KwaZulu-Natal, Mpumalanga and Gauteng have emerged as the epicentres of the HIV/AIDS epidemic raging in South Africa with the Free State following closely, according to the latest national HIV survey released yesterday (Tuesday).

The 2000 ante-natal HIV survey revealed staggering HIV infection rates in KwaZulu-Natal, where 36,2% (32,5% in 1999) of the pregnant women who participated in the study tested HIV positive. Mpumalanga recorded the sharpest increase at 29,7% (23,8% in 1999), Gauteng 29,3% (23,8% in 1999) and the Free State 27,9% (27,9% in 1999).

Based on the 16 548 blood samples tested in October 2000, it is estimated that nationally, 24,5% of the women who presented at the public health facilities (for the first time during that current pregnancy) were infected with HIV by the end of the year. This is a slight increase on the previous years – 22,4% in 1999 and 22,8% in 1998.  

Projections extrapolated from the survey estimate that 4,7-million people in South Africa are HIV infected of which the majority is women and in their prime years.

According to the survey, pregnant women in their late twenties show the highest infection rate at 30,6%, whereas survey participants aged 20 to 24 years showed a rate of 29,1%.  

There are various key factors that should be born in mind when reading the ante-natal survey figures.

According to the South African Health Review, 80% of all pregnant women, of whom 85,2% are African, attend public sector ante-natal clinics.

This means that the sample of women participating in the HIV survey is predominantly African and somewhat under-represents women from other race groups.

Another key factor is that HIV is known to cause infertility. In a study conducted by the Johns Hopkins School of Public Health in the United States, the fertility of HIV-infected women was 37% less than that of non-infected women.

Pregnant women sampled at ante-natal clinics are therefore less likely to be HIV infected than the sexually active population they are supposed to represent.

But according to the ante-natal survey, pregnant women are normally preferred for testing as they are sexually active, constitute an easily identifiable, accessible and stable population, and are more likely than other groups to be representative of the general population.

In addition, this group obtains health care at facilities where blood is drawn as part of routine medical services offered for women’s health.  

AIDS researchers also point out that if the overall number of HIV infections is stabilising and remaining constant, this may well be because HIV positive people are dying rather than because others have stopped becoming infected.

Metaphorically speaking, if the level of HIV in South Africa is now stable, this is partially because the bathtub is unplugged rather than because the water has ceased to flow.

Encouragingly the survey also found that the number of women who were infected with syphillis (4,9%) had dropped by more than half from the 1997 national figure. It is a well-known fact that the prevalence of a sexually transmitted disease dramatically increases the risk of HIV transmission.  

National HIV survey 2000 – provincial breakdown:  

• Western Cape 8,7%  
• Northern Cape 11,1%
•  Northern Province 13,2%  
• Eastern Cape 20,2%  
• North West 22,9%  
• Free State 27,9%  
• Gauteng 29,3%  
• Mpumalanga 29,7%  
• KwaZulu-Natal 36,2%
  

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