HIV prevalence and progress on reaching the UNAIDS 90-90-90 target in KwaZulu-Natal
In 2016 UNAIDS indicated that the reduction of new HIV infections had stalled globally and cautioned that if efforts to prevent infections were not redoubled, there could be a reversal of earlier success. That same year, approximately 270 000 people became newly infected with HIV in South Africa. In 2017, it was estimated that nearly eight million South Africans were living with HIV. South Africa’s National Strategic Plan for HIV (2017-2022) calls for a focus on the geographic areas and populations most severely affected by HIV in order to reduce the burden of HIV in South Africa.
KwaZulu-Natal is the province with the highest HIV prevalence in South Africa where more than a quarter (27%) of adults aged 15 to 49 years old were living with HIV in 2017, compared to 20.6% nationally. The National Strategic Plan for HIV, STIs and TB has identified seven high burden HIV priority districts for focused attention in KwaZulu-Natal.
HEARD, Epicentre and CAPRISA, with funding from the United States Centre for Disease Control and Prevention, established the HIV Provincial Surveillance System (HIPSS) in the priority district of uMgungundlovu, in the Greater Edendale and Vulindlela areas in KwaZulu-Natal. The surveillance system was used to monitor the impact of the government’s HIV prevention and treatment programmes on HIV incidence, HIV prevalence and a number of other health outcomes.
The study enrolled 9 812 individuals aged from 15 to 49 years old from 2014 to 2015. More than a third (36.3%) of the study participants were living with HIV. Females had a particularly high HIV prevalence of 44%, whilst more than a quarter (28%) of males were living with HIV. Nearly two-thirds (60.2%) of the respondents aged from 40 to 44 years old were living HIV. HIV prevalence, disaggregated by age and gender, was highest (66.4%) amongst females aged from 35 to 39 years old. Among those who tested HIV positive, 52% of males and 65% of females knew their HIV status. Of those who already knew their HIV status, 69% of males and 70% of females were on antiretroviral treatment. Less than half (43%) of all HIV-positive respondents were taking antiretroviral treatment. However, for those who were on treatment, the vast majority of males (86%) and females (90%) were virally suppressed at a viral load of less than 1000 copies/ml.
The HIPSS study indicates that HIV remains a significant challenge in the Vulindlela and Greater Edendale area with the prevalence of HIV double that of national levels. While there has been significant progress on diagnosing those with HIV, linking them to treatment, and ensuring that those individuals on treatment are virally suppressed, less than half of all HIV positive individuals were on ARV treatment. The importance of improving the provision and scale-up of HIV prevention and treatment programmes are underscored by the findings from HIPSS in order to reach the 90-90-90 targets.