Young South African women are bearing the brunt of the HIV/AIDS epidemic with nearly one in four women aged 20 to 24 testing HIV positive compared to one in 14 men of the same age, a new study has revealed.    

The results of the largest survey ever of South African youth, conducted by the University of Witwatersrand’€™s Reproductive Health Research Unit (RHRU), confirms that although HIV prevalence among youth is still high, the epidemic looks to be stabilising in this age group.

The survey, commissioned by the loveLife consortium, interviewed 11 904 people. This large sample size enables researchers to describe in detail the behaviour of South African youth aged between 15 and 24, and to provide a reliable baseline for HIV prevalence and age-specific trends.

This survey confirms findings of the government’€™s 2002 Ante-Natal Clinic survey and the 2002 Nelson Mandela/HSRC survey that HIV prevalence among 15-24 year olds appears to be stabilizing.

The survey found that one in every 10 young South Africans between age 15-24 is HIV-positive. By age 22 one in four South African women has HIV.

A total of 9.2 million South Africans are aged between 15-24 according to Census 2001.Among the 10.2 percent of South African youth who are HIV positive, 77 percent are young women.

The highest prevalence was found in KwaZulu-Natal (14,1%) and the lowest in Limpopo (4,8%). Youth who live in informal settlements and on farms were most at risk of HIV infection compared to youth living in urban formal areas or in deep, rural areas where HIV prevalence rates were lower.

‘€œThere is something really terrifying about these numbers. These are children whose lives haven’€™t even begun yet,’€ said Principal Investigator and executive director of the RHRU, Prof. Helen Rees.

While 94% of young people reported that they knew how to avoid HIV infection, the survey showed that youth were persisting in risky sexual behaviour and had not internalised the extent to which they could contract HIV.

According to the study, almost one-third of sexually experienced women (31%) reported that they did not want to have their first sexual encounter and that they were coerced into sex. They also reported that their sexual partners were on average four years older, making it more difficult for them to refuse unwanted sex or negotiate condom use. When asked whether they had ever been physically forced to have sex, six percent of all sexually active youth replied that they had.

A further worrying finding was that sexually active young women reported having more sex than their male counterparts. This places them at greater risk of exposure to infection.

Audrey Pettifor, author of the study and Programme Director of Adolescent Health at the RHRU said this finding was ‘€œsomething new which has not been put forward before’€.

Prof. Rees agreed that this was worrying, saying that in self-reported surveys, men traditionally over-reported the frequency of sexual activity, while women usually reported less sex.

These young women were also less likely to report having used a condom during their last sexual encounter.

According to loveLife CEO, Dr David Harrison, one of the key factors driving this gender disparity is that women were exposed to a greater degree of coercion.

Young people were immersed in a society that has little tolerance for women’€™s sexual rights and will not change their behaviour when these prevailing norms are endorsed by older people.

But the survey contained some good news. Youth reported easy access to condoms and this was borne out in the study which showed significant use of condoms among young people.

This was ‘€œconfirmation that something is happening,’€ despite the lack of evidence of change in other key behavioural indicators, said technical consultant on the study Dr. Debbie Bradshaw, Director of the Burden of Disease Research Unit at the South African Medical Research Council.

Bradshaw said that while there was no evidence that young people were abstaining from sex or waiting until they were older to have sex, what has changed is condom use, which was significantly higher.

Although more than half the youth (52%) surveyed said they used a condom the last time they had sex, consistent condom use is ‘€œstill too low to have an impact on the epidemic,’€ said loveLife’€™s Harrison.

While 33 percent of youth who had sex in the past 12 months reported always using a condom, 67 percent were still not using condoms consistently.

Despite high levels of awareness about HIV/AIDS, the vast majority of youth do not think they are personally at risk of contracting HIV. Even more concerning was that 62 percent of youth who tested HIV-positive in the study, thought they were at no risk at all or had a small chance of getting HIV.

Denial and the failure to internalise risk were partly to blame, said Pettifor who warned that young people had not taken prevention messages to heart.

For Harrison, the country’€™s ‘€œculture of death’€ associated with violent crime, high road accident rates and the cheap cost of life, contributed to this nihilistic attitude.

Young people who were surrounded by death felt that taking a risk by having unprotected sex, ‘€œfar outweighed the benefit’€ of preventing something that might occur in 10 to15 years time.

Admitting that changing behaviour was ‘€œnot quick and not a magic bullet,’€ Pettifor called for HIV prevention campaigns to take their messages to the next level by addressing gender imbalances, conditions of poverty and making youth aware that they were affected.

According to Rees, the study had identified the most vulnerable groups of young people and as long as they continued to be at risk, very little would change.

The full survey may be found here

Survey methodology

A representative sample of 11 904 South African youth completed the survey which included answering a questionnaire and donating oral fluid for an HIV test. This number represents 77,2% of the youth enumerated and identified as eligible for the survey. The questionnaire was available in all nine South African languages and ethics approval was provided by the Committee for the Protection of Human Subjects at the University of the Witwatersrand. Parental consent was obtained for respondents under 18 years.

The survey was conducted by Wits University’€™s Reproductive Health Research Unit in partnership with the Medical Research Council of South Africa.   Field work was undertaken by Durban-based Development Research Africa.   A technical advisory board based in the Centre for AIDS Prevention Studies at the University of California, San Francisco provided independent oversight. The survey was commissioned by loveLife.

E-mail Kanya Ndaki