South African Statistics

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South African Statistics - 2017

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South African Health Review 2017. 20th Edition. 28/8/2017

Published by HST

The South African Health Review (SAHR) is now widely recognised as one of the most authoritative sources of commentary on the South African  health  system.  It  is  widely  used  in  teaching  public  health at  undergraduate  and  postgraduate  level  in  South  Africa,  and  it  is  used  by  scholars,  donors,  journalists,  policymakers  and  policy-implementers at various levels of the health system.

The initial edition of the SAHR was based on commissioned chapters relating to the most important health policies, reforms and priorities of  the  time.  The  chapters  were  reviewed  first  by  an  independent  reviewer  and  the  overall  composite  edition  was  reviewed  by  a  committee.  To  a  great  extent,  this  initial  publication  created  the  framework  for  subsequent  editions.  However,  there  have  been  a  number  of  important  changes  and  improvements  over  the  20  editions.

There has been a move away from commissioned articles to an open request to all authors writing on themes pertinent to the health system in  South  Africa.  The  process of peer review  has  been  improved,  with  at  least  two  independent  reviewers  assigned to each  article, as well as comment from an editorial advisory committee. In 2014, the SAHR was  accredited  as  a  peer-reviewed  publication  by  the  Department of Higher Education and Training. This has raised the profile  of  the  SAHR and  offers  a  particular  incentive to academic contributors,  as peer-reviewed  publications  are  one  of  their  key performance  areas,  and  they  can  receive  subsidy  allocations for their contributions.

You can access the resource here

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District Health Barometer 2015/16.


The District Health Barometer 2015/16, now in its 11th edition, seeks to highlight, health system performance, inequities in health outcomes, and health-resource allocation and delivery, and to track the efficiency of healthcare delivery processes across all provinces and districts in South Africa. Over the years, the DHB has become an important planning and management resource for health service providers, managers, researchers and policy-makers.

You can access the Publication here


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Explore, Visualise and Interact With Youth-Centered Data. 15/6/2017


Little coherent understanding exists about the realities that shape young people’s lives, how they change over time or differ from one community to another. This lack of understanding severely constrains the ability of policies and interventions to address the challenges facing youth and optimally support them in their attempts to forge positive and transformative pathways.

The Youth Explorer was developed to begin to fill these gaps in our understanding. Drawing on census data, it provides a range of information on young people aged 15-24*, in one easily accessible place. Indicators on young people’s education, economic opportunities, family and living environment, health and more are available at a range of geographic levels, from electoral wards to local municipalities and district municipalities**. The tool provides simple data visualisations and allows for further interactive exploration of the data.

The Youth Explorer was developed by UCT’s Poverty and Inequality Initiative, in partnership with OpenUp (formerly Code for South Africa), Statistics South Africa and the Economies of Regions Learning Network (ERLN). The 2016 pilot version in the Western Cape was supported by the Western Cape Government, City of Cape Town and the Centre of Excellence in Human Development. The Youth Explorer was built on Wazimap, which is based on the amazing Census Reporter and is entirely open source.

You can access the website here

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South African Child Gauge 2016. 1/12/2016


The South African Child Gauge is the only publication in the country that provides an annual snap-shot of the status of South Africa’s children.

It is published by the Children’s Institute, University of Cape Town, to track South Africa’s progress towards realising children’s rights.

The 2016 issue issue focuses on the theme of Children and Social Assistance.

Click on the links below to download a PDF version or order a hard copy.


Please note: When linking to the book and its supplementary material, you are required to link to this page, and not to individual pdfs downloaded from this page. That causes an undesirable separation of the book and its accompanying material and other information on the series contained on our website. Thank you for your compliance in this regard.

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AIDS Like An Atomic Bomb Every 6 Months. 14/09/2017

Published by NEWS24

Consider a scenario where South Africa is engaged in a terrible war with an invading country.

“Since the war started, over 3,8 million South Africans have lost their lives, and although the annual death toll has declined from an estimated 325 000 in 2006 to 150 000 in 2016, the war is still far from over. Yet, despite this, the South African government and its people appear to have grown complacent about the war.

“Leaders seldom refer to it, and when they do, they focus predominantly on the nation’s hard-fought victories. This short-sighted approach serves only to distract their constituencies from the horrors of potential defeat. Much of the population also chooses to live in ignorance and/or denial of the war, which in itself, undermines efforts on the frontline.”

In reality though, our enemy is not an invading country, it’s a treatable virus known as HIV.

Aids epidemic in context

The table below puts into perspective the sheer scale of South Africa’s HIV/Aids epidemic by comparing it to other widely-reported human tragedies:

Human Tragedy (year/s)                                       Official/Estimated Death Toll

Mining fatalities in SA (in 2016)                                 73

9/11 Terrorist attack (2001)                                       3 800

Ebola virus outbreak in West Africa (2014)               12 000

Aids-related deaths in SA (1 month in 2016)       12 500

Road deaths in SA (in 2016)                                      14 000

Murders in SA (in 2016)                                            18 500

Japanese earthquake/tsunami (2011)                         20 000

Aids-related deaths in SA (6 months in 2016)       75 000

Hiroshima atomic bomb (August 1945)                        80 000

Bangladesh cyclone (1991)                                         130 000

Aids-related deaths in SA (in 2016)                        150 000

Haiti earthquake (2011)                                              160 000

Indonesian earthquake/tsunami (2004)                       280 000

Aids-related deaths in SA (in 2006)                        325 000

Syrian War civilian casualties (2011 – 2017)                450 000

Rwandan genocide (1994)                                           800 000                                

Aids-related deaths in SA (1987 – 2017)                3 800 000

WW2 Holocaust (1939 – 1945)                                    6 000 000

If the figures above haven’t quite sunk in yet, consider that between 2011 and 2017, over 450 000 Syrians have been killed in the terrifying Syrian War. During that same time, South Africa registered over a million Aids-related deaths, more than double the number of Syrian civilian casualties.

The scary truth is … HIV is preying on our nation’s fundamental weaknesses and without a concerted counteroffensive strategy, this costly war will never be won.

Acknowledging our vulnerabilities

Without listing our nation’s historical shortcomings in dealing with the HIV crisis, we find ourselves here in 2017 with numerous unresolved government and societal vulnerabilities that facilitate HIV’s unrelenting proliferation.

The acronym ‘Aids’ is useful in highlighting our societal vulnerabilities: abuse, ignorance, denial and stigma. And it is these that have enabled HIV to infect 20% of South Africa’s adult population.

Ironically, it’s the mass-rollout of ARVs that is largely responsible for the steady decline in the number of Aids-related deaths since 2006 (refer to chart – red line), rather than the underwhelming efforts of national government and society to address our vulnerabilities.

This assertion is validated by the steady rise in our HIV population which rose by 180 000 in 2016, despite ARVs (refer to chart – green line). And, taking the 2016 Aids-related deaths into account, there were effectively 330 000 new HIV-infections in 2016 alone.

Today, over 7 million South Africans are HIV-positive, and the sad truth is that ARVs have lulled our society into a dangerous false sense of security.

Source: Stats SA; Statistical release P0302-2016; Mid-year population estimates; pages 6 & 7

Denialist society perpetuated by inept leadership

Considering the holocaust-scale of this HIV/Aids epidemic, one would expect it to attract war-like attention from our national leadership, the media and the general public.

But, inexplicably, this is not the case.

The ANC leadership appears to be so preoccupied with power retention, factional infighting, personal gain and scandal, that there is little time left for them to champion a nationwide Aids-awareness initiative that is serious about eradicating HIV-transmission from our society.

Emanating from this, almost every form of media has been swamped with news and opinion in the wake of unprecedented national discord … and let’s face it, Aids is old news.

All the while, our society remains stranded in either ignorance or the headlights of political and economic distraction.

Nationwide counteroffensive is needed

With South Africa’s Aids-related death toll already equivalent to: 48 Hiroshima atomic bombs; annual HIV-infections exceeding the capacity of six Ellis Park stadiums; and ARV expenditure that could have funded a nuclear power station … the time is nigh for South Africa to declare war on HIV-transmission.

This counteroffensive strategy should complement the UNAIDS 90-90-90 initiative, whose goal is as follows: “By 2020: 90% of all people living with HIV will know their HIV-status; 90% of all people with diagnosed HIV-infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.”

As a priority, the counteroffensive should ‘motivate’ HIV-testing by making it a pre-requisite not only for free ARV treatment (if HIV-positive), but also for voting, grant and tax rebate eligibility. This HIV-test would need to be undertaken every 24 months to confirm a citizen’s eligibility for these basic privileges.

Importantly, the test result itself – either positive or negative – would have no bearing on a citizen’s eligibility, just so long as each citizen has had a test and knows his/her status.

If the test result is positive, then the citizen would be added to the National ARV Program and given counselling – including being informed of the legal consequences of not taking ARV treatment as prescribed and/or transmitting the disease to others. If the test result is negative, then the citizen would receive lifestyle guidance on how to remain HIV-negative.

With respect to foreigners or asylum seekers: temporary residence permits should be issued, then renewed every two years, with an HIV-test being a mandatory requirement each time.

Light at the end of the tunnel

A significant positive of this counteroffensive strategy, is that the prevailing stigma of being seen at HIV-testing clinics will be immediately removed from society. Another positive spinoff is the anxiety associated with an HIV-test where there is status-uncertainty, which should serve as motivation to embrace responsible sexual behaviour in the future.

Ultimately, the long-term goal of the strategy would be for HIV-testing to become second nature, like relicensing your vehicle or renewing your driver’s licence.

This strategy could effectively see 90% of South Africa’s residents being tested, knowing their HIV-status, and being placed on ARVs by 2020. This success would translate into a greatly reduced transmission rate, and death rate.

The war is at a tipping point

If a counteroffensive strategy of this magnitude is not adopted for fear of public disapproval, then we risk the inevitable evolution of drug-resistant HIV-strains which could lead to future soaring infection/death rates – that could well put the rest of the world at risk.

The United States knows this and has consequently contributed over R65 billion to South Africa’s ongoing HIV and ARV campaigns. This life-saving funding, which could be cut at any time, should be seen as a golden opportunity for us to contain the spread of HIV and protect our precious future generations from it.

In times of war, there’s no time for complacency…

- Robert J. Traydon is a part-time author and BSc graduate of Mechanical Engineering. His writing explores a range of contentious environmental, economic and political themes from a uniquely contrarian perspective.


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South African Statistics - 2016

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South African Tuberculosis Drug Resistance Survey 2012–14.

Published by NICD

The South African Tuberculosis Drug-Resistant Survey (DRS) 2012-14 sought to determine the prevalence of multidrug-resistant TB (MDR-TB) and other TB drug resistance in South Africa, enrolling participants from 442 randomly selected facilities in all nine provinces of the country.  It was the largest TB DRS conducted with over 200 000 persons screened, over 5 000 000 data elements double-captured and more than 300 000 primary survey laboratory tests completed, including 100 000 individual drug susceptibility tests (against first and second-line drugs). Compared with the previous survey, the culture positivity rate was lower and in line with current recommendations, suggesting that patients are presenting earlier than before and that they are being appropriately screened.

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Status Report on SA Youth: The Good, the Bad and the Ugly. 27/5/2016

From The Daily Maverick by Marelise van der Merwe

The tenth issue of the South African Child Gauge is due for release later this year, and ahead of Youth Month, there’s some surprisingly good news: the last decade has seen substantial progress in the overall wellbeing of South African under-18s. The country’s children still have some tough hills to climb, but they’re moving – if slowly – in the right direction. By MARELISE VAN DER MERWE.

One thing must be said at the outset ahead of the publication of the latest South African Child Gauge: South African children are by no means out of the woods. Especially the country’s very youngest bear the brunt of severe inequality. There are major challenges ahead of them in terms of healthcare, education, unemployment and basic access to services.

But, say researchers at the Children’s Institute in Cape Town, there have also been significant gains over the last ten years. In a nutshell:

  • Child poverty has dropped from 74% in 2003 to 54% in 2013, driven primarily by the expansion of the Child Support Grant, which now reaches just under 12 million children;
  • Children’s access to formal housing has increased to 75%, with access to basic sanitation at 72%;
  • Deaths of children under five years old have fallen, following the rollout of the Prevention of Mother to Child Transmission programme [HIV/Aids prevention];
  • Access to early childhood development programmes has increased significantly since 2002;
  • Access to basic education is nearly universal, at 98%.

The South African Child Gauge provides an annual snapshot of the country’s children; that is, all those under the age of 18. This year it will focus on social assistance. The news is mixed: there have been substantial gains, but difficulties come in when a more nuanced picture is painted, for example in examining the quality of the education accessed. Poor quality schooling, the researchers point out, acts as a poverty trap, starting in the foundation phase and culminating in high levels of high-school dropout.

South Africa still battles unacceptably high levels of violence against children. The child homicide rate is more than double the global average, and most forms of violence are perpetrated by someone known to the child. Nearly half of child homicides take place in the context of child abuse and neglect, and of these, 75% are children under the age of five.

Nonetheless, more progressive policies are ensuring slow gains, if slowly. Shanaaz Matthews, Director of the Children’s Institute, said it was “imperative” to “find innovative ways to protect children from violence and to build children’s resilience so they are able to recover from negative experiences.”

In addition, she said, it was vital to “continue to monitor the status of children, identifying critical gaps and opportunities to strengthen policy and programmes.” Although the Constitution protected children’s rights, children continued to experience high levels of violence across multiple settings, she added. 

Some studies have turned up intriguing results in recent years. South Africa, for example, performed relatively well in the Early Childhood Wellbeing in Africa report, which found a correlation between child wellbeing and, among other things, mothers’ rights to education. In countries where there was greater equality between genders, children tended to be healthier and happier. The 2013 African Report on Child Wellbeing ranked 52 African governments in order of “child-friendliness”, and the countries that scored highest were Mauritius, South Africa, Tunisia, Egypt, Cape Verde, Rwanda, Lesotho, Algeria, Swaziland and Morocco.

Children themselves have their own ideas about their lives. The 2015 Children’s Worlds report focused specifically on an analysis of children’s subjective perceptions of their circumstances and surroundings. “The study aims to collect solid and representative data on children’s lives and daily activities and on their perceptions and evaluations of their lives,” the authors wrote. “[W]e wished to focus on children as social actors. Many social surveys gather statistics on children primarily as members of families or households. A drawback of this approach is that children’s status becomes defined by their household or family status and this may not reflect their personal experience. 

For example, a household may be defined as ‘not in poverty’ on the basis of household income, but a child in that household may still experience material deprivation depending on the spending choices that adults in the household make.” Educational crises or not, Children’s Worlds found that children in European countries tended to report higher levels of satisfaction with their friendships, while children in African countries tended to be happier in their school lives. 

One of [South Africa’s] big successes is the expansion of social grants, in particular the child support grant,” says Katharine Hall, senior researcher at the Children’s Institute. “Ten years ago, five million children were receiving the CSG, and it was only available to children up to the age of fourteen. Now it is available to all children – children being constitutionally defined as under 18 – and reaches nearly 12 million every month.” 

Although a potential difficulty lies in the sustainability of grants, Hall says the outcomes to date have been positive. “The effects of the grant have been shown in multiple studies, and are widely known: children who receive grants, or even those who live in households where others receive grants, have better health and nutritional outcomes when controlling for other variables, and they do better at school. Grants are also associated with less risky behaviour among teenagers.” Child poverty rates have dropped over the last decade, although they remain high, she says. 

Another improvement for South Africa’s children lies in the decreasing number of orphans. In the 2000s, the number of maternally orphaned children climbed steadily, says Hall, reaching a high of 1.6 million in 2009. “This was almost entirely due to HIV-related maternal deaths and the failure to roll out an efficient ARV programme. Since 2009, maternal orphaning rates have dropped substantially – much faster than those predicted by the modelled estimates – and are now around the 2005 figures, at 1.2 million.” Orphaning rates are expected to continue falling, says Hall, thanks to recently-announced eligibility criteria for enrolment into HAART

So what needs to change? The key challenge, as Mathews points out, is in ensuring child-friendly policies are enforced. The CI’s Children Count project has revealed that South African children are disproportionately affected by poverty and that one in five live in overcrowded households, with one in three having limited access to water and one in four living without basic sanitation. This gap between theory and practice remains too large, says Lori Lake, commissioning editor of the Child Gauge. “While the Constitution outlines children’s rights to dignity, equality, education, health care and a range of services, we know that the gap between rich and poor is widening, and that poor quality schooling acts as poverty trap,” she says.

Further, she adds, children’s access to services continues to lag behind that of adults, making them disproportionately vulnerable to inequality. “Many experience multiple deprivations that accumulate over time, creating long-lasting developmental setbacks – driving an intergenerational cycle of poverty, where children in former ‘homeland’ areas and informal settlements continue to experience the highest levels of deprivation.”

Hall agrees: child-friendly policies aren’t being implemented effectively enough. “Good policies don’t always translate to good services, and there’s a huge challenge to improve responsive services like the SAPS, social welfare and emergency healthcare. 

We don’t know exactly the number of children who are abused, neglected and killed, but we know that these numbers are unacceptably high. One study showed that 44% of all reported sexual offences in South Africa were against children. 

Our welfare services seem to be in disarray: they are under-capacitated in every way – not enough staff, not enough cars, offices without computers. The system is still largely paper-based, and this means that cases cannot be properly tracked or referred. The few social workers there are, are rushing around trying to deal with the foster care backlog, although this mainly involves orphaned children who are living quite safely with relatives. In the meantime, cases referred from SAPS are not followed up, and those are the really urgent ones – and only the tip of the iceberg as most cases of abuse don’t get reported at all.”

Education, Hall adds, is a “massive challenge”. “The school attendance rate is almost 100%, at least until the end of the compulsory schooling phase, but this incredible opportunity is lost when schools are under-resourced, teachers not properly qualified or frequently absent, and textbooks don’t arrive. Good quality education needs to start from the very earliest grades, before grade 1, and continue right through.” It will likely be a long time, Hall believes, before we start seeing “substantial shifts” in this area. 

And if the Children’s Institute could change one thing, right now, to make a difference? Lake says the support network for early childhood needs to be much wider, as well as strengthening efforts to prevent and respond to child abuse and neglect which, she says, contributes to an intergenerational cycle of violence. Hall says introducing Vitamin A supplementation for every child is an additional quick, easy win and that points of contact at health facilities can be used to greater effect. For that matter, she adds, basic sanitation won’t go amiss either. 

Basic services were promised years ago: adequate water and sanitation for all households. They are both inextricably linked to children’s health, but about five million children don’t have adequate services at home,” she says. DM

Photo: Children play in Happy Valley, Cape Town, South Africa, 05 May 2016. Happy Valley in the greater Blue Downs area is one of the poorest communities on the Cape Flats an area dubbed the apartheid dumping ground. EPA/NIC BOTHMA

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Report: South African Health Review 2016 - 04/04/2016

The Health Systems Trust’s annual publication on health trends and topics in South Africa includes chapters on water and sanitation, eHealth, and sexual and reproductive health.

Health Systems TrustIn a forward by authors, the review notes that its 20 chapters largely reflect current trends in the global health and development agenda, including focuses on universal healthcare as well as good governance. The 369-page report is divided into four themes, namely leadership and governance, human resources for health, service delivery and information.

Now in its 19th edition, the review begins with the usual overview by University of KwaZulu-Natal’s Andy Gray and Yousuf Vawda of new heath policy and legislation. The pair notes that while the long-awaited National Health Insurance White Paper was released, related funding and policy issues have yet to be finalised. The book then goes on to discuss topics including the impact of climate change on water, sanitation and health before looking at the state of nutrition and non-communicable diseases. Chapters on breastfeeding, the eHealth MomConnect programme and the intersection between biomedical and traditional sectors all follow.

Notable chapters focus on the rights and health issues of sex workers in the wake of the South African National AIDS Council’s national sex work plan and financing South Africa’s HIV response.

Download the report: South African Health Review 2016

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Report: 2013 National Antenatal Sentinel HIV Prevalence Survey. 10/3/2016

Published by Health-e.

Conducted in 2013, the country’s latest antenatal survey finds an HIV prevalence rate of about 30 percent among pregnant women.

2013 National Antenatal Sentinel HIV Prevalence Survey South AfricaThe survey was conducted among about 33,000 first time antenatal clinic attendees in about 1,500 clinics. About 30 percent of pregnant women surveyed were living with HIV. The report notes that while this is a slight increase from HIV prevalence rates recorded in 2011 and 2012, this increase was not statistically significant.

The report notes that continued disparities in HIV prevalence rates among pregnant women persist. KwaZulu-Natal had an antenatal HIV prevalence rate of about 40 percent, which showed a three percentage point increase from the province’s 2012 antenatal survey.

Results for other provinces are as follows rounded to the nearest whole number:

  • Eastern Cape: 31%
  • Mpumalanga: 38%
  • North West: 28%
  • Free State: 30%
  • Northern Cape: 18%
  • Western Cape: 19%
  • Limpopo: 20%
  • Gautneg: 29%

In 2013, there were six districts in the country – five in KwaZulu-Natal and one in Mpumalanga – that recorded HIV prevalence rates above 40 percent. The highest prevalence in the country was recorded in iLembe, KwaZulu-Natal (45.9%). The other five districts recording HIV prevalence above 40.0 percent were as follows rounded to the nearest whole number:

  • UMkhanyakude, KwaZulu-Natal: 44%
  • eThekwini, KwaZulu-Natal: 41%
  • UMgungundlovu, KwaZulu-Natal: 43%
  • Ugu, KwaZulu-Natal: 41%
  • UThukela, KwaZulu-Natal: 40%
  • Gert Sibande, Mpumalanga at 41%

Download the report here.

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South African Child Gauge 2016. 12/2016


This year marks the coming of age of the Child Support Grant (CSG), established 18 years ago in 1998, now recognised as one of South Africa's most successful poverty alleviation strategies.

Contributors to the 2016 Child Gauge include academics, activists, members of civil society, government officials and representatives, and representatives from international development organisations.

To look back at the evolution of the grant - and tap into the now-substantial body of research and evidence that has been amassed around it - the Children's  Institute (CI), University of Cape Town, has dedicated its South African Child Gauge(r) 2016 to the theme of children and social assistance. The issue looks closely at the CSG and its impact on millions of impoverished children and their caregivers in South Africa.

In 2016, a total of 12 million children receive the CSG, exercising their Constitutional right to social security, through their caregivers.

Launched in Pretoria on 22 November, the South African Child Gauge 2016 is produced by the Children's Institute in partnership with UNICEF South Africa; the Programme to Support Pro-Poor Policy Development in the national Department of Planning, Monitoring and Evaluation; the DST-NRF Centre for Excellence in Human Development at the University of the Witwatersrand; and the FNB Fund. The Child Gauge is the CI's annual publication, reporting on progress towards the realisation of children's rights in South Africa.

The 2016 issue is the 11th Child Gauge and looks at how the CSG has benefited South Africa's children. It also reflects on challenges that remain as the grant matures into what is now a well-established element of social protection policy.

Children disproportionately affected by poverty

Children are among the hardest hit by poverty, and poor households bear the main


R360 per month - value of Child Support Grant (CSG) as of October 2016
11,972,900 - number of children receiving the CSG (March 2016)
Means test income threshold - maximum amount a caregiver can earn to be eligible for the CSG.

- R3,600 - per month for single caregiver

- R7,200 - per month for joint income of caregiver and spouse

 responsibility for looking after the greatest number of children. Almost two-thirds (63%) of the country's children live below the upper bound poverty line (R965 per person per month in 2015), and inequalities in access to quality services and opportunities still run along racial and spatial lines. So, for example, 41% of all African children - and 33% of Africans of all ages - live in the poorest 20% of households in the country. Children in the former homeland areas are the most adversely affected.

"High levels of inequality, unemployment and poverty mean that many people do not have the financial resources to provide for their children," notes Aislinn Delany, lead editor of the Child Gauge 2016.

(Below) 2014 values of Statistics South Africa poverty lines and grant benefits

SA Statistics Poverty Lines and Grant BenefitsChild income poverty is linked to adult unemployment, which stands at 27% but is estimated to be as high as 36% if discouraged work seekers are taken into account. As a result, a third of children in South Africa (30%, or 5.5 million) live in households where no adults are employed.

"A combination of historical factors, poor education and an increasingly knowledge-based economy means that many people are unable to find employment or those who have jobs earn low incomes," explains Mastoera Sadan of the Programme to Support Pro-poor Policy Development (PSPPD) in the national Department of Planning, Monitoring and Evaluation.

Child poverty carries long-term costs for both the individual child and society at large. Professor Linda Richter, of the DST-NRF Centre of Excellence in Human Development, points out that the average loss of adult income per year of young children growing up in poverty is estimated to be 26%, trapping individuals and their families in ongoing cycles of poverty. Social assistance - or material support provided by the state to those who are unable to support themselves - is therefore indispensable for children, especially during their first two years, the period of their most rapid brain and cognitive growth.

Benefits of the Child Support Grant

"The CSG is associated with improved nutrition, health and schooling among children," explains Alejandro Grinspun of UNICEF South Africa. So, for example:

  • The CSG enables households to increase spending on food and helps to reduce child hunger and improve child nutrition, with the strongest effects in poorer households.
  • The CSG has helped halve the share of children living below the food poverty line (the most severe measure of poverty), from 58% of children in 2003 to 30% in 2014. Children living in extreme poverty have benefitted the most.
  • The CSG is associated with improvements in schooling, including enrolment, progression and attainment.
  • The CSG has a protective effect in adolescence, and receipt of the CSG during early childhood is associated with reduced alcohol and drug use and delayed sexual debut among teenage girls.
  • The CSG also enables caregivers to seek employment by contributing to travel and child care costs.

"Targeting of the CSG has been so effective that its benefits accrue mostly to South Africa's poorest, and it is children living in extreme poverty who have gained the most from it," notes Grinspun.

With these benefits in mind, the CSG is clearly a crucial investment in children and the future. "In the face of persistently high unemployment, social grants - together with access to quality education, health and social services and other measures - support families to care for their children, and are a core component of broader social protection strategies to enable all children to realise their full potential," adds Delany.

Current gaps and challenges

Challenges remain for the system, however, points out Delany. Many eligible children - around 1.8 million - are still not accessing the grant, many of these are the neediest young children. Key barriers include difficulty in accessing the necessary documents for the grant application. There is also confusion around who qualifies for the grant, and the application process can be time-consuming and costly for low-income applicants. In addition, some beneficiaries complain of being treated with disrespect by officials. While the introduction of electronic payments has improved efficiencies, it comes with its own concerns, including exploitative sales and loans, and unauthorised deductions.

More critically, at R360 per month (or R12 a day), the Child Support Grant is in effect a very small amount. It falls below all three of the national poverty lines proposed by Statistics South Africa, including the food poverty line - a measure of extreme poverty valued at R415 (in 2015) that is only enough to cover a child's most basic daily food needs.

This means that, despite all its successes, the CSG can only do so much, says Sadan. "Its effects on reducing inequality are muted in the short term because of its low cash amount."

There are a few other gaps and shortcomings in the social assistance system. Take-up remains low among caregivers of infants under the age of one year, where the effects of poverty and poor nutrition have the greatest impact on children's survival and development. Once children reach 18 years, their access to social assistance ends as there are no grants for adults aged 18-59 (unless they qualify for a Disability Grant). In addition, the use of the complex Foster Child Grant (FCG), instead of the simple CSG, to alleviate poverty of orphans living in the care of relatives has led to an unmanageable overload of the child protection system. As a result, the majority of orphans cannot access the FCG and children who have been abused or neglected are not receiving quality protection services.

The way forward

It is clear from these challenges that it is necessary not only to consolidate the benefits of the CSG over the past 18 years, but also to maximise its impact. To this end, a number of proposals are currently under consideration. This, says the CI's Delany, would assist in realising children's rights to social assistance. "Any discussion of policy reforms must be underpinned by the constitutional imperative to progressively realise the right to social assistance for children in need."

Furthermore, social grants must be seen as part of integrated social services and interventions, say Leila Patel and Sophie Plagerson of the Centre for Social Development in Africa, University of Johannesburg. "The challenge remains to build on the CSG's positive outcomes without losing its coherence, to find the right mix of solutions that can enlarge individuals' economic and social opportunities, and to address the social exclusion still experienced by many CSG beneficiaries."

Sadan reiterates the central role of the grant as an investment in children and in the country as a whole. "Given widespread and persistent poverty and inequality in South Africa, the CSG is an investment in the development and potential of children," she says. "Together with investments in other services, social grants can build the resilience of children and their families with social and economic benefits to society in the long-run."


The South African Child Gauge 2016 is available online at

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South Africa 2012.

Published by MRC

Report: Second National Burden of Disease Study for South Africa: Cause of death profile.  

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South African Statistics - 2015

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The People Living With HIV Stigma Index: South Africa 2014. 5/2015

Published by STIGMAINDEX


What is stigma and discrimination?

Stigma and discrimination towards people living with HIV (PLHIV) are widely recognized as barriers to prevention, the provision of adequate health care, adequate psychological and social support, and appropriate medical treatments in South Africa. Stigma refers to the process of devaluing or discrediting individuals in the eyes of others.

Different types of stigma have been identified, such as: external stigma; internalized stigma; anticipated stigma and “courtesy stigma”.

Stigma cannot be understood without considering the following factors: poverty, gender - based violence, social inequality, local norms and attitudes.

Discrimination, follows stigma, and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status. 

You can access the resource here

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Report: District Health Barometer 2014/15. 22/10/2015

Published at Helath -e

20 October 2015

The annual publication by the Health Systems Trust charts the lowest mother-to-child HIV transmission rate yet as the percentage of babies born to women living with HIV who test positive for the virus at about six weeks falls to 1.5 percent.

