UNAIDS | 2014

SOUTH AFRICA HIV EPIDEMIC PROFILE

2014 SOUTH AFRICA Overview The Republic of South Africa (RSA) is the southern most country on the continent of Africa. To its north lie the neighbouring countries of Namibia, Botswana and Zimbabwe; to the east are Mozambique and Swaziland; and within lies Lesotho, an enclave surrounded by South African territory. The 2011 Census results released by Statistics South Africa (StatsSA) in November 2012, estimated the country’s population at 51.7 million people. South Africa is ranked as an upper-middle income economy by the World Bank and is considered a newly industrialised country. Despite having the seventh highest per capita income in Africa, poverty and inequality are widespread. About a quarter of the population is unemployed and lives on less than US$1.25 a day. The South African government provides most of the funding for its HIV response, with donor agencies contributing less than 25%. However, based on targets set by the government in the National Strategic Plan for 2012–2016, the gap between funding requirements and actual funds for HIV, Sexually Transmitted Infections (STIs) and TB is expected to grow.

Table 1

HIV epidemic indicators People living with HIV

2010 6 100 000 [5 800 000–6 300 000]

2013 6 300 000 [6 000 000–6 500 000]

New HIV infections

440 000 [410 000–470 000]

340 000 [310 000–370 000]

Adult 15+ new HIV infections

420 000 [400 000–460 000]

330 000 [300 000–360 000]

AIDS-related deaths

410 000 [380 000–440 000]

200 000 [170 000–220 000]

HIV prevalence (adults aged 15-49)

18.9% [18.0–19.7%]

19.1% [18.1–19.9%]

HIV incidence (adults aged 15-49)

1.79% [1.70–1.88%]

1.36% [1.26–1.45%]

Children (0-14 years) living with HIV

400 000 [360 000–440 000]

360 000 [320 000–390 000]

Children (0-14 years) newly infected with HIV

15 000 [14 000–17 000]

16 000 [14 000–19 000]

Adults 15+ living with HIV

5 700 000 [5 400 000–5 900 000]

5 900 000 [5 700 000–6 200 000]

Women 15+ living with HIV

3 400 000 [3 200 000–3 500 000]

3 500 000 [3 300 000–3 700 000]

HIV prevalence among young women (15-24 years)

14.8% [13.4–18.0%]

13.1% [11.9–16.1%]

HIV prevalence among young men (15-24 years)

4.4% [2.7–6.6%]

4.0% [2.5–5.9%]

New HIV infections among young women (15-24 years) 120 000 [110 000–130 000]

90 000 [81 000–100 000]

New HIV infections among young men (15-24 years)

50 000 [38 000–60 000]

36 000 [28 000–44 000]

HIV-positive incident TB cases*

330 000 [270 000–390 000]

330 000 [270 000–390 000] (2012)

Percentage of men circumcised (adults aged 15-49) †

40.6% (2005)

46.4% (2012)

Sources: UNAIDS 2013 HIV estimates; * WHO Global TB Report, 2013; † Global AIDS Response Progress Report, 2013.

1. UNAIDS 2014 Gap Report and unpublished estimates of the Gap Report

02

Fig. 1

HIV prevalence by geographical region Limpopo

North West

Gauteng

Free State

Mpumalanga

KwaZulu-Natal

Northern Cape

0-5 5-10 10-15

Eastern Cape

Western Cape

15-20

Source: Shisana, O et al (2014). South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town, HSRC Press.

Table 2

HIV prevalence among populations at high risk of infection Population group

HIV Prevalence

Sex workers

59.6% [26 – 60%]† (2013)

Men who have sex with men

~ 10.4% - 34.5%*

People who inject drugs

19.4%‡

Sources: Global AIDS Response Progress Report, 2013; * SANAC 2013: Estimating the size of sex workers population in South Africa, SANAC, Pretoria; † Anova Health Institute 2013, Rapid Assessment of HIV Prevention, Care and Treatment Programming for MSM in South Africa report, Anova Health Institute, Johannesburg; ‡ Scheibe, A, Brown, B, dos Santos, M (2014). Draft Report: Rapid assessment of HIV and related risk factors among people who inject drugs from five South African cities, Pretoria, MRC.

