The sixth South African national HIV prevalence, incidence, and behaviour survey shows the significant progress the country has made in the HIV response. 

Released this week, the survey shows that 90% of those above the age of 15-years who are living with HIV knew their status; and 91% of those diagnosed were on antiretroviral therapy (ART);  and 94% of those on ART were virally suppressed in 2022.

National health department spokesperson Foster Mohale says the survey results show that the country is on the right track to achieve ambitious 95-95-95 targets – that by 2025, 95% of all people living with HIV should know their status; 95% of all people with HIV to receive treatment; and 95% of all people on HIV treatment to be viral suppressed.   

“The reduction in the percentage of all people living with HIV in South Africa can be attributed to collaborative efforts by various stakeholders involved and interventions introduced to curb the rate of transmission and treatment adherence,” says Mohale. 

HIV prevalence – proportion of people living with HIV – decreased from 14% in 2017 to 12.7% in 2022. The total number of people living with HIV in the country in 2022 was estimated at 7.8 million, compared to 7.9 million in 2017.

Women most affected

More than 40 years into the epidemic, young women are still among the most vulnerable to new HIV infections. The group continues to bear the brunt of the epidemic. HIV prevalence among women was 20%, that’s nearly twice as among men (12%).

“The most pronounced differences in HIV prevalence by sex were seen among younger populations which calls for focused interventions. Compared to males of the same age groups, HIV prevalence was approximately two-fold in females aged 15-19 years and 20-24 years and three-fold-higher in females aged 25-29,” says Professor Khangelani Zuma, the survey’s principal investigator in a press release. Zuma is the executive of the public health, societies, and belonging division of the Human Sciences Research Council.

South Africa’s situation mirrors the global picture. The most recent figures released by UNAIDS this week show that 46% of all new HIV infections were among women and girls in 2022. In sub-Saharan Africa, this group accounts for over 77% of new infections among adolescents and young adults.

More work to be done 

Dr Logandran Naidoo is the national medical director for AIDS Healthcare Foundation (AHF) in South Africa, an organisation which provides medical care for people living with HIV.  He says South Africa still needs to do more work in order to achieve the 95-95-95 target.

“More needs to be done in terms of identifying people with HIV, especially using targeting testing which is offering HIV tests to people deemed to be at a higher risk of HIV infection such as key populations,” says Naidoo.

“We also need to work on viral load suppression to undetectable levels, (viral load which is too low to be picked up by viral load tests)” he says.  

Viral load suppression is an indicator of how well ART is working. A person with an undetectable viral load can’t transmit the virus to their sexual partners. 

“We seem to be losing several patients from care. This linkage and retention of patients and returning lost patients and ensuring adherence to their medication is important,” says Naidoo.

Naidoo says that in order for South Africa to succeed in the fight against HIV, attention needs to be given to women and key populations – which include men who have sex with men, transgender people, sex workers, injecting drug users, prisoners and migrant populations.

“KwaZulu-Natal province remains the hub of a significant HIV prevalence in the country while females are still vastly affected more than males, nevertheless the country appears to be on the right track in terms of the fight against HIV,” he says. – Health-e News