The 713-page report charts a variety of health indicators across the country’s 52 health districts. This year’s report includes 12 new indicators including:DHB 2015

  • Mother postnatal visit within 6 days rate
  • Hypertension prevalence; and
  • School Grade 1 health screening coverage

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The Good, Bad and Ugly in District Health. 22/10/2015

Published at Health E News

Written by Kerry Cullinan

21 October 2015

Teen mothers face a difficult road

In the past year, over 90 percent of pregnant women with HIV started antiretroviral medicine – a leap of 15 percent in a year – and this helped to drive the mother-to-child HIV transmission to its lowest level ever, a mere 1,5 percent.

One in 14 births was to a girl under the age of 18, with a total of 71 583 teen pregnancies.

This was almost 2 500 lower than last year, with Johannesburg having the lowest teen pregnancy rate (4% of births) and the Eastern Cape’s Alfred Nzo District having the highest (12,8%).

There was a total of 964 901 births, 17 506 more than in 2013/14.

There has been a slight one percent decrease in the national maternal mortality rate (now 132.5 deaths per 100 000 live births). This is some way away from the national target of 100. Provincially, the Western Cape performed the best (54) while the Northern Cape was the worst (254).

There was also a slight improvement of less than one percent in stillbirths (20.7 deaths per 1 000 total births). Again, the Western Cape performed best (17.2) and the Northern Cape was worst (25.5)

The Eastern Cape’s OR Tambo and Alfred Nzo districts in the former Transkei were consistently poor performers, as they have been year after year. But two new delinquent districts have emerged with consistently poor indicators: Mopani (Phalaborwa) in Limpopo and Ehlanzeni (Nelspruit) in Mpumalanga.

More than 90 percent of pregnant women with HIV started ARVs and this helped to drive the mother-to-child HIV transmission to its lowest level ever, a mere 1,5 percent

Children under five were most likely to die of diarrhoea in OR Tambo (9.6% of cases), Mopani (7.9%) and Free State’s Mangaung (6,9%).

Meanwhile, pneumonia was most likely to kill pre-schoolers in Alfred Nzo (6.7% of cases), Ehlanzeni (6%) and Mopani (6%).

The Under Fives were most likely to die of malnutrition in Mpumalanga’s Gert Sibande (22% of cases), Free State’s Lejwelepuntswa (21,5%) and Mopani (21%).

Mpumalanga had the worst death rate for kids with malnutrition (19.1%) while the national fatality rate was 11.6 percent – much higher than the national target of 8 percent . The Western Cape was the only province that achieved the national target.

The TB cure rate has inched up by one percent to 76.8 percent. The Western Cape had the best cure rate (82.6%) and Limpopo had the worst (57.6%). Vhembe, Capricorn and Sekhukhune, all in Limpopo, had the lowest tuberculosis (TB) treatment rates.

TB patients were most likely to die in the Free State (11%) and least likely to die in the Western Cape (4%). Meanwhile, KwaZulu-Natal’s uMkhanyekude and Zululand districts had the worst rates of drug-resistant TB.

Some 90 percent of one-year-olds were immunised, with Gauteng recording the best rate and Mpumalanga, the lowest. – Health-e News.

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Report: South African Health Review. 21/10/2015

Published at Health-e News

20 October 2015

This year’s report begins with a review of health policy and legislation before moving to unpack facets of the country’s move towards National Health Insurance including the creation of District Clinical Specialists Teams as well as initiatives, like ideal clinic, that have accompanied the revitalisation of primary health care.

The report also includes chapters on eHealth, disability and rural rehabilitation as well as rural-proofing health budgets.

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A Comparison of South African National HIV Incidence Estimates: A Critical Appraisal of Different Methods. 11/08/2015

Published at plusone
Written by Thomas Rehle
31 July 2015


The interpretation of HIV prevalence trends is increasingly difficult as antiretroviral treatment programs expand. Reliable HIV incidence estimates are critical to monitoring transmission trends and guiding an effective national response to the epidemic.

Methods and Findings

 We used a range of methods to estimate HIV incidence in South Africa: (i) an incidence testing algorithm applying the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) in combination with antiretroviral drug and HIV viral load testing; (ii) a modelling technique based on the synthetic cohort principle; and (iii) two dynamic mathematical models, the EPP/Spectrum model package and the Thembisa model. Overall, the different incidence estimation methods were in broad agreement on HIV incidence estimates among persons aged 15-49 years in 2012. The assay-based method produced slightly higher estimates of incidence, 1.72% (95% CI 1.38 – 2.06), compared with the mathematical models, 1.47% (95% CI 1.23 – 1.72) in Thembisa and 1.52% (95% CI 1.43 – 1.62) in EPP/Spectrum, and slightly lower estimates of incidence compared to the synthetic cohort, 1.9% (95% CI 0.8 – 3.1) over the period from 2008 to 2012. Among youth aged 15-24 years, a declining trend in HIV incidence was estimated by all three mathematical estimation methods.


 The multi-method comparison showed similar levels and trends in HIV incidence and validated the estimates provided by the assay-based incidence testing algorithm. Our results confirm that South Africa is the country with the largest number of new HIV infections in the world, with about 1 000 new infections occurring each day among adults aged 15-49 years in 2012.

Incidence estimates provide critical insights into the dynamics of the HIV epidemic and are the most direct means of assessing the impact of HIV prevention programmes. The wide-scale implementation of prevention and treatment interventions means that, more than ever, real-time estimates of HIV incidence levels and trends are essential for evaluating the epidemic trajectory, to inform a more efficient and effective response to both the national and global HIV pandemic [1].

Southern Africa remains the region most severely affected by the HIV epidemic. With over six million people living with HIV/AIDS, South Africa has the largest population of HIV- infected individuals in the world, representing a quarter of the estimated HIV infections in sub-Saharan Africa [1]. It is therefore fitting that South Africa has implemented comprehensive national HIV surveillance efforts with the annual antenatal surveys and repeated national HIV household surveys as the core components for monitoring the HIV epidemic. Antenatal surveillance in South Africa has been carried out since 1990 [2] and there have been four large nationally representative household-based surveys, in 2002, 2005, 2008 and 2012 [3].

As the epidemic matured in South Africa and as access to antiretroviral treatment (ART) was rapidly scaled up in the period post-2004, the interpretation of HIV prevalence trends became increasingly complex. ART has increased the survival time of people living with HIV, with the result that HIV prevalence has increased. Hence, measuring ART coverage and estimating HIV incidence at the population level are critical to assessing the impact of treatment and prevention programs on HIV prevalence. Population-based survey methodology has advanced to address these evolving data needs in South Africa. The inclusion of novel laboratory methodologies in the survey protocol has enabled direct estimation of exposure to ART among HIV-positive individuals as well as direct assay-based HIV incidence measures from cross-sectional blood specimens [4]. The prevalence data from the repeated national HIV household surveys were also ideally suited to estimate HIV incidence using a mathematical approach [5].

Incidence assays, which can discriminate those who have been infected recently from others previously infected with HIV, can indicate recent changes in HIV incidence at a population level. Direct assay-based incidence measures using blood samples also provide incidence estimates by risk categories and for selected sub-populations. However, incidence estimation based on testing cross-sectional blood specimens is often established on relatively small numbers of persons that are classified as recently infected, which means that estimates so derived have large confidence intervals. Furthermore, incidence assays should be used in an algorithm where assay-recent specimens are further tested for additional markers such as ART exposure and HIV viral load, to exclude ‘false recent’ results [6, 7].

Mathematical models, such as the Estimates and Projection Package (EPP) / Spectrum [8, 9] and Thembisa [10], can also generate estimates of incidence by leveraging household survey data together with data from antenatal clinic surveillance and information on survival patterns of people living with HIV (and behaviours, in the case of Thembisa). However, there is a risk, in these models, that biases in the estimates can be introduced when certain assumptions do not hold, and as the method is based on using prevalence data, sudden changes in incidence will not be detected rapidly, since such changes only manifest in prevalence levels after a considerable delay. The incidence trajectory in the Spectrum model is fairly flexible, but irregular patterns in the scale-up of ART can induce severe deviations in the estimated incidence trend. Meanwhile, the incidence trajectory in Thembisa is constrained to follow a path dictated by the patterns of risk assumed, for which some reliance is placed upon a simplified scheme of sexual behaviour derived from self-reported data, which may be inaccurate [11]. Finally, simpler modelling techniques based on the synthetic cohort principle, which compare only age-specific prevalence levels at two points in time, can also be used to generate estimates of incidence [12, 13]. However, such methods also have to rely on many assumptions, especially in the era of ART, which leads to highly uncertain estimates and biases where relative levels of incidence across age-groups are not stable.

Each of these methods has different strengths and weaknesses, a synthesis of the different approaches can generate useful insights into the estimates of HIV incidence in a given setting, as well as revealing information about the performance of the methods. In this paper we compare the different methods to estimate HIV incidence in South Africa in order to arrive at an agreement on estimates of incidence. We also compared the performance of the different components of the assay-based incidence testing algorithm to assess the effect of antiretroviral drug testing and viral load testing on direct incidence measures in cross-sectional blood samples.


Ethics Statement

The survey protocols were approved by the Human Sciences Research Council’s Ethics Committee. All information collected from study participants was anonymized and de-identified prior to analysis. Written informed consent was obtained from study participants and only samples from individuals who consented to have their samples used for future research were used in the cross-sectional incidence testing investigation. The research was conducted according to the principles expressed in the Declaration of Helsinki.

Survey data

Our incidence estimation methods used nationally representative data collected in HIV household surveys conducted in South Africa in 2005, 2008, and 2012. The surveys applied a multi-stage stratified sampling design with data weighting procedures taking into account the complex sampling design and adjusting for HIV testing non-response. The surveys collected data not only on HIV status but also information on socio-demographic and behavioural characteristics of the South African population, for each sex, age group, race, locality type and province. The 2012 survey included testing for antiretroviral drugs and HIV incidence, providing direct estimates of age- and sex-specific ART exposure and new HIV infections in the South African population [3].

Direct HIV incidence estimates: HIV incidence testing algorithm

The detection of recent infections was performed on confirmed HIV-positive samples from survey respondents aged 2 years and older. Fig 1 shows the recent infection testing algorithm we applied for the 2012 HIV incidence estimation. The HIV incidence testing algorithm used the Limiting-Antigen Avidity Assay (LAg-Avidity EIA, Maxim Biomedical Inc., Rockville, MD, USA) with a cutoff normalized optical density (ODn) of 1.5 [14, 15] in combination with additional information on antiretroviral treatment exposure and HIV-1 RNA viral load (Abbott m2000 HIV Real-Time System, Abbott Molecular Inc, Des Plaines, IL, USA). The presence of the antiretroviral drugs Zidovudine, Nevirapine, Efavirenz, Lopinavir, Atazanavir and Darunavir was confirmed by means of High Performance Liquid Chromatography coupled to Tandem Mass Spectrometry; the limit of detection was set to 0.2 μg/ml for each of the drugs.

Fig 1. Testing algorithm for recent infection.

 The figure shows the multi-assay algorithm that was applied for the 2012 HIV incidence estimation on confirmed HIV-positive samples from individuals 2 years and older. The algorithm used the Limiting-Antigen Avidity assay (LAg-Avidity EIA) in combination with testing for antiretroviral drugs (ARV) and HIV-1 viral load (VL copies/mL).

2 758 HIV-positive samples were subjected to HIV incidence testing (Fig 1), 195 specimens were identified as LAg-Avidity EIA recent and 2 563 specimens were determined as non-recent infections. LAg-Avidity EIA recent specimens which tested positive for antiretroviral drugs (n = 96) were considered chronically infected individuals on treatment. Ten out of 99 LAg-Avidity EIA recent, ARV-negative specimens had an HIV viral load < 1 000 copies/ mL (LAg +/ARV-/VL<1 000) and were classified as long-term infections found in elite suppressors or in individuals maintaining a low viral load. Only 89 LAg-Avidity EIA recent, ARV-negative specimens with an HIV viral load > 1 000 copies/ mL (LAg +/ARV-/VL>1 000) were classified as recently-infected individuals in this multi-assay algorithm.

HIV incidence calculations were performed as proposed by the WHO Technical Working Group on HIV Incidence Assays [6, 16]. Incidence was calculated as an annual instantaneous rate. HIV incidence estimates were based on weighted samples to take into account the survey design and adjusted to account for specimens with missing LAg-Avidity EIA test results. Confidence intervals were computed applying a design effect (DEFT) of 2.0 [3]. The mean duration of recent infection (MDRI) was specified as 130 days in the incidence formula [15]. No adjustment factor for false recent results was applied to the incidence calculation based on this multi-assay testing algorithm.

Mathematically derived incidence from sequential household surveys

An existing method to estimate the average annual HIV-incidence rate in the interval between two surveys was used [12, 13]. A correction was applied that accounted for the effect of ART on HIV prevalence due to increased survival of HIV-infected persons [13, 5]. This required assumptions about the scale-up of ART [17, 18], mortality rates on ART [19] and the mean survival time without ART from the point of ART initiation [20]. A sigmoid time-trend was assumed for the latter, with mean survival increasing from between 0.8 and 1.8 years in 2005 to between 2.0 and 5.1 years in 2012. Bootstrapping was used to reflect sampling uncertainty in the prevalence measurements and parametric uncertainty in the ART correction procedure [21]. Point estimates were the means of the generated distributions and the intervals span the 2.5th to the 97.5th percentiles. Updates in assumptions about the impact of ART on survival and a fuller representation of uncertainties in the present method meant that estimates for the period 2005–2008 were slightly modified from earlier presentations [5].

EPP/Spectrum model

Incidence was estimated in Spectrum through the EPP model developed by East/West Center [8]. Briefly, HIV prevalence data from antenatal clinic surveillance was used to determine the trends in prevalence over time using a Bayesian melding statistical model [22, 23]. However since pregnant women attending antenatal clinics are not representative of the adult population, the level of the prevalence curve was determined by the household surveys. The household surveys also informed the shape of the prevalence curve. The model estimated incidence trajectories that were consistent with the prevalence data taking into consideration survival of people living with HIV (including whether or not they are receiving ART).

Thembisa model

Thembisa is a model of the South African HIV epidemic, described elsewhere [10]. Briefly, the model stratified the population by demographic characteristics (age and sex), sexual behaviour characteristics (marital status, risk group and sexual experience), engagement in HIV prevention programmes (history of HIV testing and male circumcision status) and HIV disease stage (HIV-positive individuals were stratified by CD4 count if untreated, and by baseline CD4 count and ART duration if treated). Assumptions regarding sexual behaviour and changes in behaviour over time were based on reviews of South African sexual behaviour data [24, 25], and assumptions regarding changes over time in HIV testing and ART uptake were based on reported rates of HIV testing [3] and reported numbers of ART patients [18]. The model was fitted to


age-specific HIV prevalence data from antenatal surveys and household surveys, as well as age-specific reported death data, using a Bayesian procedure. Parameters varied in the model fitting procedure included rates of partnership formation, probabilities of HIV transmission per act of sex, rates of HIV-related mortality and CD4 decline, and the percentage reduction in unprotected sex following an HIV-positive diagnosis.

A comparison of key model inputs and assumptions used by EPP/Spectrum and Thembisa is provided in Table 1.

Table 1. Comparison of EPP/Spectrum and Thembisa: Model inputs and assumptions for adult HIV incidence estimation.


Prevalence results from the 2005, 2008 and 2012 national HIV household surveys served as key input data to inform indirect model-based incidence estimation. Fig 2 shows the survey estimates of HIV prevalence trends by age group and survey year.


There was a significant decline in HIV prevalence among persons aged 15–24 years from 10.3% (95% CI 8.7–12.0) in 2005 to 7.1% (95% CI 6.2–8.1) in 2012 (p<0.001). In contrast, among persons aged 25–49 years, prevalence increased significantly from 20.0% (95% CI 18.2–21.9) in 2005 to 25.2% (95% CI 23.2–27.3) in 2012 (p<0.001).

Fig 2. HIV prevalence trends by age group and survey year, South Africa 2005–2012.

 HIV prevalence among youth aged 15–24 years and adults aged 25–49 years estimated in the years 2005, 2008 and 2012. Source: Human Science Research Council Surveys [3].

Level of HIV incidence by estimation method, 2011/2012

In Table 2, we compare national HIV incidence estimates by method. In addition, Fig 3 illustrates the main findings for 2012 by age group and estimation method. In 2012, we found no significant difference when we compared incidence generated by the assay-based approach, the synthetic cohort method, the Thembisa model and the EPP/Spectrum model. Assay-based HIV incidence was estimated at 1.72% (95% CI 1.38–2.06) for persons aged 15–49 years, but higher among


females (2.28%; 95% CI 1.84–2.74) compared to males (1.21%; 95% CI 0.97–1.45). The synthetic cohort approach estimated HIV incidence to be 1.9% (95% CI 0.8–3.1) in the same age-group for the inter-survey period 2008–2012, with a less substantial difference between females (2.1%; 95% CI 1.0–3.4) and males (1.6%; 95% CI 0.6–2.7).

Table 2. Comparison of South African national HIV incidence estimates, 2005–2012.

 2012 HIV incidence rates (males and females combined) for the age groups 15–49 years, 15–24 years and 25–49 years provided by the four different estimation methods (LAg-Avidity/ARV/VL, Synthetic cohort, EPP/Spectrum, Thembisa). The error bars show the 95% uncertainty interval.


Fig 3. HIV incidence by age group and estimation method, South Africa 2012.

The mathematical models produced similar results to one another for the age group 15–49 years. The Thembisa model estimated incidence at 1.47% (95% CI 1.23–1.72), with HIV incidence significantly higher among females (1.88%; 95% CI 1.48–2.28) than males (1.10%; 95% CI 0.84–1.36), while the EPP/Spectrum model estimated incidence at 1.52% (95% CI 1.43–1.62), and, similar to Thembisa, produced incidence estimates that were higher among females (1.78%; 95% CI 1.67–1.90) than males (1.29%; 95% CI 1.21–1.37).

Among young persons aged 15–24 years, incidence was similar by estimation method, ranging from as low as 1.49% (95% CI 1.21–1.88) using the assay-based approach to as high as 1.77% (95% CI 1.56–1.98%) using the Thembisa model. Similar trends were observed by sex among persons aged 15–24 years, with female incidence ranging from as low as 2.1% (95% CI 1.2–3.1) using the synthetic cohort to as high as 2.83% (95% CI 2.38–3.29) using the Thembisa model, and significantly higher than incidence for males which ranged from a low of 0.55% (95% CI 0.45–0.65) using the assay-based approach to a high of 1.0% (95% CI 0.4–1.6) using the synthetic cohort approach. In contrast, among persons aged 25–49 years, incidence differed considerably by estimation method, with lower estimates generated by the Thembisa (1.27%; 95% CI 0.93–1.63) and EPP/Spectrum models (1.42%; 95% CI 1.22–1.61) compared with the assay-based (1.87%; 95% CI 1.51–2.23) and synthetic cohort methods (2.1%; 95% CI 0.8–3.7).

Trends in HIV incidence by estimation method, 2005–2012

We observed different temporal trends in HIV incidence by estimation method between 2005 and 2012 for persons aged 15–49 years. Estimates generated by the synthetic cohort method indicate stable incidence: 1.9% (95% CI 0.8–3.3) between 2005 and 2008, and 1.9% (95% CI 0.8–3.1) between 2008 and 2012. Both the Thembisa and EPP/Spectrum models suggest a declining trend in HIV incidence between 2005 and 2012, with a percentage point (pts) change of -0.51% pts between 2005/2006 and 2011/2012 for the Thembisa model and -0.49% pts between 2005/2006 and 2011/2012 for the EPP/Spectrum model.

Among persons aged 15–24 years, a declining trend in HIV incidence was estimated by all three methods: the percentage point change was -0.80% pts between 2005–2008 and 2008–2012 for the synthetic cohort method; -0.30% pts between 2005/2006 and 2011/2012 for the Thembisa model; and -0.53% pts between 2005/2006 and 2011/2012 for the EPP/Spectrum model.

Among persons aged 25–49 years, we observed a similar pattern of declining incidence for the two mathematical models, with a percentage point change of −0.65% pts between 2005/2006 and 2011/2012 for the Thembisa model and -0.44% pts between 2005/2006 and 2011/2012 for the EPP/Spectrum model. This was not consistent with the synthetic cohort method, which produced a pattern suggestive of increasing incidence over time, with a percent change of +0.60% pts between 2005–2008 and 2008–2012.

Performance of incidence testing algorithm by testing component

Table 3 compares the performance of the different components of the multi-assay recent infection testing algorithm we used for direct HIV incidence estimation. The 3-assay algorithm consisting of the LAg–Avidity assay in combination with antiretroviral drug testing and viral load testing estimated an incidence rate of 1.72% in the 15–49 years age group, with a zero false recent rate (FRR) assumed (see discussion for explanatory comments). When used in a single-assay format, the LAg–Avidity assay provided an incidence estimate of 3.58% for the same age group, which would require a FRR of 3.10% to be included in the incidence calculation in order to reproduce the incidence estimated by the 3-assay algorithm (LAg/ARV/VL). The LAg–Avidity assay in combination with antiretroviral drug testing (LAg/ARV) estimated an HIV incidence of 1.98% compared to 2.24% estimated by the Lag—Avidity assay in combination with viral load testing (LAg/VL). The computedthumbnail false recent rates associated with these testing components, 0.40% for LAg/ARV and 0.86% for LAg/VL (assuming zero FRR for the 3-assay algorithm), are substantially smaller than the FRR of 3.1% found with the performance of the LAg–Avidity assay alone.

Table 3. Assay- based HIV incidence and FRR by testing component, South Africa 2012.


Given the evolving field of HIV incidence estimation and limitations of current methods for estimating incidence, our results suggest that a synthesis of multiple methods for estimating incidence in the same population is helpful in producing robust estimates of national HIV incidence levels and trends. More confidence can be placed in such results, as opposed to relying on findings from individual methods alone [26]. In the era of rapidly expanding antiretroviral treatment programs, HIV incidence estimation among different age groups is difficult but nevertheless critical for assessing the changing age-specific pattern of HIV prevalence.

Overall, the different incidence estimation methods were in remarkable agreement on 2012 HIV incidence estimates among persons aged 15–49 years. Though the direct assay-based method produced slightly higher estimates of incidence compared with mathematical models and slightly lower estimates of incidence compared to the synthetic cohort, the multi-method comparison shows similar levels and trends in HIV incidence, validating the results of the incidence testing algorithm and highlighting its utility in estimating incidence in cross-sectional settings.

There has been substantial progress over the past decade in the development and evaluation of HIV incidence assays [14, 27]. The LAg-Avidity EIA, used in an algorithm where assay-recent specimens are further tested for HIV RNA levels and for the presence of antiretroviral drugs, is currently the recommended approach to classify recent infections [28]. Our analysis of the performance of the different components of the incidence testing algorithm confirms the utility of testing for ART exposure and viral load to correct for the main sources of false recent misclassifications [29]. We have also demonstrated the relatively poor performance of the LAg-Avidity assay if applied in a single-assay format, requiring a false recent rate correction of 3.1% to reproduce the incidence estimate provided by the full algorithm. Out of 195 LAg-Avidity assay-recent specimens, 106 (54.4%) were re-classified as non-recent infections after testing for antiretroviral treatment exposure and viral load. This algorithm can be performed using dried blot spot (DBS) specimens, which is an important advantage in large population-based surveys [15]. The use of self-report of ART exposure in an incidence testing algorithm may be highly unreliable, as has been shown by several studies [30, 31, 32].

Based on the latest recalibration of the LAg-Avidity EIA in different HIV-1 subtypes, we applied a normalized optical density (ODn) cutoff of 1.5 and the corresponding mean duration of recent infection of 130 days for the incidence estimation [15]. Our assay-based HIV incidence estimates seem to confirm the validity of the selected parameters in the incidence calculation. A recently published assessment by the Consortium for the Evaluation and Performance of HIV incidence Assays (CEPHIA) proposed an alternative MDRI of 177 days and a false recent rate of 1.3% for the LAg-Avidity EIA (1.5 ODn cutoff) in subtype C specimens which excluded treated subjects and elite controllers [33]. However, applying those parameters in the incidence calculation based on our testing algorithm would have resulted in a change of the incidence estimate from 1.72% (95% CI 1.38–2.06) to 0.66% (95% CI 0.04–1.28) in the 15–49 year age group—an estimate that is not supported by any of the epidemiological/mathematical models. A recent revision by the CEPHIA group suggested a MDRI of 140 days and a FRR between 0% and 0.5% for an algorithm that assessed the LAg-Avidity EIA (1.5 ODn cutoff) in combination with a viral load threshold of ≥ 1000 copies/ml [34]. This parameter setup would have produced incidence rates more in agreement with our results, with estimates varying from 1.31% to 1.60%.

We did not include a false recent rate in our incidence calculation, relying on the correction of potential “false recent” results by means of additional testing for antiretroviral drugs and viral load in LAg-Avidity EIA recent specimens. Incidence testing algorithms of this type can reduce the false recent rate to almost zero, as has been demonstrated in samples from individuals in the United States [35]. Although the debate has focused so far on the potential false recent rate, we may also have to consider potential ‘false long-term’ misclassifications associated with this testing algorithm. HIV seroconverters who have been exposed to early treatment may be misclassified as chronically infected individuals on ART, e.g. recently infected pregnant women enrolled in prevention of mother-to-child-transmission (PMTCT) programs or persons on post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) regimens [36]. However, the extent of these potential misclassifications in the context of the 2012 national household survey was most likely extremely small. Finally, we should note that antibody-based screening assays are unable to detect acute HIV infections in the pre-seroconversion window. In the recently conducted national household survey in Swaziland, 13 (0.1%) of the 12 338 HIV antibody-negative specimens were identified as HIV RNA positive recent infections [37]. Based on these considerations discussed above we decided not to apply a correction factor to the multi-assay algorithm-derived 2012 HIV incidence estimates at this point in time.

Two mathematical models produced consistent estimates of HIV incidence level and trend, despite important differences in model assumptions and calibration procedures. While the EPP/Spectrum model allows a fair degree of flexibility in the estimation of HIV incidence trends, the Thembisa model estimates of HIV incidence are to some extent constrained by assumptions about trends in sexual behavior. The models also differ in their assumptions regarding ART rollout, with Thembisa assuming greater ART uptake and estimating a greater reduction in AIDS mortality due to ART. While the Thembisa model is calibrated to age-specific HIV prevalence data and recorded death data, the EPP/Spectrum model is calibrated to HIV prevalence data for the entire 15–49 age group. Since HIV prevalence data are not disaggregated by age groups in the model, EPP/Spectrum is not able to capture a scenario in which the incidence trend for 15–24 year olds is different from the trend observed in 25–49 year olds. A future step will be for the models to use age-specific data in their inference of epidemic trends.

All incidence estimation methods produced similar estimates for 15–24 year olds, and were consistent in their estimates of trends. In the population aged 25–49 years, however, the discrepancies between modelled estimates and the 2012 survey-based estimates are more evident. The Thembisa model may have overestimated treatment exposure among older adults aged 25–49 years and, as a result, overestimated the impact of ART on HIV incidence reduction in this age group. In the Thembisa model, 40.6% of HIV-positive adults aged 25–49 were estimated to be on ART in 2012 compared to 31.2% treatment exposure measured in the HIV-positive blood samples [3].

While important differences were observed in HIV incidence levels by sex, age, and time in our analysis, the wide confidence intervals around the incidence estimates suggest that these differences should be interpreted with caution. The synthetic cohort model appears to produce more uncertain estimates than other modelling approaches. This is because the method is unconstrained—i.e. the incidence pattern estimated from the HIV prevalence data does not have to be consistent with any theory or hypothesis about epidemic dynamics. The synthetic cohort approach is more sensitive to sampling errors or other aberrations in the data compared to the mathematical models, which are constrained to follow smooth changes over time or changes that are consistent with an underlying theory of epidemic dynamics. For example, if the previous survey in 2008 slightly underestimated adult HIV prevalence compared to the results obtained by the more representative 2012 survey design, the underestimate would particularly affect the synthetic cohort approach. The incidence estimate among persons aged 15–49 years produced by this method would be 1.5% instead of 1.9% if the bias in the 2008 prevalence estimate was about one percentage point overall and uniform by age and sex. Moreover, many assumptions required by this method are not readily identifiable from the input data, meaning that uncertainties, especially about ART, are propagated to the results.

Our results confirm that South Africa ranks first in the world in the annual number of new HIV infections [1]. The HIV incidence rates presented in this analysis suggest that about 1 000 new infections occurred each day among South Africans aged 15–49 years in 2012. Although the declining trend in HIV incidence between 2005 and 2012 observed among young adults aged 15–24 years is encouraging, the incidence rates still remain at unacceptably high levels, especially among female youth. The current National Strategic Plan on HIV, STIs and TB 2012–2016 states as its primary goal a reduction in new infections of at least 50% [38]. This would require a reduction in HIV incidence well below the 1% level among persons aged 15–49 years by 2016—a considerable challenge given the transmission dynamics that still prevail in the country. The 2012 survey findings indicated that there was a drop in condom use at last sex, an increase in the proportion of people reporting multiple sexual partners, and an increase in the proportion of young women reporting age-disparate relationships [3]. South Africa needs to balance treatment and prevention with a strong focus on the reduction of new HIV infections in the sexually active population.


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Children’s Institute: The Child Gauge 2015 Report

 The South African Child Gauge® is an annual publication of the Children's Institute, University of Cape Town. It aims to report on and monitor the situation of children in South Africa, in particularly the realisation of their rights. The publication focuses on a different theme each year.