Table 3

HIV programme data 2010

2013

June 2014

Number of adults living with HIV receiving ART

729 312

2 466 565

2 593 630

Number of children living with HIV receiving ART

51 052

156 706

158 208

Adult ART coverage (of all adults living with HIV)

13% [12–14%]

42% [40–43%]

Child ART coverage (of all children living with HIV) 13% [11–14%]

44% [40–48%]

Number of women receiving PMTCT services

253 468

232 854

Number of women needing PMTCT services

270 000 [250 000-290 000] 260 000 [230 000–280 000]

PMTCT coverage

94%[86 – >95%]

90% [83 - >95%]

Sources: UNAIDS 2013 HIV estimates; UNAIDS 2014 Global AIDS Response Progress Reporting.

03

HIV trend data Fig. 2

Fig. 3

Number of new HIV infections 1 000

7

Thousands

Millions

Number of people living with HIV 6 5 4

800 600

3

400

2

200

1 0

1990

1995

2000

2005

2010

0

1990

2015

1995

2000

2005

2010

Number of people living with HIV increased from 57 000 [50 000–64 000] in 1990 to 6 300 000 [6 000 000–6 500 000] in 2013.

New HIV infections declined to less than 340 000 [310 000–370 000] people in 2013, from about 680 000 [640 000–730 000] people in 2001.

Source: UNAIDS 2013 estimates

Source: UNAIDS 2013 estimates

Fig. 4

Fig. 5

Thousands

Number of AIDS-related deaths

Prevalence (%) among young people (15–24)

500

25.0

400

20.0

300

15.0

200

10.0 5.0

100 0

2015

0.0 1990

1995

2000

2005

2010

2015

1990

1995

2000

2005

men

2010

2015

women

HIV-related deaths declined by almost 50% from around 380 000 [350 000–420 000] in 2005 to less than 200 000 [170 000–220 000] in 2013.

Prevalence among young women fell from 19.1% [17.4–22.8] in 2001 to 13.1% [11.9–16.1] in 2013.

Source: UNAIDS 2013 estimates

Source: UNAIDS 2013 estimates

Fig. 6

Fig. 7

ART coverage (%) of all people living with HIV

ART coverage (%) of children living with HIV

80

80

60

60

40

40

20

20

0

2001

2003

2005

2007

2009

2011

2013

0

2001

2003

2005

2007

2009

2011

2013

About 4 out of 10 people living with HIV received antiretroviral therapy in 2013.

About 4 out of 10 children living with HIV received treatment in 2013.

Source: UNAIDS 2013 estimates

Source: UNAIDS 2013 estimates

04

Fig. 8

Fig. 9

Number of new child HIV infections Thousands

PMTCT coverage (%) 100 80 60

80 60 40

40

20

20 0

100

0 2001

2003

2005

2007

2009

2011

2013

1990

1995

2000

2005

2010

2015

In 2013 about 9 out of 10 women and their infants had access to antiretroviral drugs during delivery and breastfeeding to prevent mother-to-child transmission of HIV.

The number of new child infections has fallen by 52% between 2009 and 2013.

Source: UNAIDS 2013 HIV estimates

Source: UNAIDS 2013 HIV estimates

Table 4

HIV knowledge, attitude and practice Men

Women

Total

Percentage of young women and men aged 15–24 who correctly identified ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission and prevention

23.2%

25.3%

24.2%

Percentage of young women and men aged 15–24 who have had sexual intercourse before age 15 Percentage of adults aged 15–49 who had sexual intercourse with more than one partner in the last 12 months Percentage of adults aged 15–49 with more than one sexual partner in the past 12 months who reported the use of a condom during last intercourse Percentage of sex workers reporting the use of a condom with their most recent client

16.7%

5.0%

10.7%

23.2%

5.1%

14.1%

58.7%

49.7%

57.1%

—

—

—

Percentage of men reporting the use of a condom the last time they had anal sex with a male partner

—

—

—

52.6%

45%

Percentage of women and men aged 15–49 who received an HIV test in the last 12 months 37.4% and who know their results.

