Periodic Review ccm request template

Please describe any changes to the disease epidemiological situation that is likely to affect program implementation or strategies. (Please indicate sources of information)

South Africa’s generalized HIV epidemic continues with HIV prevalence in the general population estimated at 17.3%³. The 2011 HIV antenatal survey showed that the national prevalence estimate has remained stable around 29% since 2008⁴. The 2011 Census put South Africa’s population at 52 million (or 0.7% of the world’s population), and with 5.6 million people living with HIV (PLHIV), South Africa carries 17% of the global burden of HIV⁵. Nationally the prevalence among pregnant women (15-49 years) now exceeds 30%, though most, if not all, of the increase in prevalence in recent years can be attributed to the increase in survival of those on ARVs.⁶ Provinces that recorded the highest HIV prevalence were KwaZulu-Natal (39.5%), Mpumalanga (35.1%), Free State (30.6%) and Gauteng (30.4%). The Northern Cape and Western Cape recorded the lowest prevalence at 18.4% and 18.5% respectively.

There has been clear progress in stemming the rise of infections, with the incidence of new HIV infections reduced by more than 41% among adults (15-49 years) between 2001 and 2011. In addition, mother to child transmission of HIV has declined from 8.5% in 2008, to 3.5% in 2010 and 2.7% in 2012, a direct impact of the accelerated programme for the elimination of vertical transmission. Still, there were more than 343 000 new HIV cases in 2010, with a disproportionate percentage coming from three of the country’s nine provinces, namely KwaZulu-Natal (29.4%), Gauteng (20%) and Eastern Cape (13.8%). See the Table below.

Table 6: Annual rate, estimated number and percentage of new infections by province, 2010

There was a rapid decline of 49% in new HIV infections among children from 2009 to 2011, and HIV prevalence levels in children aged 2-14 years have also gradually decreased, primarily as a result of the scaled-up national PMTCT programme ⁷. Among youth aged 15-24 years HIV prevalence declined from 10.3% in 2005 to 8.7% in 2008, but further data is required to assess whether this represents a statistically significant downward trend.

HIV continues to hit young women particularly hard. In most provinces, prevalence in women aged 15 and older is significantly higher than in men, particularly in the 20-24 year age group.⁸ South African young women between the ages of 15 and 24 years are four times more likely to have HIV than males of the same age. This risk is especially high among pregnant women between 15 and 24 years, and survivors of physical and/or intimate partner violence. On average, young females become HIV positive about five years earlier than males⁹. SA researchers also found that women accounted for 90 per cent of all new HIV infections in the 15–24 age group. Nationally, the HIV prevalence among women in the age group 30 - 34 years remains the highest, though it has stabilized and actually decreased slightly from 42.6% in 2010 to 42.2% in 2011. See Figure below.



Figure 2: HIV prevalence by gender/province

The life expectancy increased to 60 years in 2011 from a low of 51 in 2005, but it is still well below the pre-epidemic high of 64 years in 1997¹⁰. See the table below for more detail.

Table 7: Key Mortality Indicators

Indicator	2009	2011
Life expectancy at birth	56.5 years	60.0 years (increase of 3.5 years)
Adult total mortality	46%	40% (reduced by 6%)
Under 5 mortality per 1000 live births (U5MR)	56	42 (reduced by 10%)
Infant mortality per 1000 live births (IMR)	40	30 (reduced by 25%)

Improving survival rates mean that the absolute number of PLHIV is rising fast, even as infection rates drop, with approximately 100 000 additional PLHIV being added to the existing pool each year. Better life-expectancy and quality of life make an enormous difference for PLHIV and their families, but the costs of caring for all PLHIV and the range of HIV-related diseases grows along with the total pool of PLHIV.

There has also been a substantial downturn in AIDS related mortality, with the annual number of AIDS deaths falling from about 257 000 in 2005 to 194 000 in 2010¹¹. HIV/TB co-infection rates are still quite high, but testing and treatment have improved. Among PLHIV, 3.2 million were reported to have been screened for TB in 2011, and the number of PLHIV receiving preventive TB therapy increased nearly three-fold, from 146 000 in 2010 to 373 000 in 2011. In 2011 460 000 people living with HIV without active TB received isoniazid preventive therapy¹².

Figure 3 below illustrates this combined effect and trends in HIV incidence, prevalence and mortality.



Figure 3: Trends in HIV incidence, prevalence and mortality, South Africa, 1990-2009¹³

Key Populations at Elevated Risk

Key populations defined by the National Strategic Plan on HIV, STIs and TB, 2012-2016 (NSP) still remain at elevated risks of infection. Among these groups are: young women between the ages of 15 and 24 years; people living close to national roads and in informal settlements; young people not attending school and girls who drop out of school before matriculating; people from low socio-economic groups; uncircumcised men; people with disabilities and mental disorders; sex workers and their clients; people who abuse alcohol and illegal substances; men who have sex with men and transgender individuals.

Table 8: HIV infections amongst some key populations¹⁴

	Estimated HIV prevalence (11)	New HIV infections, group only (%)	New infections, group and their partners / clients (%)
Women 15-24 years	20.5 %	34% (2005)	Not available
SW	44–69%	5.5%	19.8%
IDU	5.4 - 35%	1.1%	1.3%
MSM	10–50%	7.9%	9.2%
Prisoners	22.8% (2009)	Not available	Not available
Migrant farm labourers	28–49%	Not available	Not available