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South African Statistics - 2014

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HIV Goes Up, Condom Use Goes Down. 2/4/2014

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South African National HIV Prevalence, Incidence and Behaviour Survey, 2012

Published by HSRC Press
First published 2014
ISBN (soft cover) 978–0-7969–2455-1
ISBN (pdf) 978–0-7969–2456-8
© 2014 Human Sciences Research Council
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South African Statistics - 2013

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Healing the South African Family 30/10/2013

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A Research paper by the South African Institute of Race Relations sponsored by the Donaldson Trust

March 2011

By Lucy Holborn

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South African Statistics - 2012

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Key Findings of the Third South African National HIV Communication Survey, 2012

The 3rd South African National HIV Communication Survey (NCS) results, released at the XIX International AIDS Conference in Washington, D.C., revealed new data that show substantial increases in behaviors that reduce the risk of HIV: condom use, HIV counseling and testing and voluntary medical male circumcision. The data also confirm that exposure to HIV communication programs have a direct impact on people practicing these behaviors.

Download the Key Findings Report in PDF (491.75 KB)

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SA PMTCT Evaluation Shows that Virtual Elimination of Paediatric HIV is Possible with Intensified Effort. 9/6/12

South African PMTCT programme at six weeks postpartum show that out of a sample size of 9915 infants, 31,4% were HIV-exposed

9 June 2012


Study results from a national survey, conducted between June to December 2010, to evaluate the effectiveness of the South African Prevention of Mother To Child Transmission (SA PMTCT) programme at six weeks postpartum show that out of a sample size of 9915 infants, 31,4% were HIV-exposed. The national HIV transmission rate from mother-to-child, measured in these 9915 infants aged 4-8 weeks attending public sector clinics for their (six week DTaP/Pentaxim) immunisation was 3.5%.

This survey was conducted by the Health Systems Research Unit of the Medical Research Council on behalf of the National Department of Health and several other role players including CDC (technical and financial support), Unicef (financial support for the data collection technology), NCID/NHLS, Wits Infant HIV Diagnostics and UWC.

The table below shows the rates of infant HIV-exposure and HIV transmission from mother-to-child transmission measured at 4-8 weeks post-delivery, by province.

(Analysis on 9915 completed interviews with DBS results)


Researchers visited 580 facilities across South Africa. Interviews were conducted with consenting caregivers of infants aged 4-8 weeks and dried blood spots (DBS) were collected from enrolled consented infants. DBS were tested for HIV-exposure using ELISA to detect maternal antibody. ELISA positive DBS were then tested for DNA PCR to detect HIV transmission. All infant test results were returned to mothers by the routine health care system and HIV-infected infants were fast-tracked into care. All mothers were encouraged to access HIV counselling and testing services.

“This survey was the first ever rigorous national SA PMTCT evaluation in the nine provinces of South Africa,” said Dr Ameena Goga, MRC, as she spoke on behalf of the survey principal investigators (Dr Goga – MRC; Prof Jackson – UWC and Dr Dinh – CDC) and collaborators. “The survey highlighted the acceptability of routine infant HIV testing once the advantages were explained” said Professor Jackson (UWC).”92% of eligible caregivers agreed to their infants being tested for HIV”. Dr Dinh (CDC) highlighted the fact that 4.1% of infants whose mothers reported being HIV negative were actually exposed to HIV, highlighting the need to strengthen repeat testing in pregnancy and couple testing.

The survey also highlighted gaps in postnatal care and infant follow-up” said Dr Goga, MRC. “This emphasises the importance of tracking MTCT rates until 18 months to measure the effectiveness of the complete PMTCT programme. In 2010 the SAPMTCT Evaluation only measured the effectiveness of the antenatal and intrapartum components of the PMTCT programme. Our sample size was calculated to obtain valid national and provincial level MTCT estimates at 4-8 weeks post-delivery”, said Dr Goga.  “In 2011 and 2012 we plan to repeat the PMTCT Evaluation so that we can track MTCT rates over 3 years. However we will also follow-up infants so that we can also measure HIV transmission rates between six week and 18 months.”

In 2010 the South African government revised the PMTCT guidelines to include AZT from 14 weeks, HAART for all pregnant women with CD4 cell counts less than or equal to 350 and infant nevirapine prophylaxis for six weeks (if mum on HAART or not breastfeeding) or throughout the breastfeeding period. Furthermore the PMTCT guidelines promote the integration of PMTCT services into routine maternal, newborn, and child health services.  The PMTCT Evaluation provides data to track the operational effectiveness of the revised guidelines.

Dr Goga mentioned that the SAPMTCTE data shows that virtual elimination of paediatric HIV could be possible by 2015, with intensified effort. However, we need to address the postnatal component and variabilities in PMTCT service coverage.” She added that:” Reduction in MTCT will contribute towards reduction of incident HIV infections at population level.”

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National Antenatal Sentinel HIV & Syphilis Prevalence Survey Data for the year 2011.

The Minister of Health, Dr Aaron Motsoaledi on Monday (10/12/2012) released the National Antenatal Sentinel HIV & Syphilis Prevalence Survey data for the year 2011.

The antenatal sentinel HIV and Syphilis prevalence survey is conducted annually by the Department of Health to map the epidemic and monitor HIV infection trends amongst pregnant women who attend and consult at antenatal clinics in the public sector.

The three main objectives of the survey are:

· Determine estimates of HIV and syphilis prevalence among pregnant women who come to the antenatal clinic for the first time,
· Describe HIV and syphilis trends in respect of time, location and age among pregnant women.
· Determine the estimate of HIV infection in the general population through modelling.
Highlights from the report include the following:
  • KwaZula-Natal has recorded a notable decrease in HIV prevalence which is promising, whereas Mpumalanga has recorded an increase in the past four years which is worrisome.2.1% decline in HIV prevalence in KZN, Mpumalanga increase in estimated HIV  prevalence of 2.0%
  • According to the UNAIDS SPECTRUM model the estimated national HIV prevalence among the general adult population aged 15-49 years old has remained stable at around 17.3% since 2005.
  • In 2011, an estimated 5,600 000 [5 300 000-5 900 000] people living with HIV resided in South Africa.
  • The estimated number of new infections was 1.43% in 2011 compared to 1.63% new infections in 2008.

You can download the full report here

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South African Statistics - 2011

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HCT Campaign: The Numbers so Far. Living with AIDS # 478. 30/6/11

More people than expected have tested HIV-positive in the national HIV Counselling and Testing (HCT) campaign.


By Khopotso Bodibe
30 June 2011

More people than expected have tested HIV-positive in the national HIV Counselling and Testing (HCT) campaign.

When the campaign was launched in April last year, it was expected that about 1.6 million or 11% of the 15 million South Africans targeted for HIV testing, would come out HIV-positive. The projection was based on the national HIV prevalence level of 11%. But of the 10.2 million people who tested in the national HIV Counselling and Testing (HCT) campaign, about 17 – 18% or round about 1.7 million people were found to be having HIV infection. While figures vary from province to province, Mpumalanga is leading in the preliminary data, says Dr Thobile Mbengashe, Chief Director of the HIV and AIDS and STIs programme in the national Health Department.

“What we know now is that the national average of people who were positive was about 17% - 18% of the total number that have been tested. The results of the campaign itself concurred with the results that we’ve been getting on the annual antenatal survey, which actually shows where the biggest burden of the disease in relation to the provinces is and the districts. Mpumalanga was slightly more than we expected at around 24%, KwaZulu-Natal was about 22%, Gauteng was the third largest and, then, we had a number of provinces which were consistently low in terms of the number of people testing positive… that’s Western Cape, Northern Cape. And, co-incidentally, Eastern Cape and Limpopo were actually more or less below the national average”, Dr Mbengashe says.

Preliminary figures show that over 12 million South Africans have been counselled for HIV since April last year when President Zuma and the Health Minister launched the national HIV Counselling and Testing campaign. Of these 12 million people, about 85% or 10.2 million have accepted the HIV test after counselling. This means that the department is almost 5 million under its target.   

“When the target of 15 million people was set, that was an extremely ambitious target”, Mark Heywood, deputy chairperson of the South African National Council (SANAC), which co-ordinates the HCT campaign, admits.

“I don’t think there is any parallel in the history of the global response to HIV where so many people have been offered HIV testing and so many people have been tested for HIV within such a fixed period of time. Although we may not have met 100% of the target for testing, I think that what has been achieved must be celebrated”, he adds.

“In many instances, the quality of the counseling and testing itself could have had an impact. Secondly, the demand for testing – the long queues and the time it actually takes… it takes about 30 – 45 minutes to go through the process… Most people would not have been able to do that. I think it’s also very true that there is a fear of the results of the test. People are very afraid to know the result. Some people were not ready. They exercised their right not to take the test”, says Dr Mbengashe, explaining why 15% of South Africans who were offered the HIV test did not accept it.

SANAC’s Mark Heywood finds it hard to understand why anyone wouldn’t want to know their HIV status.   

“It raises the question why anybody at this point in time in our country would decide not to test because the message we’re trying to get out is that we all need to know our HIV status - that it is the best thing to know whether you’re negative or whether you are positive because whether you are negative or positive there are steps that you can take to protect and to preserve your health because part of this campaign is about: How can we get ahead of the HIV epidemic? In the past we’ve always lagged far, far, far behind the epidemic. One way to get ahead of the epidemic is to normalise HIV testing; it’s to use HIV testing as a way to try to begin to break down the stigma around HIV; and it’s to use HIV testing to try to get much larger numbers of people onto treatment”, he says.

However, Heywood believes that the campaign has started a revolution.

“In the course of just over a year – 15 months – this HCT campaign has begun a revolution in our response to HIV in this country. The challenge now is to continue with the campaign into the next National Strategic Plan. Also, the challenge is to identify what have been the weaknesses, what have been the problems with this campaign, but also fix them as rapidly as possible”.

It is not clear when the final results of the HCT campaign will be released. But what is certain is that the campaign will continue after the June deadline so as to encourage as many South Africans as possible to find out their HIV status.

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S.Africa's HIV Infections Fall to 5.4 Million: Government. 26/8/11

The number of people living with HIV in South Africa has dropped slightly to 5.38 million

26 August 2011

Johannesburg — The number of people living with HIV in South Africa has dropped slightly to 5.38 million, and the number of AIDS deaths is finally starting to fall, Deputy President Kgalema Motlanthe said Thursday.

South Africa has more HIV infections than any country in the world, previously estimated at 5.6 million by the United Nations in its global report on HIV in 2009, released late last year.

"South Africa has invested a large amount of resources into its HIV response," Motlanthe said in a written reply to a question from parliament, where lawmakers had asked for an update on the success of the anti-AIDS fight.

"The number of deaths due to HIV-related causes is beginning to show a decline due to the intensification of anti-retroviral treatment."

He said government statistics place South Africa's HIV infection rate at 10.6 percent of the overall population of 50 million people, with 16.6 percent of 15- to 29-year-olds infected.

Among pregnant women, the infection rate stands at just below 30 percent, Motlanthe said. But he added that transmission of the infection from expecting mothers to their babies has fallen from 10 percent to 3.5 percent in the last three years.

Motlanthe said the government is still struggling to reduce the number of new infections.

"The rate of new infections continues to outpace our prevention efforts, and thus prevention programmes will be prioritised in the new national strategic plan which is being developed for the term 2012 to 2016," he said.

Motlanthe's response came several weeks after the end of a massive testing campaign that reached nearly 14 million people, two million of whom tested positive.

It also came on the heels of an announcement by the government that it will provide potentially life-saving anti-retroviral (ARV) drugs to all HIV patients whose CD4 count, a measure of white blood cells, falls below 350 cells per microlitre.

Previously the drugs were only handed out when the count hit 200 cells per microlitre, but studies have found earlier treatment can save people's lives.

South Africa has the largest ARV drug programme in the world, with some 1.3 million people receiving treatment.


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South African Statistics - 2010

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HIV Rate Stabilizes In Pregnant Women. 2010/11/12

Kerry Cullinan


Although the HIV prevalence rate for pregnant women has been virtually the same over the past four years at 29.2%, this was still a “high and unacceptable” level.

Download the National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa, 2009. (PDF. 2.10MB)

This is according to Health Minister Dr Aaron Motsoaledi, who released the country’s 20th antenatal HIV survey in Johannesburg yesterday.

The biggest increase in HIV was among women aged 35 to 39, where there was a jump of 6% to 35.5% but researchers say this does not indicate that more women of this age were getting infected but rather that women infected earlier are surviving for longer because they are on antiretroviral medication.

KwaZulu-Natal fared worst in the country again, with close on four out of 10 pregnant women (39.5%) infected with HIV, while nine of the 10 districts with the worst HIV rates were in KwaZulu-Natal.

The worst affected district in the country is uThukela where 46.4% of pregnant women had HIV, while the safest place is Namaqua in the Northern Cape, which had no HIV positive pregnant women.

Gauteng showed no increase over last year with almost a three out of 10 women testing HIV positive, although there was an alarming 8% increase in HIV in Metsweding. Women in Ekurhuleni have the highest HIV rate (34%) followed by Metsweding with a prevalence of 33.3%.

The Eastern Cape, Limpopo, Northern Cape, KwaZulu-Natal, and Western Cape all recorded slight increases in HIV infection.

However, the Free State, Mpumalanga and the North West recorded slight decreases in HIV.

Over 32 000 pregnant women were tested at all 52 districts countrywide, and 30% of districts recorded HIV prevalence levels of over 30%.

While he acknowledged the enormity of the task, Motsoaledi said it was “encouraging to note the renewed commitment of our government and political will to face the epidemic” and that “an additional R5.4 billion has been committed to support scale up of the ART treatment programme in the 2010-11 financial year”.

Meanwhile, the Democratic Alliance’s Mike Waters welcomed the “much-delayed release of the annual HIV Antenatal Clinic Survey”.

“It suggests that the HIV epidemic in South Africa is stabilizing, with the number of pregnant women infected with HIV now standing at an estimated 29.2%, compared to 30.2% in 2005,” said Waters.

He noted that the DA had submitted a Promotion of Access to Information Act (PAIA) application for this report, which was due to expire on Sunday.

“This report has been released later and later every year, making the information outdated by the time it is released. As a result we have on three previous occasions submitted PAIA applications for its release,” said Waters.

The Health Department only gave notice on Wednesday night that it was due to release the report yesterday.

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No Change in HIV Rate among Pregnant Women. 12/11/10

About 29 percent of South African pregnant women were living with HIV in 2009

12 November 2010

Johannesburg - About 29 percent of South African pregnant women were living with HIV in 2009 - a figure that has barely shifted over the past four years, despite increased levels of commitment from the country’s health department and numerous prevention campaigns.

Based on blood samples from nearly 33,000 pregnant women in all 52 health districts, HIV prevalence was estimated at 29.4 percent, against 29.3 percent in 2008 and 29.4 percent in 2007.

Prevalence among 15-24 year-olds also remained the same as in 2008 at 21.7 percent. Also following the trend of previous surveys, prevalence among older women continued to increase. In 2009, an estimated 41.5 percent of pregnant women aged 30 to 34 were living with HIV, up from 40.4 percent in 2008 and 39.6 percent in 2007. In the 35-39 age group, prevalence increased by 6 percent over four years to reach 35.4 percent in 2009.

The survey authors point out that “most, if not all of the increases in recent years can be attributed to the increase in survival of those on ARVs [antiretroviral drugs]”.

In introducing the results on 11 November, South African Health Minister Aaron Motsoaledi focused on the positives: “The renewed commitment of our government and political will to face the epidemic squarely” and the additional R5.4 billion (US$77 million) committed to scaling up ARV treatment in the 2010-11 financial year.

Prevention challenge

Speaking at the HIV/AIDS in the Workplace Research Conference in Johannesburg on 9 November, Mark Heywood, deputy head of the South African National AIDS Council and a veteran AIDS activist, welcomed the steps Motsoaledi’s department had taken in 2010 to combat the epidemic through “a swathe of policy reform on HIV”, including implementation of a male circumcision policy, the introduction of better ARV drugs and the launch of a national HIV counselling and testing campaign that aims to reach 15 million South Africans.

“The one area where we continue to be fundamentally challenged, where it's hard to point to change or success, is in the area of prevention,” he said, adding that the new antenatal survey results “don’t show significant improvement in outcomes – in parts of the country, incidence is still rising”.

KwaZulu-Natal Province in particular has recorded a steady climb in infection rates, with 39.5 percent of pregnant women testing positive in 2009 against 38.7 percent in 2008. All five health districts with the highest HIV prevalence in the country were in KwaZulu-Natal, the worst affected being uThukela district, where 46.4 percent of pregnant women were HIV-infected.

In contrast, the Western Cape had a prevalence of 16.9 percent and zero infections were found among pregnant women in the Northern Cape district of Namaqua.

Risk factors

Echoing a recommendation made in the 2008 survey, the authors describe the "crucial" need for the health department to carry out epidemiological surveys in high prevalence and low prevalence districts "in order to investigate potential risk factors that drive the epidemic".

South Africa's HIV prevalence for the general population in 2009 was estimated at 17.8 percent by UNAIDS, equivalent to 5.63 million HIV-positive adults and children.

Motsoaledi identified South Africa as one of many countries in sub-Saharan Africa with a generalized epidemic that has stabilized in the past four years, "albeit at high and unacceptable levels". But, according to UNAIDS, several countries in the region have started to see substantial declines in HIV prevalence, most notably Zimbabwe, where national adult HIV prevalence has steadily decreased from a high of nearly 26 percent in 2002 to 13.7 percent in 2009.


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South Africa: Child Deaths Stubbornly High. 27/7/10

South Africa is unlikely to reduce its burden of deaths in children under five for MDG's

27 July 2010

Johannesburg — The race to meet the Millennium Development Goals (MDG) by 2015 is more than halfway run, but new reports say South Africa is unlikely to reduce its burden of deaths in children under five in time to cross the finish line.

A report by Countdown to 2015, an international group monitoring maternal and child health, has singled out South Africa as one of the countries that has made almost no progress in the last decade in bringing down deaths among children under the age of five.

Although infant deaths have declined by 20 percent since 2001, they remain high, with 47 out of every 1,000 babies dying before they are one year old.

In its latest report the group said that if South Africa is to meet MDG 4 - a two-thirds drop in under-five mortality by 2015 - it would have to almost halve deaths among children in the next five years. So far, child deaths have declined by less than one percent annually, with 46 percent caused by AIDS-related illnesses.

Recent estimates by Statistics South Africa (Stats SA), a government agency, reveal that 43 percent of all deaths are AIDS-related. The country has an HIV prevalence of about 18 percent, and has long struggled with high maternal and child mortality.

Stats SA, which has increasingly included HIV figures as part of its general population monitoring, also estimated that 410,000 South Africans would be newly infected with HIV in 2010, and that 10 percent of them would be children.

Former South African health minister Dr Manto Tshabalala-Msimang instituted audits into maternal and newborn infant deaths at public health facilities, a move the Countdown report lauded as helping to provide national health departments with the information they need to address specific problems.

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HIV Incidence in South Africa: What is Really Happening? 6/7/10

There is supporting evidence that HIV incidence in South Africa may be decreasing, albeit that it remains very high

Treatment Action Campaign
6 July 2010

HIV incidence is the measure of how many new HIV infections there are over a period of time. Measuring changes in HIV incidence is key to evaluating the effectiveness of prevention interventions – including the provision of antiretroviral treatment (ART), which has been shown to reduce transmission – as well as for quantifying the need for future services, which is important for planning and budgeting. One of the targets of South Africa’s HIV National Strategic Plan is to reduce HIV incidence by half from 2007 to 2011.

HIV prevalence, on the other hand, is the proportion of the population that is living with HIV at a given point in time, regardless of when they were infected. Therefore, prevalence is influenced by the incidence (the number of new cases) and the length of time that people with HIV live. HIV prevalence will increase as availability of ART increases since people with HIV taking ART live for longer, and will decrease as people with HIV die. To understand how the HIV epidemic is progressing and how well our prevention and treatment programmes are working, we need to know about changes in incidence.

The Human Sciences Research Council (HSRC) has published an article that shows no statistically significant decline in incidence in people aged 15 to 49 from 2005 to 2008 compared to the period 2002 to 2005. However it does show a significant decline in HIV incidence in women aged 15 to 24 over these same periods. The HSRC paper highlights the importance of measuring HIV incidence and encourages further research and dialogue on the reasons why HIV incidence may be decreasing .

There is supporting evidence that HIV incidence in South Africa may be decreasing, albeit that it remains very high. Mathematical models that have been based on measurements of HIV prevalence over time show that HIV incidence peaked in 1999 and has declined since then . Various factors may have contributed to this decline, such as the epidemic hitting its natural peak, the impact of ARV scale-up (about 1 million people have initiated treatment in South Africa) and/or prevention efforts focused on behaviour change (there is evidence that condom use is increasing) . However, the contribution of these and other factors is speculative and more research is needed to understand this better.

Measuring incidence is difficult, particularly in South Africa which has historically faced challenges with collecting reliable data of the number people living with HIV and the number of people on treatment. This has cast doubts over the accuracy of prevalence measures in the past, which in turn casts doubts over the accuracy of incidence estimates when they are calculated from prevalence as is done in the HSRC article. More robust collection and analysis of data by government, in collaboration with academic and non-governmental institutions, is of critical importance – not only for monitoring incidence trends, but also for understanding the reasons behind changes in these trends.

More research is necessary to demonstrate the impact of scaling up treatment and prevention interventions, as well as to guide policy and funding decisions in future. A decline in incidence does not mean that the HIV crisis is over – rather, it would suggest either a natural progression of the epidemic or that the investment in treatment and prevention is paying off and needs to be sustained and increased in future if continued progress is to be seen. Given the evidence that treatment reduces sexual and vertical transmission of HIV, the funding cuts by international donors that have threatened the sustainability of ARV programmes will not only affect the health and lives of people living with HIV, but threaten to reverse the welcome trends in incidence that we are now beginning to see.

We call for more research and improved data management to strengthen the underlying assumptions and measurements on which national incidence calculations are based, as well as to improve the analysis of factors that contribute to changes in incidence.

We also call for the HSRC to make the data from the three National HIV Behaviour and Health Surveys publicly available so we can work together on understanding the epidemic as it changes, and on identifying and strengthening the interventions that are shown to have the greatest impact on preventing new infections.

Review of A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008


The HSRC authors used a technique based on a relatively new mathematical methodology to calculate HIV incidence. While the mathematics is complex, the underlying concepts are not too difficult to understand.

The HSRC conducted country-wide surveys in 2002, 2005 and 2008. These surveys measured HIV prevalence. HIV prevalence is the proportion of the population that is HIV-positive at a given time. By examining differences in prevalence across surveys it is possible to estimate the number of new infections (i.e. incidence).

Ideally incidence would be measured by following a large group of people over time and seeing how many of them become infected with HIV. This is unfortunately impractical at a national level.

Different people participated in each of the three HSRC surveys, but nevertheless, it is reasonable to assume that if the surveys were properly conducted then the people in the 2002 survey of a particular age were similar to people in the 2005 survey of the same age plus three years. Likewise the people in the 2005 survey could be assumed to be similar to the people three years older in the 2008 survey. This is what the HSRC researchers assumed. They calculated the change in prevalence for people of a particular age in 2002 to those three years older in the 2005 survey. This almost calculates the incidence for that period, except that it does not take into account that some people with HIV would have died. How the researchers accounted for this is explained below. The researchers then did exactly the same thing for the 2005 to 2008 period. The researchers then compared the difference in incidence between the two periods.

Taking deaths into account

When people with HIV die, HIV prevalence decreases. So the change in prevalence between 2002 and 2005 and from 2005 to 2008 is not only affected by new infections but also by deaths of people with HIV. To calculate incidence, you have to remove the effect of HIV deaths decreasing prevalence. Calculating these deaths is difficult and it was further complicated because ART, which increases the length of time people with HIV live, was scaled up from 2004 to 2008. The researchers were helped by the fact that the 2008 survey checked for antiretrovirals in the blood. The researchers also made an assumption that people initiate treatment one year before they would otherwise have died. They then made a complex calculation of the effect deaths of people with HIV had on prevalence. This then enabled them to calculate incidence.


In the article the researchers calculate a reduction in incidence of 35% among South Africans aged 15-49. However, the confidence intervals for these two estimates overlap and the reduction is not statistically significant and might be due to chance.

Nevertheless, the researchers did find that for a subset of the population, women aged 15 to 24, there was a statistically significant reduction in incidence. In the 2002-2005 period the incidence was estimated to be 5.5 per 100 person-years. It declined by 60%, to 2.2 per 100 person-years in the 2005-2008 period. Here the confidence intervals do not overlap. Provided the estimates are unbiased the difference is likely to be meaningful and not due to chance.


The methodology of this study is sound. However, the accuracy of the incidence calculations are only as good as the underlying data used and the assumptions made. There are several limitations with the data:

- The 2002 HSRC survey was the first of its kind. It was widely criticised for having a low response rate and anomalous results. The accuracy of the results of this study is dependent on the accuracy of the 2002 survey. There is great uncertainty about the accuracy of the prevalence estimates of the 2002 survey and consequently there must be great uncertainty about the 2002 to 2005 incidence estimate.
- The method used to calculate the 95% confidence intervals assumes the data were collected in a simple random sample, but the data was from clustered samples. Therefore, the confidence intervals around the estimates of incidence should be larger.
- The researchers make some assumptions, some of them implicit, regarding the effects of antiretroviral treatment, such as the length of time people would have lived if they did not access ART as well as about the scale up of antiretroviral treatment from 2004 to 2008. Therefore their calculation of the number of people with HIV who died between surveys has a wide margin of error.


1. Rehle et al. 2010. A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008. PloS ONE 5(6): e11094. Doi:10.1371/journal.pone.0011094
2. Dorrington et al. 2006. The Demographic Impact of HIV/AIDS in South Africa. National and Provincial Indicators for 2006. Cape Town: Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa.
3. Republic of South Africa. 2010. Country Progress Report on the Declaration of Commitment on HIV/AIDS – 2010 Report.
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Huge Drop In HIV Infections. 20/06/2010

New HIV infections in South Africa dropped by 35% between 2002 and 2008, a study reveals.
Jun 20, 2010 By Claire Keeton
Sunday Times

The most striking reduction was a 60% decline among 15 to 24-year-olds.

These results - obtained from analysing three national HIV household surveys conducted in South Africa in 2002, 2005 and 2008 - confirm the initial findings of the 2008 survey: SA National HIV Prevalence, Incidence, Behaviour and Communications Survey: A Turning Tide Among Teenagers?

They provide the first scientific proof that HIV prevention campaigns in South Africa, promoting condom use and HIV testing, are making a dent in the high rate of new infections.

"Behaviour change has definitely helped to reduce incidence among young women," said Professor Thomas Rehle, the lead author of the paper published this week in PLoS One, an open access scientific journal.

HIV incidence may be declining, but South Africa already has a high prevalence of HIV, with about one in seven adults (15%) infected by the virus.

Dr Nono Simelela, chief executive of the SA National Aids Council, said the latest findings were important.

"They suggest we are making progress with behaviour change and treatment. But ours is a mature epidemic and the pool of HIV-positive people is already high."

Simelela suggested the goal of halving new infections - a target in the national HIV-Aids Strategic Plan 2007-2011 - was ambitious.
Dr Sue Goldstein from Soul City said the 2008 survey had hinted at a decrease in incidence and the latest analysis was good news.
"I think the decrease, especially in the younger group, means that all the education and communication is coming to fruition.

"We do know that there has been a huge increase in the use of condoms among the youth particularly and this, with other safer sexual practices, is starting to show an effect.

"We cannot let up, and it is important that older people take their role modelling seriously and focus on all safer sexual behaviours."

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More Children Orphaned – Study. 14/5/10

Almost half a million (419 144) children in South Africa are growing up without both parents, a Human Science Research Council study has revealed.

Health-e News

By Kerry Cullinan and Lungi Langa
14 May 2010

This is one of the findings from a study, “The Health of our Children in South Africa: Results from a national HIV prevalence population survey”, released in Cape Town yesterday (13 May).

Almost 9 000 children up to the age of 18 were surveyed in 2008 in the nationally representative study.

According to the study 2,1 percent of children up to the age of two were HIV positive, whereas 3,3 percent of children up to the age of four were living with the disease.

The study also found that three million children had lost either one or both parents and that more boys than girls were being orphaned. 

The study recorded 1 899 000 paternal orphans, 713 000 maternal orphans and 419 000 double orphans.

Paternal orphans are as defined as children without fathers while those without mothers were referred to as maternal orphans. Children who have lost both parents are called double orphans.

 Researchers said the likelihood of being orphaned increased with age with a third of teenagers between the ages 15 to 18 years without one or both parents.

They noted a slight hike in the number of orphans (where one or both parents are absent) between the ages of two and 18 years (19.3%). This was compared to 15.6%  in 2002 and 14.4%  in 2005.

The study found that overall 96,5% of South African children attended school, but the picture changed with orphans with more than one in 10 (12.9%) receiving no schooling. The likelihood of the children attending school plummeted even further if the mother had died.

Most orphans were located in the Eastern Cape (23.2%) followed by KwaZulu-Natal with 19.4%. The Northern Cape and Western Cape had the least number of orphans. More orphans were located in rural areas.

One percent of children were reported to be heading households in 2008 a decline from 2.6% in 2005.

Researchers said one of the main impacts of HIV was the premature loss of young parents leaving their children orphaned. However, they said it was difficult to trace the parents’ cause of death.

The report also found that government’s programme to prevent babies from getting HIV from their mothers appeared to be working as fewer children under the age of two are now infected with the virus.

Less than one percent of Western Cape children were HIV positive whereas 4.5 percent of Mpumalanga’s children were HIV positive.

“This pattern could indicate a possible positive impact of the national prevention of mother-to-child HIV transmission (PMTCT) programme in the two years before the study took place,” said the researchers, who were drawn from a number of organisations including the Human Science Research Council (HSRC) and the Medical Research Council (MRC).

