson Mandela Bay to 18.9% in Buffalo City.
Having multiple sexual partners was another significant driver. In 2022, 11.9% of people aged 15 years and older in the province reported having multiple sexual partners, an increase from 10.9% in 2017. Males were three times more likely to report having multiple partners (17.9%) compared to females (5.5%).
The prevalence of multiple sexual partners was highest in rural informal or tribal areas (13.6%), with Alfred Nzo and OR Tambo districts reporting the highest rates (15.2%).
Condom Use and Prevention Strategies
Condom use in the Eastern Cape saw a decline, with 34.7% of respondents reporting using a condom with their most recent sexual partner in 2022, compared to 38.1% in 2017. Condom use was significantly lower in rural formal or farm areas (18.0%) compared to urban areas (35.6%). Nearly 60% of adolescents and youth reported inconsistent or no condom use.
Nelson Mandela Bay had the highest consistency in condom use among those aged 15 years and older (65.5%), while Amathole had the lowest (38.7%).
The survey also noted that the self-reported circumcision rate in the province dropped from 80.5% in 2017 to 77.2% in 2022. The Eastern Cape had the lowest proportion of medical male circumcisions in the country at 14.3%.
While knowledge (30.9%) and use (2.5%) of HIV pre-exposure prophylaxis (PrEP) were universally low, willingness to take PrEP was high at 70.3%.
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