Looking into the future Living with AIDS # 334

KHOPOTSO: Revised figures released recently by the Joint United Nations’€™ Programme on HIV/AIDS, UNAIDS, show that they have overestimated the number of people living with HIV in the world. It is now said that thirty-three million, instead of last year’€™s 40 million people in the world, have HIV. The new figures show that South Africa now has the largest absolute number of HIV-positive people. Previously, the country was second to India. However, the results show that adult HIV prevalence in South Africa is either stable or has started to decline. This is in line with South Africa’€™s own antenatal clinic survey results released in August. The study, conducted among pregnant women attending public health facilities, is used to gauge HIV infection trends among the general population. The Minister of Health, Dr Manto Tshabalala-Msimang, launched the findings at a media briefing.      


Dr MANTO TSHABALALA-MSIMANG: The report shows a trend towards a decrease in the prevalence of HIV amongst women who use public health facilities ‘€“ 29.1% in 2006, as compared to 30.2% in 2005 ‘€“ suggesting that this may be the beginning of a decline in the HI(V) prevalence rates in our country’€¦ An encouraging observation is that the HIV prevalence trends amongst pregnant women under the age of 20 years continued to show a significant decline from 16.1% in 2004 to 15.9% in 2005 and to 13.7% in 2006’€¦ There was also a significant decline in prevalence in the 20-24 year age group.            


KHOPOTSO: Head of Epidemiology and Research in the national Department of Health, Dr Lindiwe Makubalo, says there is a great deal of importance linked to the reduction of HIV prevalence in women younger than 24.        


Dr LINDIWE MAKUBALO: This particular age group is very significant because this particular age group is a group that gives us a good sense of what the new infections are like ‘€“ a good indicator of incidence. And it’€™s also an important indicator for the Millenium Development Goals. It’€™s Goal 6 – Target 7  – our main goals here, is to reverse HIV infection within this particular age group.


KHOPOTSO: Pointing a cursor at a graph, Makubalo says this overall decrease in prevalence, does not come as a complete surprise.


Dr LINDIWE MAKUBALO: This trend has been predicted by the UNAIDS Spectra model’€¦ Between 1990 and 1998, there’€™s almost an exponential rise in HIV prevalence. Between ‘€˜98 and 2005, there’€™s been more or less a slowing down in this increase ‘€“ what we begin to call a plateau. A plateau doesn’€™t mean that it’€™s absolutely flat, but it’€™s just sort of stabilising a little bit. And in 2006, for the first time, we’€™re seeing what seems to be a decline, which we’€™re really excited about’€¦ The Spectra model is a UNAIDS model which predicts that roughly around 2006/7, we should be seeing a slight decline’€¦ and most models are predicting the same. So, this, we find very encouraging.


KHOPOTSO: The Spectra model began to be used as recently as about three years ago. While UNAIDS attributes its finding of reduced HIV figures in the world to what it says is a combination of ‘€œbetter data collection, better epidemiology and a better understanding of the disease, especially survival time’€, the Department of Health in South Africa says the lower figures showing in last year’€™s national antenatal survey, especially among younger women, are an indication that its ABC prevention strategy is beginning to bear fruit.


Dr MANTO TSHABALALA-MSIMANG: The findings of the report suggest that a sustained change in behaviour among young people, including abstinence, being mutually faithful as well as condom use may be taking place. In order for this trend to be sustained, it is important that we continue, therefore, to strengthen our prevention programmes targeting the youth and sustaining safer sexual behaviour.              


KHOPOTSO: But some suggest that the levelling off may show that the number of people becoming infected is being balanced by an equal number dying. The Health Department’€™s Dr Makubalo refutes this


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: Dr Magda Robalo, of the World Health Organisation’€™s office in South Africa, concurs.  


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 showing that, actually, we are making an impact, if I may say, rather than saying, ‘€œit’€™s deaths that are overtaking new cases, that’€™s why prevalence is going down’€.  


KHOPOTSO: From the survey, it is estimated that 11.5% of the total South African population, that is about 5.4 million are HIV-positive, down from 5.54 million. But in the face of reduced HIV infections, UNAIDS has warned countries not to relax their prevention efforts. This is particularly important for South Africa. Although the antenatal survey shows a decline in HIV prevalence in younger women, this is not so for women over 30. Most women in this age group are either in stable relationships or married.

The high HIV prevalence in this age group could be due to the fact that prevention efforts are generally targeted at younger people. As we bid 2007 farewell, this is a stark reminder that the ABC strategy of HIV prevention does not suit every sector of society. It is clear that new, diverse and improved methods that target behavioural change across ages and many other personal and social factors are required to reduce HIV risk.      


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