Girls aged 12 to 14 were far more likely to have had sex than boys in the same age group, with one in seven girls having had sex in comparison to one in 10 boys.

A quarter of the girls aged 12-18 years had most recently had sex with males who were five or more years older than themselves. Older male partners are more likely to be HIV positive.

Of the sexually active boys aged 15 to 18, over a quarter had more than two partners in the past year as opposed to one in 10 girls. However, condom use was reported to be high (92.1% among males and 83.9% among females).

Nearly all pregnant women in South Africa attended antenatal care clinics during pregnancy (97%), and most births took place in health facilities overseen by midwives.

“Yet maternal mortality remains high (at about 2,500 per year) and this suggests that challenges remain with the quality of health care provided,” notes the report.

National Minister of Health Dr Aaron Motsoaledi said his department was encouraged by the findings of the study.

He said the antenatal uptake was impressive and that one of the department’s priorities was to see more women seeking antenatal services earlier.

“It is noteworthy that there has been a very high level of uptake of antenatal services with a level of 97% being attained. Among our key policy priorities for the health sector for the upcoming period is increasing the percentage of pregnant women who book for antenatal care before 20 weeks gestation,” he said.

He said it was unfortunate that the country continued to have high rates of maternal deaths. Motsoaledi added that most of the maternal deaths were preventable sighting negligence in the part of health care providers as the most probable cause.

Although children also had good access to primary health care, fewer than 70% of children had routine immunisations other than BCG which is given at birth.

“(This) demonstrates a shortcoming of the primary health-care system to prevent and adequately manage disease among children,” notes the report.

It recommends that the Department of Health (DoH) “prioritises strengthening the primary health care system, particularly expanding the number and scope of work of community health workers to include high impact but low-cost child health and nutrition interventions”.

Motsoaledi added that the study highlighted other issues that were of importance like immunisation and mixed feeding practices which “were still a great concern”. He said there was too much damage being done by the fact that more mothers were dependent on formula milk and opting out of breastfeeding.

“Breastfeeding is by far the best method of feeding. Infant feeding formula milk should be banned altogether,” he said.

It also says that HIV testing should be routine for sick children and primary health care providers must be trained to “identify HIV infections and to ensure timely referral and management of advanced HIV infection in children”.

Some eight percent of children reported that male teachers tried to have sex with school girls. The report commends “the initiative by the South African Council for Educators (SACE) to establish a website that publishes the names of teachers found guilty of sexual misconduct with pupils”.

Although children aged 12 to 18 were found to have good access to broadcast and print media for AIDS communication, there was lower access to national AIDS communication programmes in rural areas, as well as among home language speakers of English, Afrikaans, Tsonga or Venda.

Over one in five boys (21.7%) aged 15-18 years were circumcised, mostly for traditional reasons. However, almost one-third of young men knew that male circumcision reduced HIV risk.

The survey was funded by the US Centers for Disease Control and Prevention (CDC) using funds from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Children’s Fund (UNICEF). – Health-e News.



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Study Suggests HIV Prevalence has Dropped among Children. 14/5/10

UNICEF has welcomed finding from “The Health of Our Children” HIV prevalence survey and called for better strategies to be developed to promote exclusive breast feeding.

14 May 2010

UNICEF today welcomed the results of a study by the Human Sciences Research Council suggesting that HIV prevalence has dropped by more than half in children ages 2-14. According to the survey, HIV prevalence dropped from 5.6% in 2002 to 2.5% in 2008.

UNICEF Representative Aida Girma said, “For the first time ever, we have a measure of levels of HIV in children under two. Surveys such as this provide useful data to guide programming for children. UNICEF is committed to continuing to support the Department of Health and other partners in the follow-up from this important work.”

Ms. Girma added that UNICEF plans to focus on strengthening districts’

capacities to provide quality health services that are responsive to the needs of women, children, and adolescents, and will work to ensure that their protection and access to quality education are also secure.

Infant Nutrition remains a concern

The HSRC study also showed a threefold increase in exclusive breast feeding – 26 percent of children between 0-6 months as compared to 8.3 percent as stated in the Demographic and Health Survey of 2003. For the safety of infants, WHO and UNICEF recommends exclusive breast feeding for the first six months of a child’s life.

“UNICEF and its partners in the child survival and development arena welcome this significant improvement in the rates of exclusive breastfeeding as documented in the HSRC report,” Ms Girma said.

UNICEF further advocates for strategies to be developed to harmonise messages used in the promotion of exclusive breastfeeding, starting at the household and community level so that mothers and families are counselled on the benefits of breastfeeding in saving babies lives.

A credible body of global evidence and programmatic experience, including the recently released WHO HIV and infant feeding Revised Principles and

Recommendations: Rapid Advice, November, 2009, demonstrating that exclusive breastfeeding, coupled with appropriate counselling and support is one of the most important child survival interventions.

In particular, the Rapid Advice states that antiretroviral (ARV) interventions to either the HIV-infected mother or the HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. In this regard, UNICEF will partner with the South African National AIDS Council

(SANAC) and the Department of Health to ensure that mothers and families are made aware of the potential of maternal treatment and infant ARVs to reduce HIV transmission through breast feeding and thus contributing to saving many more babies’ lives.

Child–friendly health services

Quality public sector services remain critical for children, notably at the primary level of health care, UNICEF said, where services must address the major threats to the health of children and that of women. Optimal infant nutrition and routine immunization remain critical to keeping children alive.

The Presidential announcement on World AIDS Day and the recent launch of the HIV Counselling and Testing (HCT) campaign provide significant opportunities to expand services for PMTCT and child survival. HIV and ART services need to be child and adolescent friendly.

The results of the survey were made public today by Dr. Olive Shisana, CEO of the Human Sciences Research Council (HSRC) in the presence of Health Minister, Dr. Aaron Motsoaledi and other key stakeholders.

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South Africa: Youth Risky Behaviour Shows Decline, but Minister Still Concerned. 20/4/10

The survey showed that fewer school learners had ever had sex (from 41% to 38%) as compared to a previous study in 2002


By Gabi Khumalo
20 April 2010

Johannesburg — Although the 2008 South African National Youth Risk Behaviour Survey shows reductions in risky sexual behaviour as compared to a previous survey, Minister Collins Chabane remains concerned.

The survey, which was released today and focused on behaviours of young people between grade 8 and 11 showed that fewer school learners had ever had sex (from 41% to 38%) as compared to a previous study in 2002.

The national study conducted among 10 000 learners in 2008 also focused on risk behaviours related to infectious and chronic diseases, injury and trauma, mental health, alcohol and illegal drug use.

Of those who had sex, the number of school learners that had two or more sexual partners in their lifetime reduced (from 45% to 41%), and less learners had one or more sexual partners during the past three months (from 70% to 52%). Also, of those who ever had sex, the incidence of sexually transmitted infections reduced (from 7% to 4%), while consistent condom use increased slightly (29% to 31%).

However, the Minister in the Presidency responsible for Performance Monitoring and Evaluation is not impressed by the decrease in numbers, saying that from the 38% of learners who had reported ever having sex, 16% did after consuming alcohol and 14% after taking drugs.

"These highlight the highly unacceptable trends young people are faced with in society which all of us should protect them against.

"These are our children who still need our protection and guidance."

Minister Chabane said the programmes of government should begin to turn these figures around and develop initiatives that can discourage and detract young people from such risks altogether.

The survey revealed further that 15 percent of learners carried weapons, 19 percent belonged to gangs and 9 percent carried weapons on school premises.

On suicide related behaviours, 24% reported having experienced feelings of sadness or hopelessness, 21% had considered or attempted to commit suicide. 50% of learners also reported to have ever dranked alcohol and 30% having smoked.

Regarding unsafe traffic behaviour, more learners drove a vehicle after drinking alcohol in the past 30 days from 8 percent to 18 percent and were driven by someone who had been drinking alcohol in the past 30 days from 35 percent to 38 percent.

"These figures are a demonstration of a society which is failing in its responsibility to take care of its children, they also demonstrate that we have abdicated our responsibilities as parents and society," Chabane said.

He assured that government will engage with society and make sure that they protect young people in their homes and learning institutions against these dangers.

"The Monitoring and Evaluation Department will use this data and work in partnership with the Medical Research Council in future to gather similar data working with relevant departments to be able to introduce necessary interventions that will reduce the vulnerability of young people," he said.

NYDA Chairperson Andile Lungisa acknowledged the outcome of the research committing the organisation to implement and respond to the issues raised.

"We should be able to provide more answers than questions and our approach should not be scientific or general knowledge but have a clear action by working together with the scientists and respond directly to the issues affecting the youth," Lungisa said.

Medical Research Council's Health Promotion Research and Development Unit co-ordinator Professor Priscilla Reddy said the survey gave a window into the conditions young people face growing up in today's South Africa.

"Seeing where the stresses are on this vital part of the population will allow us to put precious resources to work in the best way," Reddy said.

While acknowledging a decrease in the youth behaviour, compared to the 2002 survey, Professor Reddy emphasised the need to find ways to intervene and move the boundaries further.

"We need to work hard to turn the situation around, if we intervene now, it will make a huge difference in the behaviour of the youth," she said.

Download the Youth Risk Behaviour Survey 2008 report (pdf format, 1.21mb) and launch pamphlet (pdf format, 103kb)

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Higher Education Alarming HIV Stats. 29/3/10

HIV prevalence rate among administrative staff stands at 4. 4 percent whilst 9.9 percent of service workers are HIV positive.


By Gabi Khumalo
29 March 2010

Johannesburg - The recently released results of the Higher Education HIV and AIDS Programmes (HEAIDS) survey show that the HIV prevalence rate among administrative staff stands at 4. 4 percent whilst 9.9 percent of service workers are HIV positive.

The survey, conducted on 21 of the 23 higher institutions in the country, established that the national prevalence rate among students is 3.4 percent.

The Eastern Cape and KwaZulu-Natal emerged as the regions with the highest prevalence, while Western Cape has the lowest figures. Gauteng, North West, Limpopo and the Free State occupy the middle ground.

Higher Education Minister, Blade Nzimande, said one of the clearest implications of the survey is the need to strengthen workplace HIV and AIDS programmes at institutions.

"We have an obligation as a sector to act on these results and to be proactive in our messages around HIV and AIDS, the way in which the epidemic is dealt with in the curriculum, the comprehensiveness of our HIV services and the structuring of workplace programmes in particular," Nzimande said.

Nzimande challenged the sector to provide the nation with working solutions to curb the spread of the virus, both clinically and socially.

"The sector has a vital responsibility in providing intellectual leadership and to produce well informed and empowered individuals in communities as well as a country as a whole," he said.

He stressed the importance of implementing a co-ordinated, comprehensive and integrated response to HIV and AIDS among higher education institutions including further education and training (FET) colleges and the skills sector.

HEAIDS Programme Director, Dr Gail Andrews, said the study represents major achievements and gives a better understanding of the behavioural risk.

"There's still a lot of work to be done and how best to reduce the risk of infection. We now have a solid base of information for the future on how to respond to HIV in higher education," Andrews said. - BuaNews

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Low HIV Prevalence among SA Students - Study. 29/03/10

Province with the highest HIV prevalence among students was the Eastern Cape (6,4%)


By Anso Thom
29 March 2010

South Africa’s student population recorded an HIV prevalence of 3,4% in the first comprehensive study to survey the scope and impact of HIV and AIDS on the higher education sector in South Africa. The HIV prevalence among academic staff was 1,5%, administrative staff 4,4% and service staff 12,2%.

The Higher Education HIV and AIDS Programme (HEAIDS) study revealed that the prevalence among students, academic and administrative staff was substantially lower that national prevalence levels while the prevalence among service staff was similar to estimated from other studies.

Results pertaining to students revealed that among the demographic factors, age was strongly associated with HIV as was race, sex and socioeconomic bracket.

In keeping with other prevalence studies done in South Africa the HEAIDS study found that women were far more vulnerable. Women students, with an HIV prevalence of 4,7%, were found to be three times more likely to be HIV positive compared to males who recorded a prevalence of 1,5%. This pattern was consistent across the provinces.

The province with the highest HIV prevalence among students was the Eastern Cape (6,4%) while the Western Cape was the lowest at 1,1%. However, there were often wide variations in HIV prevalence between universities within regions. The Eastern Cape had the university with the lowest HIV prevalence nationally and the institution with the second highest HIV prevalence.

The purpose of the study was to enable the higher education sector to understand the threat posed by the epidemic to its core mandate.

The study involved over 17 062 students, 1 880 academics and 4 433 administrative and service staff at 21 universities in South Africa where contact teaching occurs – UNISA was excluded because it only offers distance learning and Tshwane University of Technology was experiencing unrest during the study. Participants completed questionnaires and provided blood specimens (finger pricks) for HIV testing.

The study also revealed that the HIV prevalence was low among students starting tertiary education, but escalated as they grew older. Among those aged 18 to 19 years HIV prevalence was lower at 0,7%, in comparison to those aged 20 to 25 years (2,3%) and those over 25 years (8,3%).

The study also looked at the difference between different races. The highest prevalence of HIV occurred among African students (5,6%), with one case among the 3 112 white students. Only 0,8% of Coloured and 0,3% of Indian students were found to be HIV positive.

HIV was also significantly more common among male students (6,5%) and women (12,1%)who reported symptoms of a sexually transmitted infection (STI) in the last year compared to men (2,5%) and women (6%) who did not report an STI.

The study found that male students tended to report more sexual partners in the past month (19%) that women did (6%). The majority of students who had sex in the past year reported using condoms at last sex.

Sexual liaisons between academic staff and students did not seem to be common, with only 2% of academics admitting that their most recent partner was a student.

In KwaZulu-Natal, the HIV prevalence among service staff was 20,3%. Nearly half of all service staff had never tested for HIV and of this group, 10,7% were HIV positive.

Download HIV prevalence and Related factors. Higher Education Sector Study, South Africa, 2008–2009 (1.67 MB 156 Pg)

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New Model for HIV Data takes into Account New Science. 23/3/10

Researchers are designing a new model for determining the demographic impact of HIV and AIDS in South Africa.


By Lesley Odendal
23 March 2010

Modelers Leigh Johnson of the Centre for Infectious Disease Epidemiology and Research  and Rob Dorrington of the Centre for Actuarial Research at the University of Cape Town were discussing the ASSA 2008 model, which is to replace the ASSA 2003 model for estimating HIV prevalence, HIV-related deaths, the numbers of those in need of ARVs and the impact of HIV interventions. The new model will be officially released in the next three weeks.

According to Johnson, the reason the model needed to be updated was because the prevalence data projected was no longer correct because of the new data that emerged from South Africa’s antenatal HIV-prevalence survey. The survey increased the number of women who were tested for HIV and was thus more representative, although there was very little difference in the HIV prevalence results across the board from the ASSA 2003 and 2008 models. The ASSA 2008’s female prevalence matches that of the Human Sciences Research Council Household Survey, while the same was not found for males.

ASSA 2008 takes into account new epidemiological data to allow for more accurate projections of HIV prevalence and impact of interventions. It includes the ARV rollout data for up to the end of 2008. Because data shows that two-thirds of people starting ARVs are females, the ASSA 2008 model allows for different rates of ARV initiation in males and females, as well as for children and adults. ASSA 2008 also assumes a greater decrease in viral load when patients begin ARVs from a 1,76 to 2,8 unit decrease per log of viral load.

Another difference in the ASSA 2008 model is that it recognises that the attrition rate is much higher in the Western Cape than in other provinces. The cumulative rates of attrition are lower in the 2008 model than in the 2003 model.

Data has also shown that the rollout of prevention of mother to child transmission (PMTCT) of HIV has been slower than what was predicted in the 2003 ASSA model. The 2008 model takes into account the slower pace of the PMTCT rollout and the lower than expected uptake of single-dose Nevirapine. The 2008 model has also factored in the provision of dual PMTCT prophylaxis which is more effective at preventing vertical transmission.

Adult survival rates pre-ARVs have also been adjusted in the 2008 model to allow for longer survival time. There is a significant difference in the survival time of children infected at or before birth who are not receiving ARVs.

Condom usage has also been shown to be higher than that of 2003—reported condom use at last sexual intercourse was shown to be 70% in 2008 compared to between 30 and 40% in 2003, a factor that impacts on HIV incidence figures.

Some of the issues that the new model does not address is the impact of the new ARV guidelines to be released next month, including the provision of ARVs to people with a CD4 below 350 who are pregnant or have TB. The assumed increase in the number of people needing ARVs due to provider-initiated HIV testing has not been factored into ASSA 2008. The impact of male circumcision on decreasing HIV transmission has also not been taken into account. Studies have also found that women on ARVs are 70% more fertile than HIV-infected women not on treatment. This affects the interpretation of the antenatal clinic HIV prevalence data, which has not been considered in the ASSA 2008 model.

Another limitation of the ASSA model is that people are divided into four categories of risk of infection which does not change over the course of their lives, which is unrealistic.

The difficulty with the ASSA model is that one cannot accurately determine the numbers of people in need of ARVs because the ASSA 2008 model is based on CD 4 count as the marker for ARV-need, while the new ARV guidelines determine a patient’s need for ARVs based on criteria other than CD 4 count. Johnson hopes that this will only be a temporary limitation and that South Africa will adjust its guidelines to initiating ARVs to all people who have a CD 4 of less than 350.

“In order for us to project forward HIV prevalence and the impact of interventions, we will need a much more sophisticated model than ASSA will ever be able to provide. This model will need to incorporate interventions such as the impact of male circumcision, the new ARV guidelines and the other limitations that the new model does not address,” said Johnson.

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Overall HIV Prevalence Stabilises At 11% in South Africa, With Decreases In Younger Age Groups. 18/02/10

Results of three national HIV household surveys spanning six years, presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, indicate that HIV prevalence has stabilised at 11% in South Africa, with signs that the rate of infection is falling in younger age groups.


Results of three national HIV household surveys spanning six years, presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, indicate that HIV prevalence has stabilised at 11% in South Africa, with signs that the rate of infection is falling in younger age groups.

Five and a half million South Africans live with HIV, almost a quarter of the total in sub-Saharan Africa.

The household surveys were conducted in 2002, 2005 and 2008, and another is planned for 2011. They collected data on HIV status, sociodemographic characteristics and behavioural factors of adults and children at 1000 sites throughout the country.

The first survey tested saliva specimens for HIV while the second and third surveys tested dried blood spot specimens.

Nearly 8500 people were surveyed in 2002 and 16,000 and 15,000 respectively in 2005 and 2008.

Overall HIV prevalence has stabilised, with the surveys showing an HIV prevalence of 11.4% in 2002 and 10.9% in the other two years.

Among children aged 2 to 14, HIV prevalence decreased significantly from 5.6% in 2002 (95% confidence interval [CI], 3.7-7.4) to 2.5% in 2008 (95% CI, 1.9-3.5), probably due to increasing coverage of prevention of mother-to-child transmission.

HIV prevalence has stabilised, or is possibly starting to go down, in young people aged 15 to 24: it was 9.3% in 2002 and 8.7% in 2008. It increased in the core group of adults aged 15 to 49 from 15.5% in 2002 to 16.2% in 2005 and 16.8% in 2008. In neither of these age groups, however, were the changes statistically significant.

South Africa also now has the largest HIV treatment programme in the world, with an exponential expansion in the numbers of people taking treatment from nearly 33,000 in January 2005 to 744,000 in March 2009. Rather than ask people directly, the 2005 and 2008 surveys screened the blood specimens of HIV-positive people for antiretroviral drugs. In 2008, antiretroviral drugs were detected in 16.6% of specimens.

The researchers calculated that the effect of highly active antiretroviral treatment (HAART) at present was to increase HIV prevalence due to lower mortality: they estimated that without treatment prevalence among adults aged 15 to 49 would have been 1.7% lower in 2008, i.e. 15.2% instead of 16.9%.

HIV incidence was calculated using two methods. One, which calculated the incidence in young people by extrapolating directly from new infections and estimating the percentage that were recent, found that annual incidence in 18 year olds had declined from 1.8% in 2005, the peak incidence year, to 0.8% in 2008.

The second method of calculating incidence involved observing prevalence in sequential age groups. For instance, if prevalence is compared in 15 to 25 year olds in 2002 versus 18 to 28 year olds in 2005 and 21 to 31 year olds in 2008, an estimate can be made of the number of new infections that were occurring per year. The fact that three surveys have now been done then allows for this cumulative incidence to be compared with the same age groups in subsequent surveys.

This measure yielded an estimate of annual incidence of 2.0% in 2002-05 compared with 1.3% in 2005-08 in 15 to 49 year olds. This 35% decline did not reach statistical significance. However incidence declined more dramatically in young women aged 15 to 24, among whom there was a statistically significant decline in estimated annual incidence from 5.5% in 2003-05 to 2.2% in 2005-08.

Two trends are probably responsible for these estimated changes in incidence. Among survey respondents aged 15 to 49, reported condom use at last sex increased significantly from 31.3% in 2002 to 64.8% in 2008. There were particularly significant increases among women aged 15 to 49 and people aged over 50.

At the same time, the proportion of people who had ever been tested for HIV increased significantly from 25% to 56% between 2003 and 2008, while the proportion tested in the last twelve months increased from 12% in 2005 to 25% in 2008.

No changes were found in levels of other risk factors such as intergenerational sex or multiple partners.

Presenter Thomas Rehle commented that the observed figures for HIV prevalence masked two different trends, increasing coverage of ARVs and increased condom use, and these needed to be disentangled to unearth actual trends. A much higher coverage of ARVs over a longer period would have to happen for HIV treatment to have a positive effect on incidence, he added.

He recommended incorporating the testing of dried blood spots for antiretroviral drugs into routine surveillance as a means of estimating antiretroviral uptake levels.


Rehle T et al. Trends in HIV prevalence, incidence, and risk behaviors among children, youth, and adults in South Africa, 2002 to 2008. Seventeenth Conference on Retroviruses and Opportunistic Infections, San Francisco, abstract 37, 2010.

Further information

You can view the abstract on the official conference website.

You can also view a webcast and slides of this session on the official conference website.

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HIV Takes Toll on Teachers. 15/02/10


Tshwarelo eseng Mogakane

Nelspruit - More than 500 teachers in Mpumalanga are believed to have been booked off sick in the 2008/2009 financial year because of HIV/Aids-related illnesses.

However, only 98 of the 36 263 teachers employed by the provincial department of education have disclosed that they are HIV positive.

The department recorded only 56 confirmed cases of teachers who retired or took long or short leave because the disease was taking its toll.

“These are the confirmed cases, but we have 504 unconfirmed cases where we suspect that teachers stayed away from class due to illnesses linked to HIV,” said department spokesperson Jasper Zwane.

“While the number appears to be small in comparison with the total number of teachers we employ, as a department we are worried that more than 500 were constantly not in class.”

Zwane said the number of absent teachers was worrying because learning and teaching were interrupted.

Mpumalanga achieved a matric pass rate of just 47.9% last year.

Taking strain

One primary school principal in the Bushbuckridge area said there were many difficulties principals faced due to HIV/Aids-related cases.

“It is quite normal for teachers to take sick leave once in a while. But I have a teacher, who has disclosed her status to school management, whose class is suffering because at times she disappears for two months at a time,” said the principal.

He said this created problems for other teachers who had to fill in for her while she was at home.

“When we visit her at home, you can see she is recovering, but you know that bringing her back to school too soon will cause a relapse," he said.

“As a principal you wish she could retire and be replaced for the sake of teaching, but as a human being you wonder whether forcing her to retire won't lead to her early death,” he added.

Zwane confirmed that principals were taking strain as HIV affected their schools' teachers.

“Our principals are expected to perform well,  but we're constantly dealing with absenteeism and underperformance resulting from teachers' illness.

"On the other hand, teachers are experiencing financial problems due to their condition, which result in stress and underperformance,” he said.

Zwane said healthy teachers were forced to deal with heavy workloads because of backlogs caused by their ill counterparts' absenteeism.

According to the CEO of the Mpumalanga Council of Churches, Reverend Luke Dlamini, HIV has become a human rights issue that affects the overall wellbeing of the community.

“As a church, we believe that the right of a teacher to wellbeing should be a priority, but we also believe that the right of a child to learn should be considered,” said Dlamini.

He said this could be done through a support programme whereby unemployed teachers from the community volunteer at schools during the absence of a teacher who is bedridden by illness.

- African Eye

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Educators Do Not Practise What They Preach On HIV. 06/02/10

Young teachers, may be openly discussing the dangers of promiscuity with their pupils, but they are themselves engaging in risky sexual behaviour.

Times Live

Their older colleagues, on the other hand, are reluctant to talk about sex and HIV/Aids in the classroom, because of their conservative nature.

This is according to a study conducted by KwaZulu-Natal HIV/Aids research organisation Heard set to be published in the Journal of Education within the next few months.

The researchers delved into the sexual behaviour of over 800 teachers - between the ages of 31 and 50 - at 34 Free State schools.

According to the study, younger teachers interacted with pupils on issues relating to HIV and sexuality more than their older counterparts.

In South Africa, teachers have a captive audience of over 10 million pupils every day and can deliver HIV prevention messages to an age group that is largely uninfected but most at risk.

According to the World Bank, more than 8.5% of youth between the ages of 15 and 24 have sex by their 15th birthdays.

Of the teachers who took part in the study, 32.9% admitted to having sex with five or more people in their lifetime.

However, not all participants were forthcoming - 32.1% of them, mainly men, refused to comment. The study also found that over 36% of teachers did not know their HIV status. In addition, 50.9% reported never or sporadically using condoms.

"The findings suggest that there is a portion of educators who acknowledge the likelihood that they may be HIV positive at present, yet were engaging in high-risk sexual behaviour.

"Slightly under half of the sample, 48.4%, believed they were either living with HIV or were unsure, and 72% of this proportion had never used a condom during sexual intercourse," the study found.

National and Professional Teachers of South Africa spokesman, Esra Ramasetlha said the study's findings were "of great concern".

Nomusa Cembi, South African Democratic Teacher's Union spokesman, said: "We have established the Prevention Palliative Care for Teachers, Orphans and Vulnerable Children (PPCT-OVC) Project that includes a programme that targets men emphasising correct condom usage."

Commenting on aspects of the study, Chantal Ann Rama, 33, a teacher in Durban, said older teachers believed that if they spoke about sex with their pupils "they are encouraging them to have sex".

Rama's colleague, 64-year-old Jay Sewpersad said the older generation of teachers were "more conservative" than their younger counterparts.

"Our generation believed that sexual education should be done at home," said Sewpersad.

By Corrienne Louw

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Second National Communication Survey on HIV/AIDS (NCS), 2009


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Positive Signs in South African AIDS Study. 31/1/10

A South African study into antiretroviral treatment has found encouraging signs in long-term treatment outcomes.
31 January 2010

A South African study into antiretroviral treatment has found encouraging signs in long-term treatment outcomes.

The study looked at clinical, immunologic and virologic outcomes at large HIV/AIDS care clinics in resource-poor settings. These are usually poorly described beyond the first year of highly active antiretroviral treatment (HAART).

Global access to HAART has increased dramatically but in sub-Saharan Africa, where the majority of those in need are, people often remain untreated. South Africa has an estimated 5,000,000 people living with HIV and AIDS, and made a political commitment to include HAART in the public health treatment programs from April 2004.

South Africa now has the largest number of people receiving HAART in the world but the scale-up has been slower than anticipated, with a treatment gap that remains in excess of 500,000 people.

Researchers carried out a cohort study of patients who initiated HAART between April 1 2004 and March 13 2007, and followed up with them until April 2008 at the care clinics. They found good long-term retention and excellent clinical, immunologic and virologic outcomes.

A relatively high early mortality rate and high loss to follow up in the first months of treatment also demonstrated the need to strengthen strategies that promote early HIV diagnosis, early access to care and rapid initiation of HAART in very ill patients.

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AIDS Ignorance in SA is Down, Survey Says. 27/1/10

More South Africans are discussing HIV testing with their partners.
January 27 2010
By Mercury Reporter

A new survey suggests that more South Africans are discussing HIV testing with their partners and, as a result, those couples are more likely to submit themselves for tests.

Furthermore, there has been a significant uptake of testing among men, in particular.
The survey, the second National Communication Survey, attributes this behaviour to the success of the country's HIV/Aids communications programmes.

A senior researcher at Johns Hopkins University, Dr Larry Kincade, one of the lead researchers on communication interventions in South Africa, said the 2009 survey demonstrated a casual connection between such programmes and people's behaviours.

"The more programmes people were exposed to, the more they are positively influenced," said Kincade. "This is a clear indication that the programmes are having a substantial impact on South Africans."

The survey found that knowledge of HIV/Aids had increased significantly since the last survey, which was conducted in 2006, with more people now aware that having multiple sexual partners increased their risk of contracting the virus. Also, an "overwhelming majority" of South Africans now knew that condoms were effective for HIV prevention.

However, the survey also highlighted a number of gaps in the programme, including that the message needed to be sustained, that links between alcohol, sex and HIV needed to be strengthened, and that knowledge levels of safe feeding practices for HIV-positive pregnant mothers needed to be increased.

Junaid Seedat, communication, advocacy and campaigns manager for the South African National Aids Council, said: "The National Communication Survey is a great barometer of how communication is increasing knowledge about HIV, and bringing about change in people's attitudes to having responsible sexual lifestyles, and provides the foundation for an evidence-based national HIV communication strategy."

The results of the survey are being revealed at the Hilton Hotel in Durban. The survey's findings cover aspects such as condom use, awareness of HIV/Aids, multiple sexual partners and HIV/Aids testing.

This breaking news flash was supplied exclusively to by the news desk at our sister title The Mercury. For more about this story, carry on watching or click here to subscribe to the digital or print edition of the newspaper.

