KHOPOTSO: The survey, conducted annually among pregnant women attending public health facilities, gives a general trend of HIV infections across the population. It shows a steady decline of HIV infections over the last three years. Prevalence among young women under 20 years has dropped from 15.9% in 2005 to 13.7% last year. A significant decline in prevalence was also noted in the 20 ‘€“ 24 year age group. The Department of Health says the declines are an indication that the country’€™s prevention programme, which encompasses the Abstain, Be faithful and Condomise strategy, is now bearing fruit among the youth. But some suggest that the decline could be as a result of many AIDS deaths that have occurred in this age group. Dr Lindiwe Makubalo, head of Epidemiology and Research in the national Department of Health, disagrees.

Dr LINDIWE MAKUBALO: It is true that some people will die at some stage. But because of the HIV incidence, which are the new infections, this does give us the confidence that, in fact, what we are seeing is not as a result of deaths.

KHOPOTSO: The World Health Organisation concurs with the assessment. Dr Magda Robalo is the organisation’€™s representative in South Africa.

Dr MAGDA ROBALO: The fact that the younger age group is showing, consistently from 2004 up to now a decrease in the prevalence, is something that takes us to think that the intervention approaches that have been put in place over time are starting to show that we are making an impact, if I may say, rather than saying, ‘€˜it’€™s deaths that are overtaking new cases, that’€™s why prevalence is going down’€™.                

KHOPOTSO: Announcing the results of the survey, Health Minister Dr Manto Tshabalala-Msimang, expressed concern that the infection rates were increasing in older women.

Dr MANTO TSHABALALA-MSIMANG: We also need to ensure a concerted focus on the 30 ‘€“ 39 year old group where declines have not been observed in the 2006 survey’€¦ It is a concern that HIV rates are high in these age groups.                      

KHOPOTSO: Dr Makubalo says two reasons could be responsible for that.

Dr LINDIWE MAKUBALO: It could be the result of what we call a ‘€˜cohort effect’€™, where you have younger women who have a certain prevalence level, just getting older. So, they obviously move with the prevalence level. But it could also be that, perhaps, women in those age groups whom, I think, most of us would agree are in more stable relationships may not be finding it that easy to actually take on the interventions that we are promoting and that we encourage.

KHOPOTSO: When asked if women in that age group derived a sense of unsuspecting security from their stable relationships that in turn made them relax their attitudes towards encouraging condom use with their partners, Dr Makubalo said the desire for women in that age group to have babies could be setting them up for HIV infection.        

Dr LINDIWE MAKUBALO: I wouldn’€™t say they are relaxed. But some of the studies that are coming out’€¦ are showing that women who are in stable relationships, who are married’€¦ may find it a little bit more difficult somewhere along the line to introduce this’€¦ These are women who are also in the child-bearing age and wanting, possibly, to have children’€¦ They may not be able to apply the intervention strategies that they may know about because of the circumstances within their relationships.                      

KHOPOTSO: Mbulawa Mugabe, UNAIDS co-ordinator for South Africa, says part of the problem is that there has never been any effort aimed at HIV prevention among the older population groups, which could render them a new high-risk group.

MBULAWA MUGABE: I think most of our efforts, and rightly so, have been focused among young people. I don’€™t think we have programmes that are actually tackling middle-age group going upwards.

KHOPOTSO: Beside him, Dr Magda Robalo of the WHO, nods in agreement.

Dr MAGDA ROBALO: There is time for us to probably customise our interventions and address the older age group that, as we have seen the data, seems to be lagging behind in terms of showing a decrease in terms of prevalence.

KHOPOTSO: About 36 000 women participated in the 2006 ante-natal survey ‘€“ double the number of the previous one. From this, it is estimated that 11.5% of the total population, that is 5. 4 million South Africans are HIV-positive, down from 5.54 million.