W Cape Records Lowest HIV Prevalence, but Challenges Remain for Younger Populations

Mpumalanga now holds the highest HIV prevalence rate at 17.4%, translating to 890,000 PLHIV, followed by KwaZulu-Natal.

The Western Cape had the lowest HIV prevalence among South Africa's nine provinces in 2022, with a rate of 7.4%, down from 8.6% in 2017. This represents a population of approximately 540,000 people living with HIV (PLHIV), a slight decrease from 560,000 in 2017, according to findings from the Sixth South African HIV Prevalence, Incidence and Behaviour Survey (SABSSM VI) released by the Human Sciences Research Council (HSRC).

The report highlights that HIV prevalence is highest among those aged 25 to 49, with a rate of 10.8%. Within this group, females had a significantly higher prevalence (14.6%) compared to males (5.8%). Across all age groups, HIV prevalence among females (9%) surpassed that of males (5.6%).

The data also reveals that the HIV epidemic is shifting among age groups. HIV prevalence among 35 to 39-year-olds peaked at 12.9% in 2022, a decrease from 23.4% in 2017. However, the worsening prevalence among individuals younger than 24 is a growing concern, as new infections continue among this demographic.

Mpumalanga now holds the highest HIV prevalence rate at 17.4%, translating to 890,000 PLHIV, followed by KwaZulu-Natal.

Progress in Antiretroviral Treatment (ART) Coverage

ART coverage in the Western Cape improved significantly, increasing from 54.4% in 2017 to 76.8% in 2022. This means approximately 360,000 PLHIV are now receiving ART. However, disparities remain across age groups and genders, with lower coverage among males (75.3%) compared to females (77.1%) and among those aged 15 to 49 (76.5%).

The survey also noted a gap in ART usage between urban areas and Cape Town residents, with ART use in urban areas at 76.2% and 81.4% in the City of Cape Town.

Viral Load Suppression (VLS)In 2022, the Western Cape ranked seventh among all provinces for the proportion of PLHIV achieving viral load suppression (VLS) at 78.4%, up from 54.6% in 2017. Despite this improvement, VLS remains lower among males (76%) compared to females (79.7%), and among those aged 50 and older (69.4%).

Knowledge of HIV Status and Treatment Gaps

The report expressed concern about the high proportion of PLHIV aged 25 to 49 who are unaware of their HIV status (59.1%), aware but not on ART (64.7%), or on ART but not achieving VLS (66.7%). Adolescents and young adults aged 15 to 24 were also disproportionately represented in treatment gaps, accounting for 9.5% of all PLHIV.

Drivers of the HIV Epidemic

A notable increase in sexual debut before the age of 15 among youth aged 15 to 24 was observed, rising from 14% in 2017 to 16.3% in 2022. This early sexual activity was significantly higher among males (21.5%) than females (11.3%).

The survey also revealed a decline in condom use, with 22.1% of individuals reporting condom use with their most recent partner in 2022, down from 26.6% in 2017. Among those aged 15 to 24, 39.9% reported condom use, but the overall consistency of use remains low, with only 13.4% of respondents reporting frequent condom use with their most recent partner.

The Western Cape's success in lowering HIV prevalence is commendable, but the data underscores the need for targeted interventions for youth and men, as well as efforts to promote consistent condom use and ART coverage. Professor Khangelani Zuma from the HSRC emphasized that continued efforts are required to address the key drivers of the epidemic and to close treatment gaps, particularly among younger populations. 4o