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Key Facts of the National Communication Survey on HIV/AIDS, 2009. Jan 2010

January 2010

Survey objectives
  • To evaluate several major communication programmes in South Africa
  • To understand the key drivers of the HIV epidemic in South Africa
  • Special emphasis on multiple partners
  • To strengthen HIV communication programmes so that they are strategically aligned to important risk behaviours and key drivers of the epidemic.
  • 90% of South Africans were reached by at least one of the 11 HIV/AIDS communication programmes examined in the study.
  • Younger audiences had a higher level of exposure to (five or more) communication programmes (42%) than older audiences 20%. 
  • 86.8% of South Africans (89.6% of men, 84.1% of women) listen to the radio;  86.5% of men and 86.4% of women watch television; 56% of people (54.7% of men and 57.4% of women) read magazines; 67.3% of people (71.9% of men, 62.9% of women) read newspapers; and 18.4% of people (20.8% of men, 16.1% of women) use the Internet.
  • Knowledge of HIV prevention methods is high – 87% for condoms on average across age groups. Knowledge of other HIV prevention methods – such as faithfulness, partner reduction and abstinence – is lower, but has improved since the 2006 NCS.
  • Knowledge of treatment allowing people living with HIV to be healthy, is high and has significantly increased – of those who know of treatment, 87% (85% male and 88% female) identified antiretroviral therapy (ART) as a treatment, and 73% know that ART is for life (in 2006, 42% identified ART and 40% knew it was for life).
  • A high proportion of respondents – 81% in total, but more women than men – know that HIV can be transmitted through breastfeeding; 14.9% are aware of formula feeding as a way to prevent mother-to-child transmission, and only 1.7% know that exclusive breastfeeding prevents mother-to-child transmission.
  • Knowledge that male circumcision reduces the risk of HIV infection is low (7.5%) – and 12-22% of men and 12-17% of women across age groups (15% in total) also believe that circumcised men do not need to use condoms.
  • 44% of men aged 16-40 report that they have been circumcised – 27% of them before the age of 18.
  • Tuberculosis (TB) – the majority of respondents know what the duration of TB treatment is (75% male and 80% female), but knowledge of the curability of TB in people living with HIV needs to be addressed (49% of men and 45% of women believe people with HIV cannot be cured of TB).
  • A total of 61% of all sexually active people men and women have ever been tested – 48% of men, and 74% of women (the discrepancy due to many women being tested because they are pregnant).
  • 60% of all men and women (63% men, 59% women) reported being tested in the past 12 months.
  • Many youth have been tested – of those ever tested, 75% of men aged 16-19, and 78% of women aged 16-19, have been tested in the past 12 months.
  • 61% of men and 65% of women with high exposure to communication programmes reported being tested in the past 12 months.
  • Talking with one’s sexual partner about HIV testing also increases with exposure to more communication programmes.
  • People discussing testing with their partners are almost four times more likely to actually  test for HIV.
  • Being tested increases with exposure to the number of communication programmes.
  • The percentage of both young men and women (aged 15-24 in 2006 NCS, 16-24 in 2009 NCS) who have ever been tested for  HIV has increased dramatically – in 2006, 17% of men and 38% of women had been tested; in 2009, 31.8% of men and 71.2% of women had ever been tested.
  • Stable relationships (married/living together) are uncommon amongst young people. Only 3% of men and 15% of women aged 20-24 are in stable relationships.
  • Men tend to have more casual sexual relationships, while women tend to be in more stable relationships.
Condom use
Condom use at last sex by age and gender
  • Condom use is lowest in stable (married or living together) relationships and highest by people with less stable relationships:
    • 15% of married men and women
    • 25% of men and 29% of women living together
    • 62% of men and 51% of women with main partners
    • 74-83% of men and 56-66% of women with other partners (casual, friends and one-night encounters).
  • Condom use increases with exposure to more communication programmes:  Of those not exposed to communication programmes only 33% used condoms, while 50% of those who were exposed to all 11 programmes used condoms. (This was after adjusting for 15 socio–economic variables – clearly demonstrating the effect of communication.)
Multiple partners
  • Cheating is perceived by most South Africans as a social norm – 86-95% of men and 90-95% of women across age groups believe this is so; but the reality is different.
  • Multiple partners is highest among youth, especially among young men (around one-third of men aged 16-24 have had more than one partner in the past year, compared with 6-9% of women aged 16-24), but decreases by age (4% of men aged 50-55 and 1% of women aged 50-55)
  • 14% of respondents have had inter-generational sex (defined as having at least one partner 10 years older or younger) and 37% of men aged 50-55 have partners who are 10 years younger or more.
  • 20% of men and 3% of women report having multiple partners in the past 12 months.
  • There is evidence that people have decreased the number of sexual partners from one year ago – men have had 2.6% fewer partners and women 3.1% fewer partners, for a net total partner decrease of 2.8%.
  • Decreases in multiple partners by women can be more clearly correlated to exposure to communication programmes than men: 1.9% of women with no exposure to communication programmes, compared to 7.2% of women exposed to all 11 programmes (a more than threefold difference); with men there is no statistical difference*.
* It should be noted that communication programmes about multiple and concurrent partners were less than a year old when the study was conducted. Condoms have been promoted over the past 12 years.
  • There is a significant correlation between heavy drinking (defined as four or more alcoholic drinks in one sitting for women, and five for men) in nightclubs, bars and shebeens, and having multiple partners, and 68% of men and 56% of women believe it is easier to have sex with people who frequent nightclubs, bars and shebeens.
  • Men and women of all age groups believe that when they are drunk, neither they nor their partners will care about HIV.
  • Of all respondents, 7% said that the last time they went to a nightclub, bar or shebeen, they had had sex with someone they had never met before.
Social capital and attitudes
  • 44.6% of respondents countrywide agreed with the statement that leaders in communities take HIV/AIDS seriously.
  • 42.1% of respondents countrywide agreed with the statement that people in communities are joining together to help people with HIV and AIDS.
  • 53.4% of respondents countrywide agreed with the statement that they trust most people in their communities.
  • 57.3% of respondents countrywide disagreed with the statement that people with HIV will soon lost their friends.
  • 79.6% of respondents countrywide disagreed with the statement that when you learn that you have HIV, your life is over.
  • 83.4% of respondents countrywide disagreed with the statement that they would be embarrassed to be seen with someone who everyone knows has HIV.
Comparison of 2006 NCS and 2009 NCS
Mean age (years)
Ever had sexual relationships
Sexual relations in the past 12 months
Condom use
Reduce the number of partners
Used condoms to prevent AIDS
Used condoms at last sex
VCT ever tested
VCT last 12 months
Multiple partners in last 12 months
Multiple partners in last 12 months (males)
Multiple partners in last 12 months (females)
MCP in the past month
  • The survey findings indicate that communication programmes are impacting significantly  upon young people, knowledge levels and behaviours in relation to condom usage and HIV testing. There are indications that communication programmes are beginning to impact on knowledge levels in relation to numbers of partners and risk of HIV infection. Programmes therefore need to continue to emphasise the need to reduce partners.
  • Communication programmes have been very successful in promoting condom use in high risk sexual partnerships, such as with friends, people just met or known for a while and one night encounters. Programmes need to focus more on condom messaging for people in long-term and stable relationships, such as married, living together and main partner. Condoms need to be promoted beyond HIV and AIDS prevention, to include their use in family planning
  • Programmes have excellent reach among adults and youth, but need to focus more on reaching older people, especially men.
  • Multiple partners are not the norm, however they are perceived as the norm by the majority of people. Multiple partners is highest among youth, especially among young men (around one-third of men aged 16-24 have had more than one partner in the past year). Messaging around partner reduction and multiple partners need to be carefully crafted such that audiences can appreciate that these are not being presented as the norm that must be redefined, but rather that where they are practiced they present an increased HIV risk.
  • The survey shows that there has been increased communication with sexual partners and friends about HIV testing and that there has been an increase in HIV testing.
  • Knowledge around safe infant feeding options for HIV-positive women is low. As part of accelerating PMTCT and other communication programmes, greater efforts need to be made to reach people with the correct messages on safe infant feeding practices.
  • The majority of people are aware that ART is a treatment for HIV and that it needs to be taken for life.  This is a boost on communication efforts on treatment literacy over the past few years, and needs to be sustained.
  • The survey shows that levels of knowledge around male circumcision in relation to HIV risk reduction are low. Once the policy on male circumcision has been finalised, it will be critical for communication programmes to embark on public education on the sexual and reproductive health benefits,  including the HIV risk-reduction benefits.
  • Beliefs about the link between alcohol consumption and risky sexual behaviour are evident from the survey. Communication programmes need to highlight the linkages between alcohol, sex and HIV.  Legal and other avenues to reduce heavy alcohol consumption need to be explored and put in place.
To download the National Communication Survey results in PowerPoint format or PDF, please go to
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Press Release from Siyayinqoba Beat It! and CMT on the 2009 National Communications Survey. 28/1/10

 The survey confirms the key finding of the 2006 survey that the greater exposure to HIV communications, the greater the likelihood of safer sexual practices.

Siyayinqoba Press release
28 January 2010

Community Media Trust (CMT) the producers of the Siyayinqoba Beat It! TV programme and Prevention and Treatment Literacy Training Materials, welcome the release of the 2009 National Communications Survey. CMT is a sponsor of the survey. CMT would like to thank Johns Hopkins Health Education in South Africa (JHHESA), Health & Development Africa (HDA) and our other partners for their work in producing this valuable study.

The survey confirms the key finding of the 2006 survey that the greater exposure to HIV communications, the greater the likelihood of safer sexual practices. When adjusted for any other variable that could have affected the result the survey found that:

-33% of people not exposed to any HIV communications used condoms with a partner in the previous 12 months and that this rose to 50% for those exposed to at least 9 of the 11 programmes evaluated.

-24% of people not exposed to any HIV communications used condoms with their main partner, rising to 35% for those exposed to at least 9 of the 11 programmes evaluated. These results, with increased response by those with greater exposure to communications, were repeated across a range of variables. Performance of Siyayinqoba Beat It!

When asked specifically about Siyayinqoba Beat It! 38% of people (~10.4 million people) said that they had heard of Siyayinqoba Beat It! in the last 12 months. Almost 39% (~10.5 million people) recognised the Siyayinqoba Beat It! logo and some 15% of people were able to complete the slogan “Protect yourself. Protect others”.

Siyayinqoba Beat It! was the only communication brand for 20% of the sample. Given that CMT has a modest total budget across all activities of R25 million rand per year, the results show that the Siyayinqoba Beat It! brand is one of the most cost effective communications programmes. Siyayinqoba and Condom use at last sexual encounter

A key finding of all surveys has been very high knowledge of condoms as a means to prevent HIV infection. 83% of those who were not exposed to HIV communications knew about condoms compared to 90% of those who were highly exposed.

What is more important is condom use at last sex. Here a different picture emerges:

-Only 40% of the overall sample used condoms to prevent HIV (compared to 44% in 2006).
-Amongst those who watched Siyayinqoba Beat It! 55% of used condoms at last sex to prevent HIV.

As this is a core Siyayinqoba Beat It! message, the survey shows that people do respond to positive information encouraging correct and consistent condom use and that a greatly increased effort is needed to promote this. It is shocking that while government annually distributes 400 million male condoms, there is very little positive communications that encourage correct and consistent condom use and make condoms cool and sexually desirable. CMT is committed to doing more work in this regard. Other areas where Siyayinqoba Beat It! has an impact:

-27% of those highly exposed to Siyayinqoba Beat It! mentioned that HIV testing should be undertaken every six months compared to 23% of those with low exposure.
-Additionally, the percentage of females who listed “I was pregnant” as the reason for their most recent HIV test was 25% percent amongst those who were exposed to Siyayinqoba Beat It! and 21% amongst those not exposed. This is important has Siyayinqoba Beat It! has had a specific objective to increase the uptake of VCT, particularly amongst pregnant woman.
-Some 50% of the national population with high exposure to Siyayinqoba Beat It! discussed HIV testing with their friends compared to 39% of those with medium exposure and only 29% of those with low exposure. This shows that Siyayinqoba Beat It! is contributing to making HIV testing a routine part of life that is talked about openly.

In General

One of the most important findings, that confirms other similar findings was that between the ages of 25 and 39 only 42.6% of women and 35.3% of men were in stable relationships. This makes sense in a country with a highly mobile population driven by:

-regional instability and migration,
-historical patterns of labour migration,
-newer patterns of rural migration to urban informal settlements since the 1970s,
-the expulsion of farm workers from their homes on farms (something that has affected millions of workers not least since 1994).

These structural forces encourage multiple partner relationships and short term relationships as well as intergenerational relationships. 30% of respondents under 30 years old had more than one partner in the previous year, confirming the results of previous surveys. But over 90% of respondents under 40 years old held the perception that cheating is the norm in relationships. We need to know if the partners in concurrent relationships consider this cheating? How are the terms “cheating” and “faithfulness” used and understood? Given the structural determinants of MCP and the evident efficacy of communications around correct and consistent condom use, this type of communication need to be greatly intensified.


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HIV/AIDS Communication Programmes are Getting the Message Across: National Survey Finds. 01/10

HIV/AIDS communication programmes in South Africa are successfully influencing people to have safer sexual relationships – and the more programmes to which people are exposed, the more they take heed.

Johns Hopkins

 This is the conclusion of the second National Communication Survey on HIV/AIDS 2009(NCS 09). Dr Saul Johnson, of Health & Development Africa, who led the research process, says that overall, the country’s HIV/AIDS communication programmes are working – and they are having a positive impact particularly with youth, on the levels of condom usage, HIV testing, and knowledge of the risks of having multiple sexual partners.

One of the major findings of the study is that men and women are only likely to settle into stable relationships – married or living together – once they are in their late 30s, and this has implications in relation to condom usage and their number of partners.

The survey revealed that an overwhelming majority of South Africans – 87% across all age groups – know that condoms are effective for HIV prevention. Clear evidence was found showing that condom usage is highest among youth and decreases among older people. People in stable, long-term relationships are less likely to use condoms than people who are in less stable relationships. Condom usage clearly increases with the number of communication programmes to which people are exposed.

Most respondents, across age groups and gender, believe that cheating is the norm – but this perception does not match reality. Multiple partnerships are only relatively common among younger men (16%) but decline with age, and are very low among women across all ages.

An important finding from the survey is that more people are aware that having multiple partners increases the risk of HIV infection, increasing from 6.2% in the 2006 NCS to 12.2% in the 2009 NCS. In addition, more people are reporting having fewer sexual partners in the past 12 months, reducing from 16.5% in 2006 to 11.4% in 2009.

"While the reduction in sexual partners is still modest, we have observed much greater levels of knowledge about the risks of multiple partners. This indicates that communication programmes are starting to impact on the levels of knowledge and there are some indications of behaviour change that has been the emphasis of many communication programmes in the past year, although there is still no clear statistical correlation as yet," says Johnson.

The survey found that communication programmes have been successful in getting people to discuss HIV testing with their partners – and that couples who do so are four times more likely to be tested for HIV. There has been a significant uptake of testing among men, in particular, with many more indicating that they have tested for HIV than previously.

Knowledge levels amongst South Africans in relation to treatment for HIV has increased significantly, with the majority knowing that antiretroviral therapy (ART) is a treatment for HIV and more than 73% knowing that ART needs to be taken for life.

Johns Hopkins University-based researcher Dr Larry Kincaid, one of the lead researchers on the impact of communication interventions, says: “The survey demonstrates a causal connection between the communication programmes and people’s behaviour, and also that the more programmes people are exposed to, the more they are positively influenced – a clear indication that the programmes are having a substantial impact on South Africans.”

While the survey points to many successes it also highlights a number of gaps and risks in the AIDS communication response.

While there is evidence that the message around the risks of multiple partners is getting through, this message needs to be sustained in the future to further increase knowledge levels and bring about behaviour change. This should not be done at the expense of messages that promote correct and consistent condom usage, particularly in high-risk sexual encounters.

Communication programmes need to strengthen interventions that highlight the linkages between alcohol, sex and HIV. The survey found that there is a relationship between heavy drinking and having multiple partners, and that when people are drunk, they and their partners are more likely to not care about contracting HIV.

There is an urgent need to increase knowledge levels around safe feeding practices for pregnant mothers living with HIV. Only 1.7% of people know that exclusive breastfeeding and only 14% know that exclusive formula feeding can prevent HIV. Mixed feeding, which is a common practice in South Africa, is known to increase the risk of transmission of HIV from mother to child.

"The National Communication Survey is a great barometer of how communication is increasing knowledge about HIV, and bringing about change in people’s attitude to having responsible sexual lifestyles, and provides the foundation for an evidence-based national HIV communication strategy," says Junaid Seedat, Communication, Advocacy and Campaigns Manager for the South African National AIDS Council (SANAC).


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South African Statistics - 2009

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Top SA Scientists Challenge Denialists on AIDS Stats. 2/12/09

 South Africa’s top scientists and researchers have come out in support of health minister Dr Aaron Motsoaledi after the furore over Home Affairs supplied AIDS death statistics he quoted recently - which may have been incorrect.

Anso Thom

The error has emboldened some AIDS denialists who now claim the 2008 deaths were deliberately exaggerated because “big AIDS numbers are good for business” while scientists are saying the mistake is of little consequence considering the massive burden of the AIDS epidemic, including the high number of deaths.

“(It’s) as if the scale of the AIDS devastation needs to be artificially inflated and overstated for it to be taken seriously,” the letter from the scientist group said.

“As a vivid reminder of the cynical questioning of AIDS-related mortality we have witnessed in the past, the seeds of doubt are ever-present regarding the extent to which AIDS mortality is increasing or decreasing and which one of the many death rates most accurately reflects the South Africa reality. Each one of us, as doctors and scientists who deal with HIV on a daily basis in this country, sees the pain, knows the suffering, is aware of the premature loss of life and unequivocally appreciates that AIDS is the number one cause of death in South Africa.”

The signatories include among others Professor Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in SA; Dr Francois Venter, President of the HIV Clinicians Society; Professor Helen Rees, Director of the Reproductive Health and HIV Research Unit; Professor Laetitia Rispel of the Centre for Health Policy and Professor Lynn Morris of the National Institute for Communicable Diseases.

They present statistics from their own studies which reveal the following:
·         With only 0,7% of the world’s population, South Africa has 17% of the world’s HIV/AIDS cases – the greatest burden of HIV infection in the world;
·         It is estimated that about 5,4-million people were infected with HIV in South Africa in 2006;
·         From 2006 to 2008, 29% of pregnant women were HIV positive, with little change over the three years;
·         New infections have continued to occur over the last three years;
·         The number of deaths have risen substantially from 1998 to 2006 with AIDS largely responsible for the substantial increase in deaths of young adults. “The increase over the 9 years is evident regardless of whether data are from Stats SA or Home Affairs,” they said.
·         HIV/AIDS has taken South Africa off track in the quest to reach the Millennium Development Goals, especially MDG 4 and 5, dealing with child and maternal motality.

“In short, the available information point indisputably to the heavy toll imposed by HIV/AIDS on South Africa with unacceptably high rates of HIV infection and AIDS mortality,” the signatories said.


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Life Expectancy Drops. 21/11/09

South Africans are dying younger and in greater numbers, and HIV/AIDS is to blame, according to a report released this week by the South African Institute of Race Relations.


  Average life expectancy declined from 62 years in 1990 to 50 years in 2007; it is projected to fall even further by 2011, to 48 years for men and 51 for women, according to the Institute's annual South Africa Survey.

  The authors note that among 37 developed and developing countries, South Africa is one of only six where life expectancy fell between 1990 and 2007, with only Zimbabwe showing a steeper decline.

  Of South Africa's nine provinces, those with the highest HIV prevalence rates also had the lowest life expectancy - KwaZulu-Natal at 43 years, followed by Free State and Mpumalanga, both at 47 years. The leading causes of death were tuberculosis (TB), influenza and pneumonia, all common opportunistic infections associated with HIV/AIDS.

  Seventy percent of people diagnosed with TB in South Africa were co-infected with HIV, and "it is thus reasonable to assume that at least 70 percent of observed mortality from tuberculosis, and by extension a comparable percentage of deaths from influenza/pneumonia, also has HIV and AIDS as an underlying cause." Nearly half of all deaths in 2008 were thought to be HIV/AIDS related - up from a third in 2001.

  Gail Eddy, a researcher at the Institute, commented that although neither the public health system nor the government's antiretroviral (ARV) treatment programme were reaching all those in need, particularly in rural areas, a slight decrease in mortality rates in the last two years may be the result of ARVs gradually becoming more widely available.

  The HIV/AIDS epidemic contributed to a 43 percent reduction in population growth between 2001 and 2008; a fall in birth rates also played a role.

  Although fewer children are being born, HIV/AIDS is creating an increasing number of orphans: of the estimated 2.5 million children who had lost a parent by 2007, more than half were orphaned as a result of HIV/AIDS. According to the survey, by 2015, 32 percent of South African children will have lost one or both parents to the virus.

  Eddy noted that the government's social grants programme was not addressing the need of orphaned children for psychosocial support. NGOs were attempting to fill the gap created by a chronic shortage of social workers but many were underfunded. "There's a need to strengthen government/NGO partnerships," she said.

  The report was released amid mounting controversy over mortality figures quoted by President Jacob Zuma during a speech on 29 October. He said that 756,000 deaths had been recorded in 2008 - an astounding 30 percent increase from the previous year.

  He attributed the increase to the AIDS epidemic, an admission that the AIDS lobby group, Treatment Action Campaign, welcomed as "the ushering in of a new era", after a decade of government denial about the extent of AIDS by former President Thabo Mbeki. However, a number of researchers have questioned the figure, reportedly supplied by the Ministry of Home Affairs.

  Eddy confirmed that the figure was significantly higher than the one provided by the Actuarial Society of South Africa, on which the Institute based its calculations.

  "I think it was really a miscalculation," she said. Estimating HIV/AIDS deaths in South Africa is particularly problematic because the disease is not notifiable.

© IRIN. All rights reserved. HIV/AIDS news and analysis:



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SA Life Expectancy Still Falling. 20/11/09

The average South African will not live much longer than 50 years.

INTERNATIONAL comparisons show that the average South African will not live much longer than 50 years, the South African Institute of Race Relations (SAIRR) said yesterday.

SA was among six out of a group of 37 developed and developing countries that had a decreasing life expectancy between 1990 and 2007.

SA’s life expectancy decreased from 62 years in 1990, to 50 years in 2007. Only Zimbabwe had a worse trend for life expectancy.

Statistics released by the SAIRR in its annual South Africa Survey show that this year the average life expectancy at birth for South Africans was 51 years.

Between 2001 and 2006 the life expectancy at birth was 51 years for males, and 55 years for females. This is expected to drop between 2006 and 2011 to 48 for males and 51 for females.

KwaZulu-Natal had the lowest life expectancy at birth this year, at 43 years, followed by the Free State and Mpumalanga at 47.

These three provinces also had some of the highest HIV prevalence rates, at 16%, 14%, and 14% respectively.

International comparisons also show that in 2007, only 27% of males and 33% of females in SA would survive to age 65. Out of a comparison group of 37 developing and developed countries, only Mozambique and Zimbabwe had lower survival rates.

Gail Eddy, a researcher at the SAIRR, said: “These figures show that SA is one of a handful of countries in the world that has had a decreasing life expectancy over the past 17 years. This decrease is related to the high HIV/AIDS prevalence rate in the country.

“SA’s life expectancy and survival to age 65 figures are in the same league as countries such as Zimbabwe, which has gone through tremendous political upheavals and economic decline over the past decade.”

If one had to compare SA with other countries of similar economic size and political stability, it is clear SA is lagging far behind.

“These figures highlight the extent to which HIV/AIDS has affected the quality of life of South Africans,” Eddy said.

“They also raise pertinent questions about the ability of the public healthcare system to improve the health and life spans of South Africans.”



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Cause of Death in SA. 17/11/09

Leading causes are tuberculosis, influenza and pneumonia

November 17, 2009

Although HIV/Aids is gaining acceptance as a cause of death in South Africa, the leading causes are tuberculosis, influenza and pneumonia, according to a report released by the South African Institute for Race Relations on Tuesday.

"This should not be taken to mean that HIV/Aids was not a direct contributor to a very large proportion of observed mortality, but rather it should be noted that these statistics track, for the most part, direct causes of death," the researchers said.

Close to 70% of all people diagnosed with tuberculosis (TB) in South Africa were also HIV-positive, the report found. There were 353,879 TB cases in 2007 compared with 73,917 in 1995.

"It is thus reasonable to assume that at least 70% of observed mortality from tuberculosis, and by extension a comparable percentage of deaths from influenza/pneumonia, also has HIV/Aids as an underlying cause," the report noted.

Aids-related infections
A person did not die from HIV/Aids directly, as it was a syndrome which caused immune system deficiency.

"Rather, mortality from Aids-related infections will be observed," the researchers said.

"It is possible that a person who is immuno-compromised enough to be classified as having reached 'full-blown' Aids would succumb to a great many infections that a person with a healthy immune system would never suffer from."

This meant that people infected with HIV/Aids could die from a vast range of secondary infections.

"It is impossible to say with certainty how much mortality is directly attributable to HIV/Aids, although the Actuarial Society of South Africa estimates that by 2009 some 2.9 million people will have died from HIV/Aids-related disease in South Africa," according to the South Africa Survey 2008/9.

It records 382,521 HIV/Aids related deaths for 2009. The report found that the "actual" figure of people living with HIV/Aids was 5,728,711, or 11.7% of the population.

Death by race
Researchers said that when analysing causes of death by race, a very clear pattern of mortality emerged for each different race group.

For Africans, the leading causes of death were TB and influenza/pneumonia - the diseases most closely associated with HIV/Aids-related mortality.

Coloureds were likely to die of TB, but also suffered from cerebrovascular disease and diabetes; Indians were most likely to die of diabetes or heart disease; and whites were most likely to die of heart disease.

"These causes of death are closely related to socio-economic status."

There had also been an unprecedented spike in deaths between the ages of 25 and 45, but antiretroviral treatment seemed to be having a positive effect. The researchers estimated that there were 497,756 new infections in 2009.

Other statistics the report identified were:

  • An increase in the deaths of children up to the age of four from 32,468 in 1997, to 63,596 in 2006.

  • A decline in malnutrition of children up to the age of six from 25% in 2001, to 5.7 percent in 2006.

The report found that there were five recorded malaria deaths in 1971, but this spiked to 459 in 2000 and declined to 48 in 2007.

It also found that there were 81,900 terminations of pregnancy in 2007.

Researchers projected life expectancy for people born in 2008 as 50,5 years. – (Sapa, November 2009)



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Death Stats ‘Implausible’. 17/11/09

The Health Department's claim of a massive jump in deaths in 2008 is unlikely, according to experts.

Health-e News
Kerry Cullinan

Death statistics released by the Department of Health last week that showed a jump of 182,654 deaths in a single year are “implausible”.

This is according to the Medical Research Council (MRC), which usually supplies government with mortality figures.

Health Minister Aaron Motsoaledi told a press briefing last week that, in 2007, the total number of deaths from all causes was 573,408 but by the end of 2008, this figure had jumped to 756,062.

This increase in deaths in a single year is the equivalent of everyone in an area bigger than the size of Randfontein (Gauteng) or all the citizens of George and Plettenberg Bay combined (W Cape) dying in a single year, in addition to the usual deaths.

However, it is appears that the Minister got his figures from the Department of Home Affairs. The MRC says it does not yet have the 2008 mortality figures and Statistics SA only released the 2007 mortality statistics two weeks ago.

The Stats SA death rate for 2007 was 601,133 – almost 30,000 higher than the 2007 figures quoted by the health minister.

In addition, Stats SA noted that there was slight decline of 1,8%  in deaths between 2007 and 2006 when 612 462 people died. Some interpreted this as a modest indication that government’s antiretroviral treatment programme was working.

Thus, the Minister’s report last week of the massive jump in deaths – which he attributed to AIDS – caused disbelief among statisticians and researchers who track the mortality rate.

The MRC’s Dr Debbie Bradshaw has written to the acting Director-General of Health, Dr Kammy Chetty, to express her concern about the figure.

Health Department spokesperson Fidel Hadebe said officials were looking into the figure and “we will correct it if necessary in due course”.

What is not in dispute, however, is the fact that the death rate of South Africans has more than doubled in the past decade, with the greatest increases occuring in adult women in their late twenties and early thirties and men in their late thirties – a clear indication of the impact of AIDS. – Health-e News Service.


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AIDS and Mortality In South Africa. 16/11/09

Nathan Geffen writes that the post-2004 ARV roll-out has stabilised the death rate

Nathan Geffen
16 November 2009
On 2 November 2009, Statistics South Africa released the latest mortality data, which goes up to 2007 (Stats SA, 2009).
This table gives the number of recorded deaths per year:
Number of recorded deaths by Stats SA

You do not need to be a statistician to be astounded by this. Recorded deaths have increased over 90% in a decade. Improved death registration and population growth can account for only a small portion of this increase. The vast majority of additional deaths are due to the HIV epidemic. A huge body of evidence shows this. For example, there has been a three-fold increase in TB deaths over the same period and TB is the leading cause of death in people with HIV. Also the age pattern of the deaths --younger instead of older adults comprise the bulk of them-- and the drop in the median age of death from 51 in 1997 to 44 in 2007 are consistent with the way AIDS works. (For more detailed evidence see Dorrington et al. 2006, Dorrington et al. 2001 and Stats SA, 2002).

Also noticeable is that the number of deaths appears to have stabilised from 2005 to 2007 and perhaps has even begun to decrease slightly. This is most likely due to the state's antiretroviral (ARV) treatment programme.