Source: Shisana, O et al (2014). South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town, HSRC Press.

05

Fig. 10

Gender equality Present at national level Integrating services for sexual and reproductive health and for HIV Women living with HIV participated in response review HIV plans and budgets in ministries responsible for gender Data on resources used for women’s programmes Response budget for women’s organization Available on project basis National Response gender review undertaken Women living with and affected by HIV participated in CEDAW monitoring Qualitative assessments conducted Funding gender-equity programmes for men and boys Disaggregated data available (age and sex) Data available on gender-based violence and HIV Social protection includes women living with HIV Female condoms procured and distributed Health sector policy on gender-based violence

Not Available

Source: South Africa Gender Score Card (2013–2014). Completed by South African Department for Women, Children and People with Disabilities, April 2014.

Spending on HIV response Table 5

Amount spent annually on HIV programmes Year

South Africa Rand (ZAR)

2007/2008

ZAR 7.9 Billion

2008/2009

ZAR 11 Billion

2009/2010

ZAR 12.9 Billion

Fig. 11 ZAR Billions

Spending proportions by source of funding 14

Private funds

12

International funds

10

Public funds

8 6 4 2 0

2007/08

2008/09

2009/10

Source: South Africa NASA, 2007/10.

06

Fig. 12

Distribution per AIDS spending categories 14

Total Research

12

Total Human Rights & Advocacy

10

Total Human Capacity Building

8

Total Programme Management

6

Total Social Protection

4

Total OVC Care & Support Total Treatment

2 0

Total Prevention 2007/08

2008/09

2009/10

Source: South Africa NASA, 2007/10.

Commitment to HIV prevention, treatment and care 







The South African National AIDS Council (SANAC) was established by the national cabinet of the South African Government to build consensus across government, civil society and all other stakeholders to drive a comprehensive country response to HIV, TB and STIs (http://www.sanac.org.za/). In July 2014, the South African Government committed to increasing treatment coverage for people living with HIV, as of January 2015, according to the World Health Organization (WHO) guidelines published in 2013. All HIV-positive pregnant women will be offered antiretroviral therapy (WHO Option B+) to prevent mother-to-child transmission, and antiretroviral therapy (ART) will be offered to all people living with HIV with a CD4 count < 500 cells/µL. Following a review of the National Strategic Plan (NSP) 2007–2011, the NSP for HIV, STIs and TB for 2012–2016 was developed and approved in December 2011. The NSP 2012–2016 vision is to achieve zero new HIV and TB infections, zero new infections due to vertical transmission, zero preventable deaths associated with HIV and TB, and zero discrimination associated with HIV, STIs and TB. South Africa is committed to reaching the 10 global targets outlined in the 2011 United Nations Political Declaration on HIV and AIDS.

Achievements/progress in the national HIV response 





 



High level political commitment has been demonstrated by the government, who is providing 80% of the AIDS response budget. Impressive gains in adult life expectancy have been achieved as a result of scaling up the provision of antiretroviral therapy to people living with HIV. South Africa has the largest HIV treatment programme in the world, with more than 2.4 million people receiving antiretroviral treatment at the end of 2013. Coverage rates for services to eliminate mother-to-child HIV transmission exceed 90%. AIDS-related deaths declined from 310 000 [290 000–350 000] in 2003 to 200 000 [170 000–220 000] at the end of 2013. The country was successful in its application for funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to increase access to HIV prevention, especially among key populations, and to address multi-drug resistant tuberculosis and HIV in prisons and mines.

Challenges in the national HIV response 





The rate of new HIV infections remains high. Young women aged 15 to 24 years account for about one quarter of all new HIV infections in South Africa. Stigma and discrimination remains a problem while there is limited information on prevalence among identified key populations. Challenges in the HIV cascade need to be addressed to ensure increased uptake of HIV testing and counselling services, and to ensure that those eligible for treatment are receiving treatment, are retained in care, are adhering to treatment regimens and are virally suppressed. 07

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