Recommendations for policy in the Western Cape Province regarding the prevention of Major Infectious Diseases including hiv/AI

A person’s vulnerability to disease should be seen as a confluence of risk factors, with individual predisposition being magnified or mitigated by community or societal pressures — HIV is no exception.

The 2005 HSRC/Nelson Mandela National HIV Household Survey confirmed that persons living in informal settlements have a significantly higher HIV prevalence than those living in other locality types. Table 3 below shows the results for the Western Cape Province for persons aged 2 years and above. An HIV prevalence of 9.0% was found in urban informal settlements, six times higher than in urban formal areas (1.5%), and ten times higher than in rural formal areas (0.9%) (Shisana et al, 2005).

Table 3: HIV prevalence by locality type,

Western Cape Province, 2005

National Household Survey (age 2 years and above)

Locality type	N	% HIV Prevalence	95 % CI
Urban formal	1754	1.5	0.8-2.8
Urban informal	214	9.0	3.9-19.2
Rural formal	236	0.9	0.3-2.8

HIV prevalence and socio-economic status

The five sub-districts that have the highest HIV prevalence rates in the province are: Khayelitsha, Gugulethu/Nyanga (now largely Mitchells Plain), Greater Athlone (now parts of Klipfontein), Bitou, and Knysna.

When sub-districts are classified according to HIV prevalence, there is some correlation between HIV prevalence, registered TB cases, certain demographic variables and associated socio-economic risk factors that were identified in the 2001 national census (Stats SA, 2001 and see Tables 4–6 below). (Note: the TB data is reported in terms of the new sub-districts while the antenatal HIV prevalence survey was planned in the period before the new demarcations.)

Table 4: Sub-districts by

HIV prevalence and TB cases, 2005

2005 HIV Prev. (%)	Sub-district	Population	No. of TB cases	Sub-district	Population
32.6	Khayelitsha	329 008	5 641	Khayelitsha	329 008
29.1	Mitchells Plain	430 175	4 300	Eastern	396 718
21.1	Bitou	29 183	3 908	Klipfontein	344 441
21.1	Knysna	51 466	3 412	Northern	361 400
17.7	Klipfontein	344 441	2 736	Mitchells Plain	430 175

Table 5: Sub-districts by HIV prevalence age and migration

Population age and migration breakdown
2004 HIV prev. (%)	District	Sub-district	Pop.	% of pop. between 16-25	% of pop. between 26-45	% pop. recently immigrated
33.0	1	Khayelitsha	329 008	24	34	17
29.1	1	Gug./Nyanga	344 441	20	31	10
17.8	3	Stellenbosch	117 706	25	30	24
17.4	5	Bitou	29 183	19	34	22
17.4	5	Knysna	51 466	18	31	19