Unfortunately because the public sector programme has not been well monitored and there are numerous treatment providers in the private sector, there is not accurate data on the number of people on treatment. But by using several sources of data, including figures published by the Department of Health, medical aid data and public sector ARV procurement data it is possible to make reasonable estimates. Muhammad Aarif Adam of Sanlam and Leigh Johnson of the Centre for Actuarial Research have made plausible calculations of the number of people on treatment in the middle of each year up until mid-2008, shown in the next table (Adam and Johnson, 2009).

Number of people on treatment

The programme began in earnest in 2004 and the stabilisation of the death rate has coincided with it. If you consider that many, perhaps most, of the people on the programme would be dead by now that would easily account for stemming rising deaths. Make no mistake; there has been a massive surge in deaths in South Africa for more than a decade and AIDS deaths continue to be very high; deaths might have stabilised but at a very high number. Life-expectancy declined to the low-50s. At least though, we are implementing the most effective known scientific medical intervention to mitigate the effects of the disease and it now appears that life-expectancy is increasing again.

But many unnecessary deaths occurred because of the delayed rollout of the ARV treatment programme. Two studies have conservatively estimated that former President Thabo Mbeki's AIDS denialist policies cost well over 300,000 lives (Nattrass, 2008; Chigwedere, 2008). Mbeki did not pursue this deadly policy without help though. Officials in government, civil servants and even  some journalists supported his policy, tried to give it legitimacy and for a time succeeded in quashing the demand for a treatment rollout from health workers and AIDS activist organisations, like the Treatment Action Campaign (TAC). Thankfully, we have moved beyond this awful era of South African history.

PS: The last two weeks have seen what I believe is the final death-knell of state-supported AIDS denialism. Both President Zuma and Minister of Health Motsoaledi have delivered important speeches showing their intention to fight the epidemic. On page 35 of his presentation Motsoaledi quoted mortality data for 2008 from Home Affairs which appears to be far too large. I am unaware of how this number was derived and it appears to be an error. In other respects Motsoaledi's speech was excellent and his mistake is of no great importance.

Adam M and Johnson L. 2009. Estimation of adult antiretroviral treatment coverage in South Africa. September 2009, Vol. 99, No. 9 SAMJ
Chigwedere P. 2008. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes. 49(4):410-415, December 1, 2008.
Dorrington R et al. 2001.  The impact of HIV/AIDS on adult mortality in South Africa .
Dorrington R et al. 2006. The Demographic Impact of HIV/AIDS in South Africa .
Nattrass N. 2008. AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa. African Affairs 2008 107(427):157-176.
Statistics South Africa. 2002. Causes of death in South Africa 1997-2001 :  Advance release of recorded causes of death .
Statistics South Africa. 2009. Mortality and causes of death in South Africa, 2007: Findings from death notification.
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'Grave Concern' Over Aids Deaths. 11/11/09


Health Minister Aaron Motsoaledi has unveiled shocking figures showing a huge Aids-related leap in South Africa's death rate - and he's blaming Thabo Mbeki's government.
News 24
Johannesburg - The SA Medical Association is "gravely concerned" about HIV/Aids statistics which show a huge Aids-related leap in South Africa's death rate.

"We have always been concerned on whether it is correct to wait with treatment until a person's CD4 count has dropped to 200 [cells per microlitre]. We believe it might contribute to a higher mortality rate by delaying treatment," Sama's chairperson Norman Mabasa said on Wednesday.

The CD4 count is used to measure the strength of a person's immune system.

Health Minister Aaron Motsoaledi said on Tuesday that in the 11 years from 1997 to 2008, the rate of death doubled in South Africa.

In 2007, the total number of deaths - from all causes - registered in South Africa was 573 408; in 2008 this figure had leapt to 756 062.

Motswaledi pinned the blame for the current scale of the pandemic squarely on the denialist health policies pursued by former president Thabo Mbeki's government.

Mabasa said the treatment threshold of 200 should be lifted to a CD4 count of between 300 and 350, which would be in line with global trends.

"This must apply to both public and private sector, as HIV/Aids does not discriminate. We are cognisant that this step will result in more people requiring treatment and thus there would be financial implications, and government must be committed to it."

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AIDS Programme May Be Reducing SA Deaths 5/11/09


[SSA P0309.3 - Mortality and causes of death in South Africa: Findings from death notification, 2007. Download the report (PDF: 1104 KB]
CAPE TOWN — The government’s AIDS treatment programme may have begun to put the brakes on SA’s rising death rate, a senior official of the Department of Health told Parliament yesterday.
Referring to figures released earlier this week by Statistics SA showing a slight drop in the number of deaths recorded by the Department of Home Affairs in 2006 and 2007, the deputy director-general for strategic health programmes, Yogan Pillay, said: “It might be a data problem or it might be good news. We hope at least in part it’s the ARV (antiretroviral) programme.”
More research was needed to determine whether the figures were part of a sustained downward trend, Pillay said.
Stats SA’s latest findings are important because, while there is plenty of published evidence that ARVs save lives, there has been little South African data showing their effect on the population level.
SA was a late starter with its state- sponsored AIDS treatment programme, largely due to former president Thabo Mbeki ’s doubts about the safety and efficacy of ARV medicines. Despite a fast-growing HIV/AIDS epidemic and rising deaths, the government only started providing ARV medicines in 2004. The programme started slowly, but by April this year more than 700000 people had started treatment at state health facilities. More than 900000 are expected to have been enrolled by the end of March.
Stats SA’s latest mortality report, released on Monday, shows 601133 deaths were registered by home affairs in 2007, a 1,8% drop on the updated 2006 figure. But it is being cautious in interpreting the data.


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HIV, AIDS Infection Among Gauteng Teenagers Decline. 24/10/09

24 Oct 2009

BUA News

Pretoria - The Gauteng Department of Health and Social Development has confirmed the reduction of HIV and AIDS infections among teenagers and children.

The department stated on Friday that the infection in the young people aged 15 to 19 years declined by half from 2 percent to only 1 percent.

"Infections among young children between the ages of 2 and 14 have also declined to 2.2 percent due to the success of the prevention of mother to child transmission programme," the department maintained.

In maintaining the reduction of infection the department has developed plans to further improve its programme on HIV and AIDS this year.

These include training an additional 1 200 health workers in the comprehensive care, management and treatment.

It said greater focus will be given to children by reducing infections, expanding services for orphans including support for child-headed and youth-headed households.

Meanwhile, the department has further reported that the number of people seeking treatment for the disease from provincial public health facilities reached half a million last year as the stigma around the disease wanes and individuals see the benefits of antiretroviral therapy.

"The number of people assessed grew from 450 706 the previous year to 540 115 last year.

"The number of those who qualified and were put on treatment increased by 56 percent from 118 671 to 185 126. More than 16 000 of them were children," the department said.

The department added that the increase in the number of people assessed for treatment corresponds to the increase in the number of sites offering comprehensive care, management and treatment of the disease.

At the beginning of this year, there were 69 sites - hospitals and clinics - accredited to provide treatment.

Anti-retroviral therapy improves the quality of life of people living with HIV and AIDS enabling them to resume productive work and fulfill family responsibilities.

The department further explained that measures to prevent the spread of the disease were stepped up with the provision of more than 150 million male condoms and more than 1.2 million female condoms.

"More than 46 000 pregnant mothers were put on treatment to prevent the transmission of the virus to their unborn babies," the department stated. - BuaNews

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SA National Antenatal HIV and Syphilis Prevalence Survey . 6/10/09

The 2008 report has been released.

This study is done annually at government antenatal clinics in South Africa. Pregnant woman attending these clinics are offered the Elisa test in confidential circumstances.

You can download the 2008 report here (PDF; 3.4MB).

You can find more information about the survey and links to previous surveys here.

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HIV Rate Among Pregnant Women Stays High. 6/10/09


OHANNESBURG, 6 October (PLUSNEWS) - The rate of HIV infection among pregnant women in South Africa has remained stubbornly high at around 29 percent for the third year running, according to government figures released on 5 October.
 The 2008 National Antenatal HIV and Syphilis Prevalence Survey - based on blood samples from 34,000 pregnant women who attended antenatal clinics in 52 health districts - measured HIV prevalence at 29.3 percent, compared to 29.4 percent in 2007 and 29.0 percent in 2006.
 Prevalence among women aged 15 to 24 declined slightly from 22.1 percent in 2007 to 21.7 percent in 2008, but the infection rate among women in the 30 to 34 age group rose from 39.6 percent in 2007 to 40.4 percent in 2008.
 Age was found to be the most important risk factor, with women of 22 years or older significantly more likely to be HIV-infected. In this age group, race was the next most important factor, with 37.6 percent of African women infected, compared to 6.8 percent of white, Asian and coloured (mixed race) women.
 "Prevalence among women aged 25 years and above has stabilized at high and unacceptable levels," Health Minister Aaron Motsoaledi said at the launch of the survey.
 He refused to comment on the success or failure of interventions aimed at combating South Africa's HIV/AIDS epidemic, noting only that the survey was "a useful tool" for observing trends, providing feedback to health workers, and increasing the commitment to an accelerated response.
 The figures revealed wide variations between the country's nine provinces: as in previous years, KwaZulu-Natal Province recorded the highest prevalence (38.7 percent) and Western Cape the lowest (16.1 percent); at district level the disparities were even greater - in some the infection rate was as high as 45 percent, in others as low as 5 percent.
 The survey authors strongly recommended that the health department conduct more in-depth epidemiological surveys to investigate the causes of these wide disparities.
© IRIN. All rights reserved. HIV/AIDS news and analysis:


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Minister: War on Aids Not Lost. 5/10/09

Pretoria - HIV prevalence among pregnant women has stabilised at around 29%, Health Minister Aaron Motsoaledi said on Monday.

"The prevalence among women aged 25 and above has stabilised at high and unacceptable levels," Motsoaledi said in Pretoria, releasing the 2008 results of a survey of antenatal HIV.

He said the report was a useful tool to observe trends and increase commitment to the implementation of government policies, as well as to provide feedback to health workers.

In 2007 antenatal HIV prevalence was 29.4% and in 2008 29.3%.

33 927 took part in survey

About 33 927 women aged between 15 and 49 who attended antenatal clinic in public health sectors participated in the survey.

HIV prevalence in the 15 to 24 year age group declined 0.4% from 22.1% in 2007 to 21.7 in 2008.

The highest prevalence was in the 30 to 34 age group, at 39.6% in 2007 and 40.4% in 2008.

According to the report KwaZulu-Natal has the highest prevalence followed by Mpumalanga, Free State and North West.

Gauteng, Limpopo and Eastern Cape have prevalence of between 20% and 30% while the Northern Cape and Western Cape have lowest prevalence of below 20%.

New ways of responding

Motsoaledi said there was a need to work with academics and researchers to find new ways to respond to the problem.

"What cannot be contested is that the burden of HIV and Aids is now weighing heavily on the shoulders of our country," he said.

He said the findings of the report confirmed earlier reports of the general population survey done by the Human Science Research Council and Medical Research Council that the battle seemed to be lost in KwaZulu-Natal and Mpumalanga.

"We seem to be losing the battle but not yet the war," he said.

The report stated there was a need to report HIV prevalence distribution by geographic area (rural, semi rural and urban) as this would assist in interventions.

Motsoaledi said he was optimistic that the next survey would be "more encouraging".



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Statement of the Minister of Health. 5/10/09

Programme Director
Deputy Minister of Health Dr Molefi Sefularo
Acting Director-General Dr Kamy Chetty
Members of the Peer Review Team
Members of the media
Let me welcome you all to this important event. I am sure that you have been waiting for the release of the 2008 national antenatal sentinel HIV and syphilis prevalence survey because we are all very concerned about the HIV epidemic and its impact on our country.
As we all know, HIV and AIDS continues to be one of the biggest challenge facing us. Over the years, as government, civil society, business and other sectors we have launched individual and joint programmes geared at responding to this challenge. It is not my intention this afternoon to comment on the success or otherwise of such interventions. What I am prepared to say with emphasis is our commitment as this government to continue to work together with all sectors of our society to continue the fight against HIV and AIDS.
Equally important for us is the need to work with academics and researchers as we continue to find new ways to respond to this challenge. It is for this reason that I am encouraged by the presence this afternoon of some of the researchers and academics who were part of our Peer Review team and I wish to thank them for being true patriots and making themselves part of this national effort. I sure that we not going to experience some of the problems we saw last year for instance where the integrity of the survey results were questioned. 
As we launch the 2008 antenatal HIV and syphilis survey Report, I do not want to fall in the trap of making good-sounding statements about whether the signs are good or bad.
The result from the 2008 Report on antenatal HIV and syphilis prevalence survey is a useful tool to observe trends, reinforce or increase the commitment to accelerate implementation, provide feedback to health workers as well as local and international groups involved in AIDS prevention and care programs. For us, the antenatal sentinel surveillance programme remains an important indicator of prevalence in pregnant women who attend public health facilities.
What are some of the more important conclusions that can be drawn from the 2008 findings?
Firstly, South Africa has an established generalised HIV epidemic with an estimated prevalence of 10.6% (HSRC 2008) in the general population and an estimated prevalence of 29.3% in the antenatal population surveyed in 2008.
Secondly, the prevalence among women aged 25 years and above has stabilised at high and unacceptable levels. The age group 15-24 years is important as it is used to estimate new HIV infections
I wish to share with everyone some of the key recommendations made from the findings:
  • The need to report on HIV prevalence distribution by geographic area (rural vs.semi-rural vs urban) because this will assist us to better target our interventions
  • HIV prevalence is a tool that gives us a sense of magnitude of the problem and anticipated disease burden. However, we have to find ways of estimating HIV incidence as a measure of new infections and success of intervention programmes
  • South Africa is rich in data on the HIV epidemic. I wish to encourage triangulation of the available data to increase the explanatory power of the dynamics of the epidemic
As I conclude, I wish to take this opportunity to thank the team for making this survey a success. As a nation we are grateful for the good work that you have done. To researchers and academics I wish to express my Department’s commitment in working with all of you as we find ways to deal with the many health challenges facing us. The challenges are many!
As we move forward, we will take very seriously some of the key points that are raised in this survey and I remain optimistic that the next survey will be even more encouraging.
Thank you very much.


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High Maternal & Child Deaths ‘Not Acceptable’ 10/9/09

About 60 000 children under five die in South Africa every year. Many women die from pregnancy or child-birth related complications, often exacerbated by HIV. The Health Department wants to change the pattern

Health –e  

Living with AIDS # 404

Khopotso Bodibe

The number of women and young children who die in South Africa is incomprehensible given the resources that the government has invested in health care compared to other countries with similar or weaker economies. Predictably, the mortality patterns vary by provinces. For child mortality, the Eastern Cape, KwaZulu-Natal and the Free State have by far the majority of deaths. Gauteng, the Northern and Western Cape contribute the least share of the 60 000 children who die between the ages of one month and five years. Deaths are “due to different reasons, but malnutrition and HIV/AIDS are the key under-lying causes”, according to Dr Neil McKerrow, chairperson of the ministerial review committee on child mortality.

“The children are dying of common, preventable diseases, and if we interrogate this a little bit further, the underlying factors giving rise to child mortality are two-fold in terms of patho-physiological processes… About 60% of children who die are malnourished and well over half of them are HIV-infected, and this 50% of HIV-infected children are those where we know that they are HIV-infected. There’s a proportion of the remainder in whom we suspect, but we haven’t confirmed this fact, and then on top of that we’ve got gastro-enteritis, acute respiratory infections, tuberculosis and sepsis”, says Dr McKerrow.

The country is one of a few countries in the world where child mortality continues to increase. We are not doing well to prevent maternal mortality due to pregnancy or child-birth, either. Just under 2 000 women die in South Africa, annually, as a result - and the number has increased from less than a thousand in 1998.

“The number of deaths has increased and we get about 1 400 deaths per year. KZN has the largest percentage of deaths and that’s because KZN is the most populous and it’s probably the most rural of provinces”, says obstetrician, Professor Jack Moodley, chairperson of the ministerial review committee on maternal deaths.     

The committee found that complications related to hyper-tension are the most common cause of death in women under the age of 20, while women aged 35 and older are more likely to die from obstetric haemorrhage, the occurrence of ectopic pregnancies and pre-existing conditions that the women might have had. These are directly related to pregnancy.  

It was found that among the causes that are unrelated to pregnancy, HIV was the major cause of death. Close to 44% of the 1 400 women died of AIDS-related conditions in the current review.

“The number of deaths from non-pregnancy related infections has increased, and most of these are due to AIDS. We were asked a number of times:

‘What would our maternal mortality ratio be if we, in fact, didn’t have AIDS?’ If you did not have HIV then the ratio would be 31, and obviously, with the HIV, the ratio is 10 times higher.

“It’s definitely not acceptable”, said Health Minister, Dr Aaron Motsoaledi when responding to the reports.

Motsoaledi said, “South Africa has good health policies but the challenge lies with implementing them”.

“I want to hear first-hand from provincial programme managers what the bottle-necks to implementation (are) and what we can do to remove them”, he said, challenging provinces to identify the impediments to policy implementation. 

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Shocking SA Health Stats. 8/9/09

Health 24

Though South Africa spends more on health than any other African country, our health outcomes are worse than those in many low-income countries.
This is among the shocking statistics published in a Lancet review of South Africa. The report blames poor stewardship, leadership and management for the poor outcomes of the health system on all levels.
Among other issues highlighted in the The Lancet online on August 25, 2009, are the following (for the full article, click on the link at the end of the article):
  • Since 1994, average life expectancy in South Africa has dropped by almost 20 years, mainly because of the rise in HIV-related mortality. Average life expectance at birth is only 50 years for men and 54 years for women.
  • South Africa has 0.7% of the world's population, but carries 17% of the global HIV burden. HIV prevalence seems to have reached a plateau, but there are 5.5-million South Africans living with HIV/Aids.
  • The overall injury death rate is 157.8 per 100,000, twice the global average. Road carnage plays a significant part: there are about 16,000 road traffic accident deaths every year. Around 7% of all deaths are alcohol-related.
  • The homicide rate is five times the global average: 38.6 per 100,000 people, with the highest rate among men aged 15 to 29 years. Still, the female homicide rate is six times the global average, and half of these women are killed by their partners. It is estimated that a woman is killed by her partner every six hours in South Africa.
  • Although South Africa and the then minister of health, Manto Tshabalala-Msimang, were signitories of the Millennium Development Goals, which were particularly focused on child and maternal mortality, our children continue to be victims. Far from reaching goals set then, South Africa has gone backward: it is one of only 12 countries in the world where infant mortality has risen since 1990. Every year, 23,000 babies are stillborn, and almost 75,000 children die in SA, nearly a third of these in their first four weeks of life. 12% of our children under 5 are underweight. Each year 37 200 children could be saved through the prevention of mother-to-child HIV transmission and safer infant feeding practices.
  • There are 4.9 physicians, nurses and midwives per 1,000 South Africans, double the World Health Organisation standard of 2.5, but most South Africans are still under-served: medical staff are clustered in urban areas. Not only that, but 79% of doctors in South Africa work in the private sector, where 60% of health spending happens, but which is accessible to just 14% of SA citizens.
  • Depending on what province they live in, only 9% to 28% of South Africans are covered by medical schemes.
  • Though the state's focus on health is significant, comprising 10,8% of total goverment spend, the price the population pays for mismanagement is dire: if the policy of free antiretroviral therapy provision in public health services had been adopted in 2003, 330,000 lives could have been saved between then and now.
  • The burden of TB has more than doubled since the year 2001. KwaZulu Natal is the hardest hit with an HIV prevalence of 39,1% and a TB notification rate of 1,066 per 100,000 people.
(Susan Erasmus, Health24, September 2009)
(Reviewed by Dr Azeem Walele)
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Teen Pregnancies Decreasing, Says Study. 31/08/09

Tebogo Monama

TEENAGE pregnancies have been on the decline though the rate remains unacceptably high, according to a survey released in Johannesburg on Friday.

Provinces that currently showed high pregnancy rates include Eastern Cape, with 69 pregnant pupils per 1000 registered, KwaZulu-Natal with 62 and Limpopo with 60 per 1000 registered.

The study was conducted by the Human Sciences Researcj Council (HSRC) on behalf of the Department of Education.

The report states that the decline can be attributed to increased access to information and improved contraception use. “This doesn’t mean it’s no longer a problem,” Basic Education Minister Angie Motshekga said. She said teenage pregnancy remained a major challenge facing young people in South Africa today as it compromised their futures and their emotional and physical well- being. “ The drop is noted and appreciated,” school governing body spokesperson Mahlomola Kekana said. “But parents need to educate their children about sexuality.”

Motshekga said there was a need to discuss supplying condoms at schools and for promoting abstinence. The department plans to amend guidelines set out in 2007 requiring pupils who give birth to stay at home for two years to care for their babies before returning to school. The results were released the same week that an 18-year-old student at Rakgotso High School in Pretoria gave birth in the school toilets.

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SA ‘Getting Better’ At Protecting Its Children From HIV. 27/8/09

Business Day

CAPE TOWN — SA is making tentative headway in its efforts to protect children from HIV, but much more needs to be done to save lives,a new scorecard from the Catch network shows. The network is an alliance of organisations that work with children and HIV.
“When it comes to children and HIV, we are making some progress, but it is insufficient,” Mark Heywood, deputy chairman of the South African National AIDS Council, said yesterday.
“No one can assume that because (former health minister) Manto (Tshabalala-Msimang) and (former president Thabo) Mbeki are gone, we are doing well, because we are not,” he said.
The scorecard measures progress towards the government’s targets for preventing infections and caring for children affected by HIV, which are detailed in its HIV/AIDS National Strategic Plan.
It shows SA is on track to meet its 2011 treatment targets for women and children, as well as those for preventing infection among teenage girls and providing drugs to HIV-positive pregnant women to reduce the likelihood of transmitting the virus to their babies.
For example, the plan says 93% of teenage girls visiting antenatal clinics in 2011 should be HIV-negative; in 2007 (the most recent year for which data were available) 87% of adolescents tested were HIV- negative, up from 84% in 2005.
The director of the Children’s Rights Centre, Cati Vawda, questioned whether these targets were sufficiently bold, warning that progress towards the goals was no cause for complacency. The figures masked the difficulties still facing many children, she said.
The scorecard also shows SA is below target regarding the number of children under the age of one who are getting the child support grant, and that there are too few social workers to provide the services promised by the Children’s Act. Last year , 38% of children under the age of one were getting the grant, but about 60% of children “would probably have qualified”, says the publication.
Vawda said monitoring SA’s efforts to deal with children and HIV was hamstrung by patchy data. It had proved impossible to determine what proportion of babies born to HIV-positive mothers were free of the virus at three months, and how many children who had been raped were able to get antiretroviral medicines to reduce their risk of getting HIV.
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A Nation Killing Itself. 25/8/09

Results from "‘violence and injuries" paper

25.08.2009 Kerry Cullinan

A Cuban doctor once told me that South Africa’s national sport was hurting one another. The chapter on violence and injuries, South Africa’s second biggest killer after HIV/AIDS, is a chilling reminder of his comment.

Deaths from violence and injuries in South Africa are almost double the global average, while the death rate of South African women killed by their intimate partners is six times the world norm.

 Some 3.5million people seek healthcare for injuries, half of which are caused by violence.

Young men aged 15 to 29 are the most affected, both as victims and perpetrators, with seven times as many men than women dying in homicides. The “Coloured” population is also disproportionately affected by homicides.

 Women were more likely to be killed by their male intimate partners than by strangers, especially those aged 14 to 44.

 Alcohol features prominently in almost violent attacks. Some two-thirds of women murdered by their partners in the Western Cape had high alcohol rates in their blood, according to a study.

 Child homicides are double those of other low income countries, with boys aged 10-14 most in danger of being killed.

 More than 40% of men admitted to being physically violent towards their partners, while 88% of Soweto women reported either physically or psychological abuse by partners.

 Although the murder rate in the country has been reduced, there has been little reduction in the rape rate and a random population-based sample found that over a quarter of men (27.6%) admitted to having committed rape. Most men first rape before the age of 20, and half of these will rape again. Up to 14% of men admit to taking part in gang rape.

 In 2003 in Gauteng, one in 35 rape cases reported involved victims aged between one and three years old, while 40% were under the age of 18.

 Almost four in 10 girls report experiencing sexual violence before the age of 18, and most of this is not reported to the police.

 “Girls exposed to sexual abuse as young children are at increased risk of being raped again in childhood and of experiencing intimate partner violence as adults,” note authors Prof Mohammed Seedat and colleagues.

 “Boys who have been sexually abused in childhood are at risk of later becoming sexual abusers.”

 In addition, many children witness violence, with 35 to 45% of children having seen their mother being beaten. Boys who witnessed this were more likely to beat their partners.

 South Africa’s road traffic death rate is also nearly double the global rate, and this has steadily increased since 2003. In 2007, four out of 10 traffic deaths were of pedestrians and deaths usually peaked over weekends.

 Again alcohol played a prominent role in traffic deaths, with over half dead pedestrians and almost half the drivers who killed them over the legal limit.

 “Alcohol misuse, and in some parts of the country drug misuse, are major factors underlying homicides, intimate partner violence, rape, abuse of children, road deaths and other unintentional injuries,” note the authors.

 They estimate the “health and social cost” of alcohol misuse to be R9-billion a year.

Excessive speed was the main culprit in 30-50% of public passenger and heavy commercial accidents.

 “Income inequality, low economic development and high levels of gender inequality are strong positive predictors of rates of violence and injury,” note the authors.

 The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement.

 In addition, during apartheid there was very little common-law policing particularly in historically black areas and some properly crimes were justified as “redistribution of wealth” and “in general, people resisted abiding by laws.. consequently lines between criminal and community were blurred and an ambiguity about enforcement emerged”.

 Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, the authors say that there has been a “conspicuous absence of government-promoted stewardship and leadership”.

 The authors conclude: “The government should identify reduction in violence and injuries as a key goal and to develop and implement a comprehensive, national intersectoral, evidence-based action plan.”

 Inventions must address youth unemployment, gender inequality, intergenerational violence, excessive alcohol consumption and uncontrolled access to firearms. – Health-e News

 * The ‘violence and injuries’ paper was written by Mohamed Seedat, Ashley van Niekerk, Rachel Jewkes, Shahnaaz Suffla and Kopano Ratele.


