Disturbing HIV trends revealed in annual survey
There has been a disturbing and significant increase in the number of pregnant women testing HIV-positive, according to Government’s latest annual ‘HIV and Syphilis antenatal sero-prevalence survey’.
Yet this has been lost in the controversy around how many people in the country are living with HIV.
The survey measures the HIV infection rate among 16 061 pregnant women seeking care in the public sector.
This week critics and journalists have been caught up in trying to understand why Government is stating that between 6,29-million and 6,57-million South Africans are living with HIV or AIDS, significantly more than the 4,5-million number provided by Stats SA or other numbers coming from other sources.
Aids experts in the know seem to agree on about 5-million.
Although the differences between the various estimates are astonishing, the discrepancies are due to different methodologies and data, and since there is no gold standard for HIV estimate calculations such varying estimates will continue to be produced.
Role-players have grown accustomed to the controversy that seems to erupt every time Government and more specifically our National Department of Health is involved in HIV/AIDS matters.
The survey, which has been kept under lock and key by Government for several months, is the only reliable annual data this country has at the moment.
But the real story here lies in the trends revealed in the new data which shows that overall the South African HIV/AIDS epidemic continues to grow, though than at a slower pace than in the 1990s.
Contrary to earlier claims, HIV prevalence among young South African women has not fallen.
Dr Lilian Dudley, Chief Executive Director of the Health Systems Trust’s immediate concerns is the continuing increase in prevalence in younger women.
This survey tells us that nearly 40% of young, pregnant women between 25 and 29 years are infected, while women in their early twenties and early thirties show a rates of around 30%. Older women and importantly teenagers have prevalence rates of below 20%, but it is still unacceptably high.
More specifically the survey shows us that over 16% of teenage, expectant mothers were HIV positive.
Dr Lilian Dudley, Chief Executive Director of the Health Systems Trust points out that the immediate concern is the continuing increase in prevalence in younger women.
When you start to dissect these numbers according to age the picture becomes even more concerning as each group from 15 to 24 shows a year-on-year increase. One in 10 15-year-olds were HIV positive, but by 24, over one in three women were HIV positive.
The increases are as follows: 10% of 15 year-olds were HIV positive; 9,1% of 16 year-olds; 12,3% of 17-year-olds; 19% of 18-year-olds; 19,9% of 19-year-olds; 25,1% of 20-year-olds; 28,5% of 21-year-olds; 31,1% of 22-year-olds; 34,7% of 23-year-olds; and 35,5% of 24-year-olds.
Dudley says the figures suggest that prevention messages are not sufficiently impacting on behaviour, particularly in youth and women in their early twenties.
This poses the question as to whether multi-million rand HIV prevention campaigns such as loveLife and Khomanani have failed.
But says AIDS and Development writer Hein Marais, ‘This data doesn’t answer that question because it reflects HIV prevalence among women who are pregnant ‘ and by definition are sexually active and have unprotected sex.’
The data does not tell us how representative these women are of their age group. It might be that large numbers of young women are not having sex or are having protected sex. ‘Indeed, some population-based surveys suggest this is the case, with young women delaying their sexual debuts and using condoms more often when they have sex,’ Marais points out.
Marais is especially struck by the pronounced rise in HIV prevalence among older women, all the way up to 40 years. ‘This is unusual,’ he says.
It’s difficult to fathom, but one possible explanation could be that women who forego protected sex (because they’re in steady relations or marriages and trust their partners, or because they wish to become pregnant) are facing extremely high odds of being infected with HIV.
It could also mean that women who have abstained from sex face very high odds of being infected once they do have sex because HIV infection is so prevalent.
Marais explains that they have seen similar trends in other southern African countries, where young women wait longer before having sex, but are then infected within a year or so of becoming sexually active.
‘What this also suggests is that abstinence simply isn’t much good when HIV is so widely prevalent in society as it is in South Africa,’ says Marais.
The data also points to the fact that Government campaigns are neglecting or ignoring older women in favour of prevention campaigns aimed at the youth.
Dudley agrees: ‘Consideration needs to be given to prevention targeting older women and the role of health services ‘ where there may still be huge missed opportunities for prevention and care.’
In a country where we have spent billions on prevention, the trends revealed by the data should provide the necessary fodder to demand intelligent, clear answers from the ultimate accounting officer, the health minister Dr Manto Tshabalala-Msimang, known to beat the prevention drum whenever she is reminded that 866 000 South Africans are waiting on treatment.
In the end, with between four and six million people infected (depending on who you ask ‘ UNAIDS, HSRC, StatsSA, Government; UCT, MRC), there is agreement that it’s not simply a matter of changing individual behaviour through persuasion and messaging, but of making it possible, advantageous and attractive to adopt behaviour that can protect against infection.
‘The socio-economic and socio-cultural terrain on which we live our lives continues to aid the epidemic’s growth,’ explains Marais.
Marais is clear that the driving factor behind the Aids epidemic is not simply poverty, but it’s inequality, basically between men and women, mostly in the lowest 40 to 60% of income layers.
Taking the trends, driving factors, statistics and other factors into consideration, what does this leave us with?
Unless the dynamics that generate these social relations are changed, the medium-to-long-term prospect of ending this epidemic is small.
Marais hits the nail on the head when he suggests ‘it is going to require social changes ‘ changes in the distribution of power, of resources and of opportunities (especially between men and women), and changes in the systems of meanings and values that also shape those relations’.
The standard packages of prevention efforts ‘ if expanded and applied intensively enough ‘ possibly can reduce the spread of HIV. But it will prove inadequate for reversing an epidemic of the scale and ferocity that we are experiencing in South Africa.
It is also important to add the the impact of treatment to the mix which could be a double-edged sword both making people complacent about HIV infection and also encouraging an end to denial which could mean more people talking about HIV and therefore are not trying to pretend that it’s ‘sex as usual’. ‘ Health-e News Service
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