Mpumalanga Reports Highest HIV Prevalence in SA, with Increased ART Coverage

Key drivers of the HIV epidemic in Mpumalanga include lower rates of early sexual debut compared to other provinces, with a decrease from 13.3% in 2017 to 5.4% in 2022.

The Human Sciences Research Council (HSRC) has released the findings of the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) for Mpumalanga, revealing that the province had the highest HIV prevalence in South Africa in 2022 at 17.4%. This translates to approximately 890,000 people living with HIV (PLHIV) in the province.

According to Professor Khangelani Zuma, the overall principal investigator of the study, the survey indicated that HIV prevalence among youth aged 15 to 24 was 7.8%, with males in this age group having a significantly higher prevalence (9.8%) compared to females (6.3%). Among adults aged 25 to 49, the prevalence was considerably higher at 26.4%, with females experiencing a 1.6-fold higher rate (31.9%) than males (19.9%).

HIV prevalence varied by locality, with higher rates observed in rural formal or farm areas (21.1%) and rural informal areas (18.4%), while urban areas had a lower prevalence (15.5%). Notably, HIV prevalence peaked at 40.8% among individuals aged 45 to 49 in 2022, a slight increase from 39% among those aged 35 to 39 in 2017, suggesting ongoing new infections. However, a downward shift was noted in the epidemic curve among those aged 15 to 44 years.

The survey focused on three priority districts in Mpumalanga: Ehlanzeni, Gert Sibande, and Nkangala. In 2022, HIV prevalence was highest in Gert Sibande (20.5%) and Ehlanzeni (16%), and lowest in Nkangala (13.1%).

In terms of antiretroviral treatment (ART), coverage in Mpumalanga rose to 81.8% in 2022, up from 65.4% in 2017. This means an estimated 630,000 people living with HIV in the province received ART in 2022. ART coverage among adolescents and youth aged 15 to 24 was 56.4%, while it was higher at 83.9% for those aged 25 to 49. Coverage was notably lower for young females aged 15 to 24 (58.6%) compared to their older counterparts (85.2%), and lower for young males aged 15 to 24 (54.8%).

The SABSSM VI survey, conducted between 2022 and 2023, aimed to monitor HIV infection and behaviors in South Africa, assess the progress of the national HIV and AIDS, STI, and TB Strategic Plan, and provide indicators for national and international reporting.

Professor Zuma highlighted that a significant proportion of people living with HIV aged 25 to 49 were unaware of their HIV status (62.3%), aware but not on ART (63.5%), or on ART but not virally suppressed (63.4%). Adolescents and youth aged 15 to 24 accounted for a smaller share of treatment gaps, with only 9.4% of all PLHIV in this age group. Among these youths, 16.9% knew their status, 16.7% knew their status but were not on ART, and 13.7% on ART were not virally suppressed.

Key drivers of the HIV epidemic in Mpumalanga include lower rates of early sexual debut compared to other provinces, with a decrease from 13.3% in 2017 to 5.4% in 2022. However, sexual debut before age 15 was higher among males (6.1%) than females (4.8%). Additionally, 5.1% of people aged 15 and older reported having multiple sexual partners in 2022, down from 7.9% in 2017. Condom use remained relatively stable, with 46.1% using condoms with their most recent sexual partner, while 32.4% reported never using a condom. The survey also revealed that only 11% of individuals used condoms almost every time, with nearly 50% of youth reporting inconsistent or no condom use.