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AIDS Might Account for as Much as 61% of Deaths in South Africa. 17/8/09

AIDS-related deaths have been miscalculated in South Africa and could be responsible for as much as 62 percent of deaths in that country, according to a University of Stellenbosch, South Africa, study reported on by the Harare Tribune.
The study revealed that AIDS-related deaths are presently being incorrectly classified as pneumonia or diarrhea on death certificates. The primary cause of death was compared with medical records of 683 deaths in the South African townships of Bonteheuwel and Langa between June 2003 and May 2004. Of 129 AIDS-related deaths, only about 27 percent were actually attributed to AIDS on death certificates.
Although the new research shows that HIV/AIDS loss is as high as 61 percent, previous South African statistics estimate the death rate to be 2.4 percent.
“Underestimating the full impact of HIV/AIDS influences policies, and more importantly, how budgeting for HIV/AIDS is done,” said Lené Burger, MD, of the University of Stellenbosch.
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Maternal Death Rate Five Times Higher In Women With HIV, South African Audit Shows 10/8/09


Maternal mortality ratios in Johannesburg, South Africa in HIV-infected women are more than six times higher than in HIV-negative women despite integration of antiretroviral treatment into prenatal services, reported Vivian Black and colleagues in a five-year audit published in the August 2009 issue of Obstetrics and Gynecology.
If the United Nation’s Fifth Millennium Development Goal (MDG) of reducing maternal mortality by 20% by 2015 is to be reached the causes of maternal mortality as well as of preventable contributing factors need to be clearly understood.
The global maternal mortality ratio of 400 per 100,000 live births as estimated by the World Health Organization does not reveal the considerable regional variations.
In 2005, South Africa—a middle income country—had a ratio close to the global average but considerably higher than countries of similar gross domestic product per person, for example, Portugal and Brazil which had a ratio of 11 and 110 respectively.
Since 1998 HIV, an indirect cause of maternal mortality, has been the leading contributor to maternal mortality in South Africa, reversing previous declines seen in maternal mortality rates.
An audit of maternal deaths for the period 1996-1998 in Durban, South Africa showed facility-based maternal mortality rates for women with HIV to be 323 per 100,000 compared to 148 per 100,000 for those not infected - over two times higher. Co-infection with tuberculosis had a considerable impact on outcomes.
The authors noted that HIV prevalence among women attending antenatal clinics has remained steady at between 28% and 33% over the past four years.
The authors reviewed maternal deaths at a tertiary level facility in Johannesburg, Gauteng Province, for the five-year period from 2003 to 2007. Variables of interest included: deaths due to HIV, the patterns of these deaths and changes over time. Antiretroviral therapy became available in 2004 and was integrated into an existing programme for prevention of mother to child transmission (PMTCT) in the prenatal clinic of the hospital at the facility. The authors assess its impact on maternal mortality.
HIV testing and counselling is offered at the first prenatal visit and CD4 cell counts done for those who test positive. Eligibility for antiretroviral treatment is based upon a CD4 cell count <200 cells/mm³ or WHO clinical stage 4. Women receive the standardized ART regimen of stavudine, lamivudine and nevirapine, along with cotrimoxazole prophylaxis. Single-dose nevirapine (for both mother and infant) was given for prevention of mother to child transmission during the period under review, prior to the updating of South African guidelines.
Patient case files, birth registers, death certificates and mortality summaries were reviewed. Maternal death was defined as death of a woman at the facility during pregnancy or within 42 days of childbirth. No information was available for women who died at home or at another facility. Cause of death was determined through multidisciplinary clinical case discussions. Annual maternal mortality ratios were calculated and disaggregated by HIV status.
For the period 2003 to 2007 a total of 108 women died and had a mean age of 28.7 years. It was the first pregnancy for eleven percent, a third of the proportion of all women in their first pregnancy delivering at the hospital.
HIV test results were available for 72 % (76); almost 80% were HIV positive. The median CD4 cell count for 53 of HIV infected women who had the test was 72 cells/mm³ (interquartile range: 29-194 cells/mm³).
Only two of the HIV-infected women had begun antiretroviral therapy. The authors note this clearly demonstrates that missed opportunities for starting treatment persist.
Most deaths were associated with advanced HIV disease, the most common causes being tuberculosis (36%) and pneumonia (20%). Median CD4 count in women whose death was due to an HIV-related illness was 50 cells/mm³ compared to a median of 335 cells/mm³ in HIV-infected women who died of non-related HIV causes.
The authors argue that most of the HIV-related deaths could have been avoided if ART and cotrimoxazole prophylaxis had been started. In HIV-negative women or those of unknown status deaths were overwhelmingly due to obstetric causes with hypertension accounting for over 50%.
While the number of deaths over the five year period ranged from 15 to 25, the number of live births remained constant at around 7,000 per year.
The authors note that while coverage of HIV testing increased each year (women in 2007 were 3.4 times more likely to have a known HIV status (95% CI 3.2-3.6) than those in 2003) HIV testing and follow-up after diagnosis remained the most significant programmatic weakness.
The authors suggest that systematic evaluation of the processes of HIV testing and care for pregnant women could be useful and might include: “assessment of performance against predefined criteria and agreed targets, for example, routine provider-initiated HIV testing, provision of CD4 results at the second prenatal visit, a target time of three weeks from first visit to antiretroviral treatment initiation and active follow-up processes to ensure that women with advanced HIV disease are retained in care”. The authors highlight the use of mobile phone technologies as an effective means of follow-up in this setting.
While the numbers of women who began ART increased over time, with coverage in 2007 estimated at 59.2%, the maternal mortality ratio for HIV-infected woman was over six times higher than the ratio in HIV-negative women (776 versus 124 per 100,000), or 6.2 (95% confidence interval 3.6 - 11.4).
44.3% (95%CI 30.8-54.8%) of total deaths were due to HIV. The mortality rate among HIV-infected women who died of non HIV-related causes was 171/100,000, similar to that of HIV-negative women.
The authors note the importance of expansion of ART to two primary health facilities close to the hospital led by nurses and midwives. Advantages include ensuring high level coverage, bringing HIV care closer to the patient and potentially avoiding unnecessary referrals to tertiary care. They stress that integration of ART into prenatal care will help secure both the health of women as well as prevent transmission to newborns. Others factors the authors cite as barriers to uptake of prevention of mother to child transmission are: the framing of PMTCT itself as a paediatric issue, weak health systems, poor communication between health workers and pregnant women as well as the fear of stigma.
Nearly three-quarters of all deaths occurred in the week after childbirth, and the authors stress the importance of strengthening postnatal health services.
The authors note that statistically, maternal deaths are rare, which makes understanding the effects of new interventions difficult. Comparison of facility-based deaths with other institutions may not be feasible since a disproportionately higher number of difficult pregnancies are referred to them increasing the probabilities of a higher mortality rate. The authors note too that their findings may be the result of changes over time and not necessarily the introduction of ART.
They conclude “Although it was not possible to demonstrate that the integration of antiretroviral treatment within prenatal care services has reduced maternal deaths, provision of antiretroviral treatment into prenatal care remains an important strategy for reducing maternal deaths in high HIV-burden countries. Interventions, such as clinical audits, are required to target weaknesses in HIV treatment and care within maternal health services”.
Black V et al. Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: A 5-year audit. Obstetrics and Gynecology 114 (2), 292-299, 2009 (full text freely available here).
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Giving Birth In SA Gets Riskier. 29/7/09

M & G Online

Deaths of pregnant women have soared by 20%, but more than a third of them could have been prevented.
Among healthcare providers, poor assessment of health problems and failure to follow standard health protocols are the most frequent causes of these deaths.
These are major findings in a report by the government-appointed National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD). The department of health silently posted the report on its website this month without any public notification.
The report is based on maternal deaths in all health institutions from 2005 to 2007 that were reported to the NCCEMD. "Maternal deaths" are defined as "deaths of women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes".
In this period 4 077 maternal deaths were reported, up 20% from the 3 406 deaths reported during 2002 to 2004. The majority of these occurred in public health institutions but the report does not specify how many.
The report states that the 4 077 deaths may be an underestimate as most maternal deaths occurring outside of health institutions are not reported to the committee.
In rural areas maternal deaths occurring in health institutions vary between 20% and 66%, the report estimates. Of the 4 077 maternal deaths reported, 38,4% of them were "clearly avoidable", the report says. Four out of five of these deaths were because of complications of hypertension, pregnancy-related sepsis and non-pregnancy-related infections.
The top five causes of maternal deaths were non pregnancy-related infections, complications of hypertension, obstetric haemorrhage, pregnancy-related sepsis and pre-existing maternal disease. HIV infections were the biggest killer, accounting for 43,7% of maternal deaths. "The ways to prevent these deaths are known," the report says. "Specific protocols have been developed … Despite this, the most important avoidable factor is still substandard care."
The lack of appropriately trained staff contributed to 9% of assessable maternal deaths and was a factor in 22,4% of anaesthetic-related deaths and 17,5% of obstetric haemorrhage cases. Incorrect diagnoses, delays in referring patients and infrequent monitoring of patients by health workers were common problems.
These occurred most frequently in community health centres and district hospitals and least in provincial tertiary and national central hospitals. The report contains no data on staff-related problems in private health institutions.
Other major problems include the lack of patient transport and of ICU facilities -- factors in more than 8% of maternal deaths. A lack of blood for transfusion was reported in 19% of cases. Patient-related avoidable factors such as delays in seeking help and lack of attendance at antenatal clinics were recorded in 46% of cases.
The report also underlines the mounting impact of HIV/Aids on maternal deaths. Seventy-nine percent of maternal deaths tested between 2005 and 2007 were HIV positive and Aids-related illnesses accounted for 43,7% of maternal deaths reported during this period.
Marion Stevens of the Health Systems Trust, a health research and activist NGO, says the intersection between HIV/Aids and maternal deaths is a major cause for concern. "While we have seen improvements in the prevention of mother to child transmissions, treatment is poorly conceptualised. At present pregnancy is an incentive to get HIV/Aids treatment. We need to better integrate HIV/Aids, sexual and reproductive health services."
She added that it was unlikely that South Africa would meet the Millennium Development Goal to reduce maternal deaths by 75% by 2015.
The NCCEDM calls for the continuous scaling of ARV therapy and HIV testing and counselling.
It stresses the urgent need for emergency transport facilities to be made available for all pregnant women. Delays in seeking medical help were recorded in nearly a third of cases of maternal deaths, with the most common reason being the lack of transport between the woman's home and a healthcare institution.
The report further recommends training for all health professionals in maternity units and the provision of comprehensive care to pregnant women, including screening for HIV, malaria, anaemia and cardiac disease.
Jagidesa Moodley, chairperson of the NCCEMD, declined to comment on the report. The department of health had not responded to questions at the time of going to press.
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HIV/AIDS Exacts Toll On SA, With 5,2-Million People Infected — Stats SA. 28/07/09


SA’s population growth rate slowed for a second consecutive year over the past 12 months as the number of people dying of AIDS-related diseases increased, figures released yesterday by Statistics SA show.
The population rose 1,07% to 49,3-million in June from a year ago, Stats SA said yesterday.
The growth rate eased from 1,1% over the previous 12 months and 1,38% in 2001-02.
The growth rate for females was lower than that of males. SA’s 25,45-million women make up 52% of the population.
The number of people living with HIV increased from an estimated 4,1-million in 2001 to
5,2-million this year.
For adults aged 15-49 years, an estimated 17% of the population is HIV-positive.
“For 2009, an estimated 10,6% of the total population is HIV-positive.” About one-fifth of SA’s women of childbearing age are HIV-positive.
For this year Statistics SA estimates that about 1,5-million people aged 15 and older and 106000 children will need antiretroviral treatment.
The total number of new HIV infections for this year is put at 413000. Of these, an estimated 59000 will be among children.
Of the general population, blacks are in the majority (39,14- million) and constitute just more than 79% of total population.
The white population is estimated at 4,47-million, the coloured population at 4,43-million and the Indian population at 1,28- million.
Gauteng has the largest share of the population, at 10,53-million people or 21,4%.
KwaZulu-Natal has the second- largest population, with 10,45- million people (21,2%) living there.
With a population of about 1,15- million people, or just 2,3% of the total, the Northern Cape has the smallest share.
At midyear about one-third of the population was aged 0-14 years and about 7,5% was older than 60.
Life expectancy at birth is estimated at 53,5 years for males and 57,2 years for females. The infant mortality rate is estimated at 45,7 per 1000 live births.
Bloomberg, Sapa
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Healthcare in Reverse. 12/7/09

 Mail & Guardian Online

South Africa is failing on the most basic international measures of poverty and healthcare, especially regarding infant and maternal mortality.
Speaking this week at the release of this year's District Health Barometer, the annual report produced by research and advocacy NGO the Health Systems Trust, Dr Molefi Sefularo, the deputy health minister, said South Africa is moving backwards on the United Nations' millennium development goals (MDGs) and preventative healthcare.
The report quantifies levels of deprivation across 52 districts in South Africa by looking at factors such as access to piped water, sanitation, electricity and housing.
The most deprived districts are KwaZulu-Natal and the Eastern Cape, where between 63% and 82% of households live on less than R800 a month.
In addition, deprivation levels in the City of Tshwane and Ekurhuleni metros increased dramatically in the past year.
In KwaZulu-Natal about half the population has no access to piped water and only 5.6% of people have medical aid. "This is a clear indication that the health department should make a conscious effort to allocate more resources to these provinces," District Health Barometer co-editor Candy Day said.
"We're doing particularly badly with regard to MDGs for the prevention of mother-to-child transmission of HIV," Sefularo said. The report showed the Free State recorded declining Nevirapine coverage rates in public clinics for the second consecutive year. Nevirapine is an antiretroviral drug (ARV) used by HIV-infected pregnant women to prevent their babies from contracting the virus during birth.
According to the British medical journal, The Lancet, South Africa's child mortality rate rose from 60 to 69 deaths in 1 000 live births between 1990 and 2006 -- one of only 11 countries in which this figure has deteriorated since the UN set its MDGs. Marion Stevens of the Health Systems Trust said the country's poor performance could be an effect of HIV/Aids.
In Gauteng four of the province's six districts and three of its six metros were found to have among the lowest primary healthcare utilisation rates in the country. Although this would seem to indicate a lack of confidence in the public healthcare system in the province, Day said a more accurate conclusion could be that Gauteng residents have greater access to medical aid and tend to use tertiary healthcare facilities instead of primary healthcare centres.
Nurses' clinical workload -- the average daily number of patients seen by a professional nurse at a primary healthcare facility -- was identified in the report as "probably the single most important factor in the delivery of primary care". Although the national average for the number of patients seen daily by nurses is 23.7, some districts in Limpopo report fewer than 15 patients a day.
On the other hand, Fezile Dabi district in the Free State has a nurse clinical workload of 44.2. On an average work day of eight hours that includes an hour for lunch and an hour for tea breaks, a nurse is left with eight minutes to spend on each patient.
"But nurses rarely have that much time," said Stevens. "They don't just see patients -- they also have to do administration and sometimes even ferry patients around."
"When you are seeing so many patients, the quality of care will obviously drop," said Thembeka Gwagwa, the president of the Democratic Nursing Organisation of South Africa. There should be a greater focus on recruiting and also retaining nurses, the union said.
Two indicators absent from the report were doctors' clinical workload and access to ARVs. "Despite these being high-profile areas, the data quality has been particularly bad," Day said, adding that ARV uptake had not been well measured across provinces.
The report used information from the Department of Health, Stats SA, the treasury and other sources to evaluate the performance of the public health sector to try to "put the best data out there and open it to further research", Day said.
Sefularo specified health information systems as one of two areas the government needs to improve, as well as "the health profile" of all South Africans. 
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Rape Linked to Manhood in SA. 09/07/09

July 09, 2009

Dumisani Rebombo had not been circumcised, did house chores considered girls' work and was sick of being taunted for not being a man. So he took the only other course considered "manly" in his rural South African village: he raped a girl.

He was 15, the victim younger. Twenty years later he searched for the woman to beg her forgiveness - a rarity in a nation where a culture of sexual violence is deeply embedded in society.

Rebombo agreed to share his story with The Associated Press as researchers presented findings Thursday at an international conference outside Johannesburg that more than one in four South African men surveyed admitted to committing rape.

South Africa has one of the highest incidences of rape anywhere.

About 100 women raped per day
Police reports show some 36,000 women were raped in 2007 – nearly 100 per day. But many attacks go unreported because of the stigma and trauma.

"Rape is an expression of male sexual entitlement," said Rachel Jewkes, chief researcher of the survey. "South Africa is an immensely patriarchal society. The history of the country has shaped the dominant forms of South Africa's racially-defined masculinities."

Preliminary findings of the report, carried out by the respected government-funded Medical Research Council and released last month, were met with horror. But many gender and human rights activists were not surprised.

Story of many men
"This tells the story of many boys, of many men," said Rebombo, now a 48-year-old divorced father of three.

His experience underscores the deep cultural roots of the problem in a country blighted by violent crime and the devastating emotional, social and economic legacy of apartheid's brutal racial segregation.

When Rebombo was a teen he was cruelly taunted for not being "a man".

Circumcision is considered a rite of passage in some tribes - but his father had almost been killed in the often unsanitary and brutal operation, and swore his son would not be abused that way.

So Rebombo was subjected to daily, constant jeering. "I was viewed as not man enough," said the large, soft-spoken man. One way to prove manhood was rape.

Teach the girl a lesson
Other boys pressured Rebombo to "teach a lesson" to one girl who did not want to go out with them. He resisted, fearful of his religious parents and their good standing in the community. Then he relented and a date was set. That Saturday, Rebombo was plied with beer and marijuana to overcome his trembling.

"I had difficulty breathing ... I had never had sex before. I was terrified."

The girl was brought to a field and Rebombo and another boy were left with her.

"He started raping her. She fought him. I was just there, dizzy with all the stuff. He just stood up and said: 'Your turn'. I was there on top of her," he said, making a rocking motion with one hand.

Afterwards, "she just ran home," said Rebombo. He said he could not even recall after the rape if he had had an erection.

Guilty, and fearful she would tell, he avoided her and a year later moved to another village.

Working to help stop violence

In Johannesburg in 1996, working for a faith-based organisation involved with unemployed mothers, he was struck by the women's tales of abuse and bruises testifying to it. He started working with men to help stop the violence.

"That forced me to do my own introspection," he said. "I felt I needed to go find her and apologise."

So he went back to his village and tracked the woman down. "I told her what I did those years back was wrong and I am here to ask for forgiveness."

Through sobs, she told Rebombo she had since been raped by two other men. Married with children, she kept the assaults secret, but sometimes cringed when her husband touched her. Her life had never been the same, she said.

But she accepted Rebombo's apology and forgave him, saying it was difficult.

She also left him a task. "She told me: 'Maybe you could teach other men out there not to do the same thing'."

Today, Rebombo works for the Olive Leaf Foundation, helping parents and children deal with challenges including HIV/Aids, abuse and sexual violence.

"If more men would stand up and say 'this is wrong', the better we can fight this carnage," he said.

Rape deeply embedded

Rape in South Africa is "deeply embedded in ideas about manhood", according to the study presented at the conference outside Johannesburg.

Researchers at this week's conference acknowledged the sexism inherent in most cultures but highlighted the strong patriarchal nature of African culture.

In South Africa, many blame the rape statistics on the violence, repression, poverty and psychological degradations of the white supremacist, apartheid regime that ended 15 years ago.

"Apartheid made violence an instrument of control and violence became the norm," said gender rights activist Mbuyiselo Botha. "Men would feel emasculated." Angry and humiliated, they took out their frustrations then - and still today - on the weakest victims, women and children, activists say.

Highest HIV rate in the world
Some 5.2 million of South Africa's 50 million people are infected with HIV - the highest rate in the world.

Despite one of the world's most advanced constitutions on human rights, traditional attitudes demeaning women persist and are perpetuated by the words and actions of leading figures in South Africa.

President Jacob Zuma, a proud polygamist with three wives, was acquitted of rape in 2006, but only after he acknowledged having unprotected sex with the HIV-positive daughter of a family friend.

Zuma's remarks about women, sex and Zulu culture caused major controversy and there were ugly scenes outside the courtroom with his supporters burning pictures of the woman.

While Zuma now speaks against violence against women, the trial did "tremendous damage" to efforts to encourage more modern attitudes toward women, Botha said.

"Fifteen years into democracy one had begun to think that life had started to normalise. This was a wake-up call."

Chief researcher Jewkes said rape in South Africa was "significantly associated" with childhood trauma and "abnormal" family structures caused by one or the other of the parents being forced to leave the household to seek work.

Apartheid destroyed families

"Apartheid really destroyed South African families," she told AP.

Only a third of the men in their sample said their fathers were often or always at home while two-thirds said their mothers were. "We know that if children are being raised by relatives they are much more vulnerable to being abused," Jewkes said, adding that 60% of women who report rape are assaulted by someone they know - with children this figure goes as high as 80%.

Researchers, who gave no margin of error, interviewed men from some 1,700 households from a representative cross-section of the population in rural areas in South Africa's Eastern Cape and KwaZulu-Natal provinces.

Daily headlines of rapes point to botched investigations and more humiliation for women.

On Monday, the daily newspaper The Star carried a front-page story about a convicted rapist given a four-year jail sentence. The judge said he was being lenient because the perpetrator was "well-educated" and his victim was "a grown-up woman" who had been hitchhiking. – (Sapa-AP)

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South Africa Fights Rape Crisis 30/6/09


JOHANNESBURG, South Africa (CNN) -- Alexandra township, north of Johannesburg, is a densely populated melting pot with some of South Africa's worst social ills: poverty, unemployment, HIV/AIDS and crime.
One of the most common crimes in Alexandra Township --- and throughout the country --- is rape.
A recent survey by the Medical Research Council of South Africa, a statutory government funded body, found that one in four South African men has raped at least one woman in their lifetimes. And that nearly half have raped more than one woman.
We talked with some Alexandra Township men who openly admitted they have raped and speaking to them it became clear that at the time they committed the crime they did not see it as wrong.
They have grown up watching male members of their community treat women with contempt, they told us.
Beating women, raping them and treating them like second class citizens -- that is what they have grown up believing was the right way to treat females.
One of the men -- whom CNN agreed not to name -- told us that he and three friends gang-raped a girl they met a party.
"With me it was not a problem," he said, "but when I went to the bathroom having to find the third guy busy with her it was like I had a problem because she was crying, she was not happy."
His friend added: "I would tell myself that there is nothing I want in life that I can't get, even a beautiful woman because when you try your luck with them, their response makes you feel like you are nothing. That's why we decide to do things like this, having sex with them forcefully."
The men we talked to have all spent time in jail but have never been convicted of rape.
Zwelithini Sono, a former defense lawyer who now helps rape victims, says he has never lost a rape case.
"Police inefficiency, criminal justice backlogs, ill prepared prosecutors who in some instances are really not sensitive about the cases and the kind of trauma that the victims are normally exposed to, and the time that it takes between arrest and the prosecution or even finalization of these cases is really too much for some of the victims to even be able to stay in the system and ensure that they finally get the justice," said Sono.
He says he reached his breaking point in 2005 after securing yet another acquittal for a rape suspect -- who then admitted to a friend that he committed the crime.
Sono now provides legal assistance for rape victims and counsels young men about the seriousness of violence against women.
He says apartheid is partly to blame for the way young men in South Africa have been socialized. It institutionalized violence, broke up homes and left boys without good role models to teach them right from wrong, he said.
"There has not been enough conversations with men to try to sensitize them on the violence of rape, how sensitive women are and the kind of love that we can actually share."
Andile Gaelesiwe is a rape victim who is also trying to change the culture by encouraging women to speak out.
She was raped by her father at the age of 11 and again by a taxi driver in her late teens. She says the stigma and shame of rape is what forces most women including herself to keep it a secret.
She said: "It's usually somebody that you know -- an uncle, a neighbor -- and therefore families would rather say, 'What are people going to say if we turn around and say Uncle-so-and-so did it? Let's rather we shut up about it.'
"Other families, especially in the rural areas, will go as far as saying the accused's family or the actual accused pays some kind of damage to this family as if to say that this girl who has been raped will now be healed because the two families have had an understanding."
She publicly revealed her experience in 2003 when a caller to the radio station where she worked threatened to kill herself after being raped.
Attitudes may take years to transform but both Sono and Gaelesiwe are among South Africans trying to turn the tide of abuse.
"There can be a change of mind-set. If we put processes together, there will be a battle that we are going to win, and that is to provide our women and children with the best support, with love that they wish for each and every day," Sono said.
The South African government's efforts to deal with the scourge have been criticized as uncoordinated and unsustainable. They include establishing courts sensitive to sexual violence.
It is a battle government alone will not be able to win and hence the importance of involvement by people like Sono.
The young rapists we met have attended Sono's session and they tell us they do not see themselves violating women ever again.
"One thing that especially us black people need is studies about humanity," one of them said, "so that I can see my sister as my sister and let not that thought come into my mind."
They now believe that part of the answer lies in women being strong enough to face their accusers in court.
But in South Africa this takes courage and is even harder when a victim does not have support from her family or community.
According to the latest police statistics 36,190 women were raped between April and December 2007 -- more than 130 rapes a day.

But these were the reported cases. Human rights activists believe the majority of rapes in South Africa go unreported.

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Way of Life? 23/06/09

Marianne Thamm

How would the media react if Michelle Obama, Grace Mugabe, Sarah Brown or Carla Bruni–Sarkozy had been violently gang–raped, asks Marianne Thamm.

While it would most certainly be easier to pretend it's not true, we have to face the horror of the findings of a recent Medical Research Council study that one in four South African men have admitted to rape.

In his column in The Weekender, Jacob Dlamini, writes about how difficult it is for him, as a South African man, to face up to and come to terms with these really outrageous statistics and what they say about us as a society.

"Is it possible that so many of us are such vile and evil bastards. How can it be that so many of us can be so bestial?" he asks in exasperation.

Dlamini suggests that South Africa is a country at war with itself and that women and children bear the brunt of this "brutal but undeclared war".

Dlamini, along with the courageous and outspoken gender activist, Mbuyiselo Botha, represent some of the good men in this country who are not afraid to face up to the reality and who are trying to find new ways of dealing with it.

The point is that rape is so much a part of our lives – the monster in the room is so huge – that we seem almost paralysed and numbed by it.

Even President Jacob Zuma's family has not escaped. In 1999 four young men attacked, assaulted and gang–raped our First Lady, Sizakhele Khumalo, at the president's homestead in Nkandla.

The men, Bernard Mabaso, Xolani Mkhize, Siphiwe Zulu and Piet Duma, were sentenced by an Mtunzini magistrate to sentences of between 30 years, life imprisonment and six years.

The point is, imagine the public reaction had the same thing had happened to other politicians wives or First Ladies of the world? How would the media have responded if this had happened to Michelle Obama, Grace Mugabe, Sarah Brown, Carla Bruni–Sarkozy?

There is something about the silence that surrounds MaKhumalo and the ordeal she has survived that speaks to the deep trauma women in this country are forced to live with.

While she might have opted to remain silent herself, the fact that the gang rape has hardly been debated or discussed in public points to a larger malaise.

The fact is we expect South African women to shut up and carry on. The underlying attitude is that rape cannot be that bad, that it is only unwanted sex. And because we don't really view rape as a serious infringement of a woman's human rights and dignity, we expect her to forget about it, move on and stop reminding us of something we'd rather not face. That's if she doesn't get murdered of course.

That MaKhumalo's own husband has been accused and acquitted of rape does not help to clarify matters either. We need very brave men like Mbuyiselo Botha and the Reverend Bafana Khumalo to keep talking, keep asking and to keep being horrified.

We need men like these to expose where young boys and men in this country are learning or picking up that women can be used, abused and violently disrespected. It is not something that is in the water or the atmosphere. There must be a source to these toxic attitudes.

What are young men told about women and their relationship to them during initiation rituals? For too long we have been told that this part of our culture is a taboo and cannot be spoken about in public. Why? If it is the proud transition from boyhood to manhood why should it be a secret and hidden? Why should women, who are expected to live with men, be excluded from the process? We are the mothers of the sons who will emerge as men. We are the women who must live with them.

And as for the men who do not find manhood through these common rituals, we need them also to question and speak out when attitudes or views that render women as "less than" are reinforced or encouraged – even when religion is used to do so.

Jacob Dlamini bravely explores his initial feelings of "unease" about what the survey reveals and then goes on to admit "I suspect my uneasiness comes from its dire implications. The report, if true implies that most of the men I know are rapists and that some of them have raped more than once. This is an uncomfortable thought to come to terms with. I find it difficult to accept the fact that I and the men I know could be potentially some of the faces and names behind the statistics."

For now, in the absence of a collective outrage, we need good men to show us that they do not support or agree with the bad boys and men.

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Study Links South Africa Rape Incidence to Macho Culture. 19/06/09

June 19, 2009

South Africa’s male-dominated culture is contributing to that country’s high incidence of rape, according to a study from the South African Medical Research Council (MRC) and reported on by Reuters.

According to the study, 28 percent of male study participants admitted to raping someone. Of those, 19.6 percent were HIV positive. Study author Rachel Jewkes says that more must be done to end abuses against women, which she affirms is driving the rate of new HIV infections in the country. She acknowledged that fighting gender inequality by revamping South Africa’s criminal justice system would not be enough. 

“Fundamentally, rape is a problem that stems from ideas of manhood in South Africa,” said Jewkes, who heads MRC’s Gender and Health Research Unit. “The position of men is superior to women in a patriarchal society and legitimates men’s behaviors towards women, predicated on ideas of sexual entitlement and behaviors that demonstrate men being in control over women.”

In addition, men who admitted to committing rape were more likely to have had more than 20 sexual partners, have had sex with a sex worker, raped a man and not used condoms consistently in the past year.

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Understanding Men’s Health and Use of Violence: Interface of Rape and HIV In South Africa. 19/06/09


South Africa has one of the highest rates of rape reported to the police in the world and the largest number of people living with HIV. The rate of rape perpetration is not known because only a small proportion of rapes are reported to the police. There is considerable concern about the links between these two problems. Obviously HIV can be transmitted in the course of rape and this compounds the human rights violation of the rape.

Research has established that men who rape and are physically violent towards partners are at more likely to engage in sexual risk taking than other men and this has raised a concern that they are more likely to be infected with HIV. The aim of this research was to understand the prevalence of rape perpetration in a random sample community-based adult men, to understand factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV.

Download the Report (PDF 91.03 KB)


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1 in 4 SA Men 'Rapists'. 19/06/09

One in every four South African men have raped a woman, according to a shock report issued by the Medical Research Council.

June 19, 2009

Health 24

What's more, 4,6% of the men interviewed had raped in the past year. Almost 8% of the men said they had raped more than 10 women or girls.

The study was conducted in three different regions in the Eastern Cape and KwaZulu Natal, and included men of all racial groups, ages and socio-economic backgrounds. Interviews were completed in 1,738 households. Electronic devices enabled researchers to gather the data anonymously.

Shocking rape statistics

More than 1 in 4 men interviewed (27.6%) had raped a woman or a girl in the past year.

Almost 10 % of all men interviewed said they had raped with one or more other perpetrators when a woman didn’t consent to sex, was forced or when she was too drunk to stop them.

Rape of men and boys was also reported, and 2.9% said they had done this.

Attempted rape was reported by 16.8% of men and 5.3% of men said they had done so in the previous 12 months.

Patterns of rape
Nearly one in two of the men who raped (46.3%) said they had raped more than one woman or girl.

In all, 23.2% of men said they had raped 2-3 women, 8.4% had raped 4-5 women, 7.1% said they had raped 6-10 and 7.7% said they had raped more than 10 women or girls.

When asked about their age at the first time they had forced a woman or girl into sex, 9.8% said they were under 10 years old, 16.4% were 10-14 years old, 46.5% were 15-19 years old, 18.6% were 20-24 years old, 6.9% were 25-29 years and 1.9% were 30 or older.

Factors associated with raping

Men aged 20-40 were more likely to have raped than younger or older men.

Men who had raped were significantly better educated, although they were not more likely to have a tertiary qualification.

Racial differences
There were significant racial differences in rape reporting, mostly notably men who were Coloured were over represented among those who had raped.

Men who had raped were significantly more likely to have earnings of over R500 per month, although they were not more likely to be in the top income bracket, over R10 000. Men who raped were more likely to have occasional work, and less likely to have never worked at all.

Family ties
Parental absence was significantly associated with raping, as was the quality of affective relationships with parents was related to raping. Men who raped perceived both their fathers and mothers to be significantly less kind. Rape was associated with significantly greater degrees of exposure to trauma in childhood.

Teasing and harassment were reported by many of the men in their childhood. Over half of the men had experienced this themselves (54%) and somewhat fewer (40%) had teased and harassed others. Both experience of bullying and being bullied was much more common among men who raped.

Criminal behaviour
Delinquent and criminal behaviour were more common among men who raped. Men who raped were much more likely to have been involved in theft and, with the exception of legal gun ownership, they were very much more likely to have been involved with weapons, gangs and to have been arrested and imprisoned.

