South African National HIV Prevalence, Incidence and Behaviour Survey, 2012
This 2012 population-based HIV prevalence survey, conducted by the Human Sciences Research Counsel (HSRC), is the fourth in a series, first conducted in 2005.
The South African HIV Prevalence, Incidence and Behaviour Survey, 2012 is arguably the most significant, reliable and thorough reflection of the status of the country's HIV epidemic.
Key findings of the survey include:
People living with HIV
Overall there was an increase in HIV prevalence - the number of people living with HIV - from 10.6% (5.2 million people) in 2008 to 12.2% (6.4 million people) in 2012. Accoridng to the report this is attributable to increased HIV treatment coverage and a corresponding increase in the life expectancy of people living with HIV.
The age group with the highest HIV prevalence was 30-34 year olds among women and 35-39 year olds among men. Boys aged 15-19 had the lowest HIV prevalence of all age groups at 0.7%.
Women contiue to bear the brunt of the epidemic due to complex physiological and social factors.
HIV prevalence differed dramatically between provinces, with KwaZulu-Natal having the highest HIV prevalence at 16.9% and the Western Cape the lowest at 5.0%.
In terms of race black Africans had the highest HIV prevalence. Whites had the lowest prevalence at 0.3%, although these figures are considered unreliable considering the low response rate among this group. The report seeks to explain racial differences in HIV prevalence through racial divides along the lines of geographical location and martial status. Living in a rural informal area and being umarried but co-habiting were predictors of higher HIV prevalence.
A significant increase in South Africa's HIV incidence - the number of new infections within a specified time period - with almost half a million new infections (469, 000) in 2012.
Again HIV incidence differed according to sex. A quarter of all new HIV infections occurred in young women aged between 15 - 24 years of age. HIV incidence among this group was four times higher (2.5%) than that of males (0.6%) of the same age. HIV incidence among females aged 15 - 49 years was 1.7 times higher than that of their male counterparts.
The rate of new infections also varied according to marital status; married people had a lower incidence rate (0.6%) than people living together with a sexual partner (3.7%).
According to the report, antiretroviral treatment (ART) exposure has doubled from 16.6% in 2008 to 31.2% in 2012, with more women (34.7%) accessing treatment than men (25.7%).
HIV-positive children aged 0-14 years had the highest exposure to treatment at 45.1%, followed by adults aged 50 and above at 42.7%.
Despite having the highest HIV prevalence only 30.9% of HIV-positive black Africans had been exposed to HIV treatment in contrast to 41.3% of people living with HIV in other race groups.
The survey found no difference between treatment exposure of people living in formal versus informal settlements. This is an indication that there is effective treatment access across socio-economic settings.
Of the 46.4% of men aged 15 and above who reported being circumcised, 40.1% said they had undergone medical male circumcision, while 39.6% of uncircumcised men in the same age group indicated that they would like to be circumcised.
Just over half of all younger men (aged 15-24) who reported being circumcised had been circumcised in a medical setting, while older males were more likely to have been circumcised in traditional settings — 54.6% of males aged 25 - 59 and 58.6% of men 50 and older.
Overall, the number of men having undergone medical male circumcision (MMC) went from 2, 268,519 in 2008 to 3,301,196 in 2012.
Awareness of HIV status
The report also showed that 93.2% of the study's respondents knew of a place where they could access HIV counselling and testing and 65.5% of respondents had tested for HIV at some point. Two thirds of people who had tested had done so recently (within the 12 months prior to their interview for the study).
Of the 79.2% of respondents who believed that they were not at risk of HIV because they were faithful to one partner, had trust in that partner or abstained from sex or used condoms, 10.7 % were in fact HIV-positive.
Behavioural determinants of HIV
According to the report 19.9% of survey respondents aged 15 - 19 years reported being involved in a relationship with someone more than five years older than them. 33.7% of all female adolescents were involved in these age-disparate relationships in comparison to only 4.1% of male adolescents. Overall there has been a steady increase in age-disparate relationships among young women aged 15-19.
Overall, from 2002 to 2012 there has been a steady increase in the number of people who had multiple sexual partners i.e. more than one partner in a 12 month period, with the figure at 11.5% in 2002 and 18.3% in 2012. Males were more likely to have mutliple sexual partners and among male surbey respondents aged 15 - 24, there was a dramatic incraese in the number who had multiple sexual partners, from 23.0% in 2002 to 37.5% in 2012.
According to the survey, men, black Africans and youth were most likely to use condoms but only just over one third of respondents had used a condom at last sex. Trends in condom use across the four surveys revealed that although condom use increased from 2002 to 2008, it decreased sharply in 2012 among all age groups and sexes; except among women aged 50 and above.
Knowledge of HIV transmission and prevention
Shockingly, only 26.8% of South Africans had accurate knowledge of HIV transmission and prevention.
The survey also indicated that levels of knowledge had declined since 2008 among key populations. Significant gaps exist in HIV knowledge among the disabled, with only 17.7% of respondents displaying accurate knowledge of transmission and prevention.
Sources of information and perceived seriousness of HIV
Preadolescents, youth and young adults indicated that television programmes were their main source of HIV information and education that encouraged them to take HIV seriously. This was followed by radio programmes, which were identified by one third of respondents from all age groups as a key source of information. Print media such as newspapers and magazines were the third most prominent source of HIV information.
Attitudes towards people living with HIV
Most respondents responded positively to 5 of the 6 stigma-realted questions used to assess attitudes towards HIV-positive people, with attitudes having improved over the past three surveys. However respondents answers to a question on HIV status and secrecy possibly revealed that living with HIV was still somewhat taboo.
The overall level of orphanhood among children aged 0 - 18 was 16.9%, 4.4% had lost their mother, 9.3% had lost their paternal parent and 3.2% had lost both parents.