The proportion of South Africans infected with HIV has increased from 10.6% in 2008 to 12.2% in 2012, according to the Human Sciences Research Council’s (HSRC) National HIV Prevalence, Incidence and Behaviour Survey that was released on Tuesday. The total number of infected South Africans now stands at 6.4-million; 1.2-million more than in 2008.

Women aged between 30 and 34 and males aged 35 to 39 had the highest infection rates: 36% of females and 28.8% of males in these respective age groups contracted HIV. Provincially, KwaZulu-Natal has the highest HIV prevalence (16.9%) and the Western Cape the lowest (5%).

The survey is the fourth in a series of national HIV household surveys conducted by a consortium of scientists led by the HSRC – the previous surveys were conducted in 2002, 2005 and 2008. The survey’s results will serve as a critical benchmark for the evaluation of the health department’s national strategic plan for HIV, TB and sexually transmitted infections for 2012 to 2016. Almost 38 000 people were interviewed and about 29 000 agreed to be tested for HIV.

According to the survey, the increased infection rate is “largely due to the combined effects of new infections and a successfully expanded antiretroviral treatment [ART] programme” – ART allow people with HIV to live significantly longer, leading to greater percentage of HIV-infected people remaining in society. ART access almost doubled between 2008 and 2012, with about a third of the country’s HIV-infected population – about two-million out of 6.4-million infected people – accessing ART in 2012.

HIV incidence rate a concern

But the rate at which new HIV infections are acquired, or the HIV incidence rate, is a concern, with the HIV incidence rate among females aged 15 to 24 being more than four times higher than the incidence rate found in males in this group. Among the teenage population, the difference between the HIV prevalence between girls and boys is even higher: girls have eight times the infection rate of their male counterparts. “Unfortunately, with over 400 000 new HIV infections occurring in 2012, South Africa ranks first in HIV incidence in the world,” said the HSRC’s Thomas Rehle and one of the principal investigators of the survey.

Black African females aged 20 to 34 recorded the highest incidence of HIV among all the analysed population groups.

Individuals who were married had a considerably lower HIV incidence rate than survey participants who were living together with a sexual partner and those who were single.

Said HSRC chief executive and principal investigator Olive Shisana of the survey: “The disproportionately high HIV prevalence levels among females in the country and high prevalence in unmarried, cohabitating people however, require a rethinking of conventional approaches of HIV prevention towards strategies that address the underlying socio-cultural norms in the affected communities.”

According the survey, the health department is unlikely to achieve its target of a 50% reduction in new HIV infections by 2016: “In view of our survey findings, this will be extremely difficult to attain given the prevailing transmission dynamics in the country,” the authors noted.

Highest HIV infection rate

Disaggregation of the survey data by race showed that “black Africans had the highest HIV infection rate compared to all other race groups [15%]”, followed by coloured people (3.1%), Indians or Asians (0.8%) and whites (0.3%). The figures for white people were however considered unreliable because of a low response rate. In attempting to understand the possible reasons for high infection rates among black Africans, the survey findings suggest that “black Africans were less likely than all other races to live in urban formal areas. Urban informal areas are generally under-resourced and lack some of the basic necessities such as formal housing, water, sanitation and access to preventative health services.”

The other distinguishing factor among races was marital status. “Black Africans are less likely to report being married than white and Indians or Asians,” the survey says. “HIV prevalence was found to be higher in the unmarried, cohabitating population than in the married population.”

Female teenagers aged 15 to 19 years were more likely than their male counterparts to have sex – not with their peers, but with older sex partners. In 2012, 19.9% of all respondents were involved in age-disparate relationships involving a sexual partner more than five years older than they were – but there was a significant sex difference, with one third of girls reporting having done so and only 4.1% of boys. Analysis of the surveys done in 2005, 2008 and 2012 shows “there was a steady increase in age-disparate relationships”.

Condom use decreased significantly from 2008 among men and women of all age groups, except for women aged 50 years and older. More than half of all respondents indicated that they had never used a condom. People living together, who were not married, aged 15 to 49 years, had the lowest rate of condom use (33.8%).

“The increase in some risky sexual behaviours are disappointing, as this partly accounts for increases in some risky sexual behaviours still occurring in South Africa. We must therefore keep reminding South Africans to avoid being complacent when it comes to HIV prevention and to continue to engage in safer sex practices in order to prevent new infections,” said the HSRC’s Leickness Simbayi.

Other findings: