SA’s overall HIV prevalence drops — but more young people shun safe sex

Fewer people are living with HIV and more people are getting access to treatment, but an increasing proportion of the population is not using condoms, according to the latest SA national HIV/Aids prevalence, incidence and behaviour survey.

The findings raise questions whether the government’s drive to meet the UN’s 95-95-95 targets and its push for new prevention tools such as PrEP have shifted attention away from campaigns to promote condoms, a well-established, cheap and effective way to prevent HIV/Aids and other sexually transmitted diseases. The 95-95-95 targets aim to ensure that by 2025, 95% of people with HIV know their status, 95% of the people diagnosed with HIV get antiretroviral treatment and 95% of those being treated achieve viral suppression, reducing the risk of transmitting the virus.

The survey was led by the Human Sciences Research Council (HSRC) and is the sixth in a series since 2002. Researchers interviewed more than 71,600 adults and children between January 2022 and April 2023 and released preliminary findings on Monday.

Overall, HIV prevalence fell from 14% in 2017 to 12.7% in 2022, with the number of people estimated to be living with HIV falling from 7.9-million to 7.8-million. An estimated 90% of adults knew their HIV status, 91% of those diagnosed with HIV/Aids were on antiretroviral treatment, and 94% of those on treatment were virally suppressed.

But self-reported condom use at last sexual encounter among people who said they had multiple partners was just 43.5% among women between 15 and 25 years old, and 50.6% among men of the same age. The figures were even lower among people between 25 and 49 years old, at 40.9% for women and 44% for men. There has been a steady decline in the proportion of people reporting they used condoms since the 2008 survey, which found 66.5% of young women and 85.2% of young men had used condoms the last time they had sex.

“Condom use is very low, especially among the young. That is a concern, because [it creates] a pool of people that have a propensity to continue transmitting the virus,” said the HSRC’s Khangelani Zuma, one of the study’s principal investigators. “We have a lot more work to [do], especially among people who have multiple partners,” he said.

Fellow principal investigator and HSRC researcher Leickness Simbayi said low condom use among young people is worrying because it suggests high HIV transmission rates among this age group. Data on HIV incidence — the rate of new infections — was not released with the preliminary findings, and is only expected when the final report is released in 2024.

“The key issue is demand creation,” said Bill & Melinda Gates Foundation director for HIV and Tuberculosis delivery Yogan Pillay. “We need to rethink our prevention campaigns, and have better targeting at people most likely to use them [condoms],” he said. Free condoms are no longer readily available throughout SA, with supplies largely distributed at public clinics and hospitals, he noted. 

kahnt@businesslive.co.za