Risky behaviour
Men who raped were significantly more likely to have engaged with a range of other risky sexual behaviours. They were more likely to have ever had more than 20 sexual partners, transactional sex, sex with a prostitute, heavy alcohol consumption, to have been physically violent towards a partner, raped a man and not to have used a condom consistently in the past year.

(Reference: Understanding men's health and use of violence: interface of rape and HIV in South Africa by Rachel Jewkes, Yandisa Sikweyiya, Robert Morrell, Kristin Dunkle, June 2009)

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SA Survey Launched. 11/06/09

- South African National Prevalence, Incidence, Behaviour and Communication Survey, 2008. A Turning Tide Among Teenagers? Download PDF (684.79KB; 120p)

- Presentation by HSRC CEO Dr Olive Shisana at the launch on 9 June 2009, before handing the report to the Minister of Health Dr Aaron Motsoaledi in Cape Town. Download Presentation (1mb): South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008

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Child, Teen HIV Down - Study. 09/06/09

The prevalence of HIV in children and teenagers has dropped, a national survey has found.
Last updated: Tuesday, June 09, 2009

"The good news is that the change in HIV prevalence is most likely attributable to the successful implementation of several HIV interventions," she said.

The survey was conducted by the HSRC, the Medical Research Council (MRC), the Centre for Aids Development, Research and Evaluation, and the National Institute for Communicable Diseases.

Condom use up
Its results, released on Tuesday, showed that HIV intervention programmes were beginning to pay handsome dividends, said Shisana.

Shisana said the study also showed an increase in condom use among young males aged between 15 and 24, which was up from 57% in 2002 to 87% in 2008. In females of the same age, there was also an increase, from 46% to 73%.

Condom use also grew among people aged between 25 and 49.

"I feel very happy that there is a clear instrument that we will use to fight the disease. I believe that we can do better that what has been done so far."

He was referring to the relationship of his predecessor, Dr Manto Tshabalala-Msimang, with HIV-stakeholders during her two terms in office.

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Third National HIV Survey Shows SA's Epidemic Has Stabilised, With Promising Signs. 09/06/09

HSRC Media Release

JOHANNESBURG – South Africa’s HIV epidemic has levelled off at a prevalence of 10.9% for people aged two years and older, with 5.2 million people estimated to be living with HIV in 2008. HIV prevalence has also declined among children aged 2-14, from 5.6% in 2002 to 2.5% in 2008, and a decline in new infections has also been noted among teenagers aged 15-19.

These findings emerge from the third national HIV prevalence, incidence and communication survey which was conducted in 2008 and which followed surveys in 2002 and 2005.

“This latest survey provides us with an opportunity to understand the HIV epidemic over time, and there are promising findings of a changing pattern of HIV infection among children and youth”, said Dr Olive Shisana, CEO of the Human Sciences Research Council (HSRC) and one of the two principal investigators of the study.

“The good news is that the change in HIV prevalence in children is most likely attributable to the successful implementation of several HIV-prevention interventions,” Shisana said. These interventions are related to addressing HIV in early childhood, particularly programmes to prevent mother-to-child transmission in the Western Cape, where the largest decline of 6 percentage points occurred.

Professor Thomas Rehle, the other principal investigator of the study, emphasised that “we may witness for the first time a decrease in HIV incidence among teenagers”. Indirect HIV incidence estimates were mathematically derived from single year age prevalence in 15-20 year olds. “This method is best applicable in younger age groups when the effect of AIDS-related mortality on HIV prevalence levels is still minimal,” Rehle explained.

Successes recorded in the study

  • A reduction in HIV prevalence in the teenage population, which indicates an overall decline in HIV in the teenage population of 15-19 years in 2008.

  • HIV prevalence among adults aged 15-49 has declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape and the Free State, with the largest decline of 7.9 percentage points in the Western Cape.

  • The percentage of people in the age group 15-49 who reported awareness of their HIV status has doubled from 2005 to 2008. This is attributable to multisectoral communication and programmes that promoted knowledge of HIV status and the substantial increase in the availability of voluntary counselling and testing services (VTC) over the period.

  • The proportion of the population who reported using a condom at their last sexual encounter was particularly high among young people aged 15-24 years: from 57% in 2002 to 87% in 2008 among young males, and from 46% to 73% among young females. This trend was also obvious in condom use among people in the 25-49 age group, where condom use among males aged 25-49 at last sex has nearly doubled, while among females in the same age group it has tripled. This may indicate a shift in power relations between males and females, but also an understanding of the value of condoms as in important prevention measure.

  • There was an increase in the population reached by at least one national HIV communication programme between 2005 and 2008. This trend is in an upwards direction, and is particularly clear among youth where 90% reported that they have been reached by at least one programme. Although reach of the main national HIV/AIDS communication programmes increased over time, the government’s Khomanani Programme had the lowest reach in comparison to other programmes. Reach of all programmes was low for people aged 50 years and older, with 37.8% of people in this age group not being reached by any programme.

Communication programmes are not reaching all sectors of the population,” said Dr Warren Parker, a co-investigator on the study. “The lack of reach into older age groups has been raised repeatedly in previous studies, yet nearly four out of ten people aged 50 years and older are not reached by any programme.”

The challenges
Dr Shisana stressed that there are still major challenges that would need coordinated, concerted and intensive effort to complement and sustain the achievements to date. “Our efforts in the coming period need to focus on key drivers of the epidemic,” said Shisana.

Professor Leickness Simbayi, the study’s co-principal investigator, added that there is a need for a clear and unambiguous emphasis on teenagers having older partners, and on all sexually active people limiting the number of sexual partners that they have. “Interventions need to be targeted to the particular issues in each province, and communication programmes need to focus on expanding their reach and intensifying their messages.”

The challenges include:

  • The high level of HIV prevalence among females aged 25-29 is persistent, and has been at a level of 33% over the period of three surveys.

  • Intergenerational sex has increased substantively among female teenagers aged 15-19, which exposes them to a group of older males with a higher HIV prevalence.

  • Having many sexual partners increases risk of exposure to HIV, and this high risk practice has increased markedly between 2002 and 2008. Among males aged 15-49, having more than one sexual partner in the past year increased from 9.4% in 2002 to 19.3% in 2008, whilst among females the increase was from 1.6% to 3.7%.

  • HIV prevalence levels among adults aged 15-49 has increased between 2002 and 2008 among the large populations of KwaZulu-Natal (by 10.1%) and in the Eastern Cape (by 5.0%). Smaller increases were noted in North West, Mpumalanga, and Limpopo.

  • HIV prevention knowledge has declined among the population 15-49 years at national level, from 64.4% in 2005 to 44.8% in 2008, and has also declined in the Eastern Cape, KwaZulu-Natal, North West, Gauteng, Mpumalanga, and Limpopo.

Shisana said “for the first time, the report provides information on high-risk groups, defined in this study as people who drink excessively, those who take drugs, men who have sex with men and people with disabilities as well as women aged 20-34 and men aged 25-49. More attention should be paid to these categories in the NSP”.


The report recommends that HIV testing be routinely offered to all patients at health facilities, and that options for safe child bearing be expanded for people in the 20-34 year age group.

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A Mixed Bag of New HIV Figures. 09/06/09

JOHANNESBURG, 9 June (PLUSNEWS) - The percentage of people living with HIV in South Africa has barely changed in the last six years, but new data released on Tuesday revealed that between 2002 and 2008 there were many changes in HIV knowledge, risk behaviour and testing habits.

The third national HIV prevalence, incidence and communication survey, conducted in 2008 by the Human Sciences Research Council (HSRC), in conjunction with the Medical Research Council (MRC) and the Centre for AIDS Development, Research and Evaluation (CADRE), has given researchers the first real opportunity to study trends in HIV prevalence and risk behaviour. Previous surveys were conducted in 2002 and 2005.

The findings, based on interviews with about 21,000 individuals, 15,000 of whom agreed to anonymous HIV tests, give a fairly detailed picture of South Africa's mixed success in fighting the largest HIV epidemic in the world.

Prevalence appears to have stabilized at about 11 percent, and infection rates among children and teenagers have decreased, but have increased slightly in adults over the age of 25.

Olive Shisana, CEO of the HSRC and one of the survey's principal investigators, noted that African women aged 20 to 34, remained the group most at risk with a stubbornly high HIV prevalence of nearly 33 percent; men aged between 25 and 49, with an infection rate of 24 percent, have the second highest risk profile.

HIV infection in the country's nine provinces still varies widely. KwaZulu-Natal, which has consistently carried the highest burden, now has a prevalence of 26 percent in the 15 to 49 age group, up from 22 percent in 2005; in Western Cape, levels increased slightly from 3 percent in 2005 to 5 percent in 2008, but are still the lowest in the country.

The 2008 study provides the first national prevalence figures for high-risk groups such as heavy drinkers, drug users and men who have sex with men; of these, people with disabilities and heavy drinkers were found to be most at risk, with both groups having a prevalence of about 14 percent.

Professor Thomas Rehle of the HSRC, another of the study's principal investigators, noted that the figures could be "masking some success stories", as the country's growing antiretroviral (ARV) treatment programme may have reduced AIDS-related deaths, thereby increasing the total number of people living with HIV.

This will become clearer when data on new HIV infections, or incidence of the disease, become available later in the year, but the estimated incidence among young people, based on prevalence, showed a substantial drop since 2005, particularly among teenagers.

Risky behaviours

In recent years, researchers have identified intergenerational sex, particularly between younger women and older men, and having multiple sexual partners at the same time, as major drivers of the HIV epidemic in southern Africa.

The HSRC survey found that prevention efforts in South Africa were having little or no impact on either of these risky behaviours: the percentage of girls aged 15 to 19 who had had a partner at least five years older rose steeply from 18.5 percent in 2005 to nearly 28 percent in 2008; the number of men aged 15 to 24 who reported having more than one sexual partner in the last 12 months increased from 27 to 31 percent.

Worryingly, since 2005 accurate knowledge about how HIV is transmitted had decreased significantly in all age groups. One researcher noted that "There seemed to be an acceptance of multiple partners, especially among the youth," and that respondents found it hard to grasp the link between multiple partners and increased HIV risk.

Shisana said these disturbing trends were somewhat offset by a significant uptake in condom use, particularly among young men, 87 percent of whom reported using a condom at last sex. "I think young men have made a decision that they're going to run around, but that they're going to use a condom," she said.

Other encouraging findings were that more South Africans had been tested for HIV (about half of all respondents in 2008 compared to 30 percent in 2005) and that national HIV communication programmes had achieved a broader reach.

The researchers recommended targeted interventions to address intergenerational sex and multiple partners, particularly in hard-hit provinces, and that routine HIV testing, with the option of refusal, should be made available at all health care facilities currently offering voluntary counselling and testing.

"As a country, we can do much better," commented the new health minister, Aaron Motsoaledi. "We have spent a lot of time fighting each other," he said, referring to the history of conflict between government and civil society on HIV/AIDS during former President Thabo Mbeki's tenure. "I'm quite sure that time is over now and instead we're going to fight this disease."

© IRIN. All rights reserved. HIV/AIDS news and analysis:

[This item comes to you from PlusNews, part of IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions:]

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HIV Drops among Teens. 10/06/09

10.06.2009 Kerry Cullinan

While South Africa’s HIV prevalence rate remains stable at 11 percent, there have been significant reductions in HIV among children and young people.

But the overall HIV infection rate among people aged 15 to 49 has inched up in the last six years, with almost 17 percent of people in this group now infected (from 15.6 percent in 2002).

This is according results of the third South African HIV national prevalence survey released by the Human Sciences Research Council (HSRC) in Cape Town yesterday (Tues 9th June).

The most heartening result is the halving of HIV amongst children aged 2 to 14, with only 2.5 percent now living with HIV countrywide. The lowest figure is the Western Cape, where only one percent of children tested had HIV, an indication of the province’s successful prevention of mother-to-child HIV transmission programme.

Condom use among young people aged 15 to 24 has increased dramatically (from 57% in 2002 to 87% in 2008), perhaps accounting for an almost two percent drop in HIV prevalence in the past three years in this age group (from 10.3 percent to 8,6 percent).

The “substantial decrease” in HIV infection among teenagers, particularly in the last three years, coincides with a doubling of knowledge about HIV.

The Western Cape has managed to cut its HIV rate by over half among those aged 15 to 49, from 13.2 percent in 2002 to an impressively low 5.3 percent. The Northern Cape and Free State also showed decreases in HIV.

But the challenges remain huge. HIV is highest among women aged 25 to 29, where one in three are HIV positive. In men, the epidemic peaks among those aged 30 to 34, where one in four is living with HIV.

HIV continues to increase in the two provinces with the highest HIV rates – KwaZulu-Natal and Mpumalanga. In the past six years, HIV has increased by a massive 10 percent in people aged 15 to 49 in KwaZulu (to 25.8 percent). However, there was a slight drop in infections amongst those aged 15 to 24 in the province.

Mpumalanga is the only province to show an increase in HIV in both the youth (15-24 years) and those aged over 25 and over, perhaps an indication of a weak HIV programme.

In the past three years, risky behaviour has also increased. There has been a substantial increase in girls having partners five or more years older than them (from 9.6% in 2005 to 14.5% in 2008), and a slight increase in girls under the age of 15 having sex – both risk factors for getting HIV.

There has been an almost threefold rise in people in the Free State having two or more partners in the past year, which is also a risk factor.

In addition, HIV/AIDS knowledge among those most at risk of HIV has plummeted – an indication of the failure of government’s Khomanani campaign. Among African women aged 20 to 34, knowledge dropped from 43.8 percent to 26.1 percent and among African men aged 25 to 29, from 40.6 percent to 28 percent.

One in three adults over 50 and over one in nine adults aged 25 to 49 were not reached by any HIV communication campaign.

Some 23 369 people over the age of two were interviewed last year in the countrywide representative survey, which is conducted every three years. However, a quarter of these refused to have an HIV test so prevalence results are based on a sample of some 15 000 people.

Research was conducted by the HSRC, Medical Research Council, Cadre and the National Institute for Communicable Diseases with funding from the President’s Emergency Plan on AIDS Relief (Pepfar).

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One Child Raped Every Three Minutes 3/6/09

Health 24  

One child is raped in South Africa every three minutes, a report by trade union Solidarity said.
A report compiled by Solidarity Helping Hand said while there are about 60 cases of child rape in South Africa every day, more than 88% of child rapes are never reported.
"This means that about 530 child rapes take place every day - one rape every three minutes," said spokeswoman Mariana Kriel. The report will be released by Solidarity Helping Hand.
Kriel said the report contains statistics and facts about the levels of child murder, rape and abuse in South Africa. "Several interviews with social workers and other employees of social welfare organisations across South Africa are included in the report, providing a unique look at the experiences of people who work with child abuse on a daily basis."
Child abuse cases increasing
Kriel said according to the report, the levels of child abuse in South Africa are increasing rapidly. "In 2007/08 in South Africa, 1 410 cases of child murder were reported - 22.4% more than in the previous year. In addition, it was found that 45% of all rapes in the country are child rapes," said Danie Langner, executive director of Solidarity Helping Hand.
"The shocking reality, however, is that these figures do not nearly reflect the true extent of the problem."
Kriel said the report also highlights the severe shortage of trained social workers and the difficult working conditions they face.
"Certain organisations, such as Childcare South Africa, work with more than two million children and their families on a daily basis. This means that the average social worker handles nearly 200 cases each year, while the accepted norm is 60."
Langner added: "For the first time in the country's history, social work is regarded as a scarce skill. There were 12 500 registered social workers in South Africa in 2007. Meanwhile the difficult working conditions and poor remuneration packages discourage people from following the career."
Langner said the report covers several issues, including the influence of gangs and drugs, as well as facts regarding child pornography and the trade in children.
'43% of cases are of sexually abused children'
"The simple fact that 80% of all children under the age of two that are helped at Childline Port Elizabeth have skull fractures, or the fact that young boys are flagrantly abused by middle-aged men at advertised places in the Western Cape or the fact that 43% of all cases in which Childline South Africa is involved are those of sexually abused children, must simply be exposed," Langner said.

Helping Hand will also launch a CD "Hande vir Hoop" (Hands for Hope) at the launch of the report. Police director Piet Byleveld, one of the country's top detectives, will also receive an award for his contribution to child protection. – (Sapa, June 2009)

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28% of SA Women Single Moms. 14/5/09

There are just over 1.5 million women with children under the age of two in South Africa. In this country, the trend toward single motherhood is not new and 28% of women are single parents.
More than half (53%) of these women have never been married and are not living with their partners, according to the All Media Products Survey 2008. Of this segment, 50% are unemployed, according to the previous All Media Products Survey (2007).
The African spirit of ubuntu and community connectedness often means that a single mother does not have to accept sole responsibility for the child and many children are often reared with the support of the community. In South Africa, the number of individuals receiving child support grants increased from 280,000 in 2004 to 7,506,000 in 2007, according to the General Household Survey 2007.
A child out of wedlock also does not carry the stigma attached in many other developing countries, as it is seen as a promising sign of fertility prior to marriage.
A worldwide trend
But this is by no means a purely South African phenomenon: single motherhood is on the increase in the developed world, according to a US study.
The study shows that 40% of births are now to unwed mothers, and most of these are to women in their 20s, not teenagers, according to a report, Changing Patterns of Non-marital Childbearing, released by the US Centres for Disease Control and Prevention.
Reduced stigma
In the United States, out-of-wedlock births increased by 26% between 2002 and 2007, according to the report. In 1980, the rate of out-of-wedlock births was 18%.
Though the reasons for the increase are not clear, one factor might be that having a child when you're not married is no longer stigmatised, according to Stephanie J Ventura, director of the Reproductive Statistics Branch at the CDC's National Centre for Health Statistics and author of the report.
"The whole thing about social disapproval pretty much evaporated in the last 10 or 15 years, and it's even more so now," Ventura said.
Also, the numbers of women having out-of-wedlock births in the United States is so large and widespread in all population groups that it cannot be accounted for by socio-economic factors, Ventura said.
Out-of-wedlock babies at higher risk
The trends, though, are concerning, she said. "Births to unmarried women are at higher risk for poorer birth outcome," Ventura said. "These babies are more likely to be low birth weight, be preterm and die in infancy. Other research has shown that children are better off being raised in two-parent families."
In addition, because most of these births are unplanned, she said, there could be substantial public health concerns.
Many Americans don't take having children seriously, said Bill Albert, a spokesman for the National Campaign to Prevent Teen and Unplanned Pregnancy. "This puts the nail in the coffin of this misperception most Americans have that non-marital childbearing is something that is primarily a teen activity," Albert said. Also, the report confirms that the United States is not alone in the high rate of out-of-wedlock births, he said, adding that "this is not a social and cultural revolution that is unique to the United States."
The real issue, Albert said, is the welfare of these children. "We now have about two decades of good social science research that comes to the conclusion that, as a general matter, children do better in low-conflict, loving, two-parent families," he added.
"There needs to be more education about the responsibility that goes along with having children, as well as education about contraception," he added.
"Young people need to understand that having children and raising children is a rewarding, but extremely challenging task," Albert said. "It is not something that should be undertaken lightly. As a general matter, everyone needs to take the important issue of sex, contraception, pregnancy and childbearing seriously."
Trend in other developed countries
For comparison, Ventura looked at out-of-wedlock births in other industrialised countries between 1980 and 2007 and found a dramatic increase there as well. The largest increases were seen in the Netherlands, where out-of-wedlock births rose from 4 to 40%. In Spain, out-of-wedlock births increased from 4% to 28%, in Ireland the numbers went from 5 to 33% and in Italy they rose from 4 to 21%.
Other findings in the report include:
  • Countries with a higher percentage of births to unwed mothers than recorded in the United States include Iceland (66%), Sweden (55 %), Norway (54 %), France (50 %), Denmark (46 %) and the UK. (44 %).
  • Countries with lower rates of out-of-wedlock births than the United States include Ireland (33 %), Germany (30 %), Canada (30 %), Spain (28 %), Italy (21 %) and Japan (2 %).

– (Stev

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Sex: Shock Findings About Youth. 12/05/2009

Die Burger

Cape Town - HIV/Aids can be transmitted via toilet seats, and the virus can be avoided by having a bath after sex.
Recently concluded research shows that these are some of the common beliefs among teenagers in the Anglican Church.
Last year the church commissioned research aimed at better understanding what its role can be in the battle against HIV/Aids among young people.
The University of Stellenbosch's unit for religious and developmental studies conducted the research among young Anglicans between the ages of 10 and 24, in 12 Anglican dioceses across the country.
A report on the research was presented at an HIV/Aids seminar at the University of Stellenbosch last week.
More than 10% sexually active
Amongst other things, the research showed that more than 10% of young people between the ages of 10 and 13 are sexually active.
About 38% of respondents in this age group said that the pill can prevent HIV/Aids, and 30.4% believe that HIV can be transmitted via a toilet seat.
About 27% think that HIV infection can be prevented by bathing after sex.
Of the respondents, 97.1% described themselves as Christians, while more than 98% of them believe it is important to be healthy.
Nothing wrong with fondling
The majority (63.5%) of those who have not yet had sex, feel that it is better to have sex only within the confines of marriage, while approximately two-thirds feel that there is nothing wrong with someone fondling them.
The researchers said that some of the more shocking findings, such as those about fondling, could be attributed to respondents misunderstanding the questions.
About 90% of the respondents indicated that they are worried about HIV.
According to the report, there is a gap between the values and morals which are adhered to on the one hand, and the behaviour which is exhibited on the other hand.
- Die Burger
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15% Of Pupils Forced To Have Sex. 11/03/09


News 24  

Johannesburg - Fifteen percent of South African schoolchildren have been forced to have sex, a study by an international group of epidemiologists based in Canada has revealed.

The SABC reported on Wednesday that the study was conducted among more than 15 000 schoolchildren.

The organisation's Nobantu Marokane said this was a 1% increase from the last study. 

"We used forced sex without consent, so they understood the term that this was forced, it was not coercion, it was forced sex without consent and that is the number of our learners that said 'yes, this has happened to me'. 

"And for me what is striking is that... this is happening to more boys than girls," she said.


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Child Rape In Gauteng. 11/03/09

Gauteng’s great shame - in one year, more than 12000 children were raped in the province
Sowetan 11 March 2009
..But many more afraid to come out
The statistics are shocking. Last year alone, more than 12000 children were raped in Gauteng.
Three different institutions – the provincial government, the Teddy Bear Clinic and Childline in Johannesburg – released the statistics yesterday and they paint a grim picture.
Lizette Schoombie, director of the Teddy Bear Clinic, said: “The reported cases are just a fraction of the actual number of children raped in Gauteng.
“The situation is more scarier than it seems. Thousands of children are sexually abused in this province but many of them do not report the incidents. Some fear being victimised while others are forced into silence by those who are supposed to support them [parents or guardians].”
In 2006 the Teddy Bear Clinic recorded 3050 cases of rape and the following year the number increased to 3 058. Last year the number escalated to 3 628. The cases were reported from three regions – Soweto, Krugersdorp and Johannesburg.
For their part, Gauteng’s clinics and hospitals treated 3 880 rapes in 2008 and 3852 the previous year, according to statistics released by health MEC Brian Hlongwa in response to a question by the DA.
Kids Clinic reported that 1502 children were raped.
Schoombie criticised the closure of the SAPS child protection unit a few years ago, citing this as the reason some of the rape cases went unreported.
“Rape victims find it difficult to relay their ordeal to a person who is not trained to deal with the situation. Some police officers have no idea how to deal with a child who has been abused. As a result many cases never make it to court.”
Lynne Cawood, director of the ChildLine, who said their centre reported more than 4000 rapes, echoed Schoombie’s concerns.
“The closure of the child protection unit has made matters worse,” she said.
The DA has also expressed concern over how many children “actually received” antiretroviral treatment after being raped.
DA Gauteng health spokesperson Jack Bloom said it was alarming that 44percent of child rape survivors treated at public health facilities between 2005 and 2008 “did not” receive ARV treatment.
The treatment should be administered within three days of rape to minimise HIV infection.
Bloom said those who had received the treatment did not complete it because little “follow- up” was done by public health facilities.
“Rape survivors should receive specialist treatment. They should receive a full month course of ARV treatment and home visits to ensure that they complete it.”
He said the number of child rape survivors treated at hospitals and clinics was probably an “underestimation” because most rape cases were not reported.
According to Hlongwa’s replies to Bloom’s questions, child rape survivors did not complete the ARV treatment because of “medical side effects, lack of food and that some parents did not have transport to take the child to a health facility on a weekly basis”.
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HIV Shock in SA Schools. 21/01/09

Wednesday, January 21, 2009

A shocking statistic showing that 15-year-old teenagers in South African account for 34% of all new HIV infections, the debate whether to distribute condoms in schools has again flared up.

According to Juliana Han (Harvard Law School, Cambridge, USA) and Michael Bennish (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA), both affiliated with the South African nongovernmental health organisation Mpilonhle, the rights afforded by the new Children's Act reflect a growing concern over the need to prevent HIV in the country's youth.

Those aged 15 years account for 34% of all new HIV infections and have an HIV prevalence of 10.3%.

The act, which came into effect in 2007 grants children 12 years and older a host of rights relating to reproductive health, including the right to access condoms. But current policies allow individual schools to decide whether or not to give out condoms - policies that two researchers, in PLoS Medicine, say could damage the health of the country's youth.

"Despite the high incidence of HIV in adolescents and the efficacy of condoms in preventing HIV transmission, condom use rates among adolescents remain low, due at least in part to limited access," they say.

Many unaware of policy regarding condom provision
One way to increase condom access for this group would be to make condoms available in schools. The act, together with government policies, allows individual schools to decide whether to distribute condoms. Most school staff, say the authors, are unaware of the policy and regulations governing condom provision in schools.

"Because of confusing and contradictory government policies and public pronouncements regarding provision of condoms in public schools, few schools have undertaken to provide condoms, leaving students, especially in rural areas, with few options for obtaining them."

The authors acknowledge that making condoms available in schools is a socially divisive issue. Critics believe that making contraception available encourages sexual activity. But proponents cite the early age of sexual debut and the futility of HIV prevention education that encourages condom use, but fails to actually provide condoms.

The researchers' own work with Mpilonhle, in which they interviewed teachers, parents, and students in rural northern KwaZulu-Natal, the province with the highest HIV prevalence, suggests there is generally support for the distribution of condoms in schools, but confusion about governmental policy.

Condom access for adolescents is also restricted by some of the funding agencies that support HIV prevention efforts. The US President's Emergency Plan for Aids (Pepfar), for example, which allocated US$398 million to South African HIV/Aids programs in 2007, prohibits use of these funds for distributing condoms in schools or for providing condom information to youth aged 14 years and under. Pepfar's policy conflicts with South African law. – (EurekAlert, January 2009)

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South African HIV Statistics - 2008

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HIV Infections are Down in Gauteng. 29/11/08

November 28, 2008

 IOL HIV-AIDSJohannesburg - HIV infections in Gauteng among young people under the age of 25 have gone down from 13,2 percent in 2002 to 10,3 in 2005, the premier's office said on Friday.

"The committee chaired by Premier Paul Mashatile noted that there had been declines in new infections among young people, that indicates the first stage of turning the tide of HIV infections in the province," said spokesperson Simon Zwane in a statement.

He said efforts to prevent infants from acquiring the virus from their mothers had also decreased, following the initiation of dual therapy as part of prevention of mother-to-child-transmission.

It was initiated by the health department in February this year. "Evidence from Rahima Moosa mother and child hospital has shown that the number of children born with HIV infection has declined from 7.5 to 3.5 percent as a result of dual therapy."

According to sexual transmitted infections statistics, many people were taking precautions to prevent HIV infections.

The syphilis prevalence rate had dropped from 4.3 percent in 2005 to 2.3 percent in 2006.

Mashatile urged people to use World Aids Day on December 1 to dedicate themselves to the prevention of new infections.

"We all know how HIV and Aids spreads. Let us now use that knowledge to change our behaviour and practice safe sex. Our vision of an Aids-free generation relies on individuals modifying their sexual behaviour. You and me can make a difference, let us start today," he said.

Mashatile said the government wanted to see new HIV infections reduced by half.

"To achieve that we have shifted our approach from awareness campaigns to focus on face-to-face education, peer education and life skills in schools to change sexual behaviour," he said.

He said the government was committed to providing treatment and support to ensure longer productive life for people living with HIV.

The number of people on antiretroviral treatment in Gauteng had grown from 12 976 in 2004 to 140 000 this year.

Zwane said Gauteng had also experienced an improvement in the control of tuberculosis (TB).

"The incidence of TB cases has decreased from 424 per 100 000 people in 2006 to 379 per 100 000 in 2007."

He said cure rates had also improved, with seven out of ten people cured of the disease in 2007 compared to six out of ten in 2006. - Sapa
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South African National HIV Prevalence, Incidence, Behavior and Communication Survey 2008. The Health of our Children

Overall HIV prevalence among children 18 years of age and younger who participated in this survey was 2.9%. The age-specific HIV prevalence levels found were as follows: 3.3% (95% CI: 2.1–5.2) among children 0–4 years of age, 2.5% (95% CI: 1.7–3.7) among those 5–11 years of age, 1.1% (95% CI: 0.5–2.4) among adolescents 12–14 years of age, and 4.5% (95% CI: 2.8–7.2) among teenagers 15–18 years of age. The HIV-prevalence level among children 0–4 years of age mainly reflects vertical transmission (i.e. from mother to child) while that among teenagers 15–18 years of age mainly reflects sexual transmission as a result of unsafe sexual practices.

First Published 2010 by HSRC - Human Science Resource Council

ISBN (pdf): 978-0-7969-2326-4

Download HERE (PDF; 3.39MB,103 Pgs)

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RSA - Mortality and Causes of Death. 27/10/08

Statistics South Africa released the “P0309.3 - Mortality and causes of death in South Africa: Findings from death notification, 2006 ” report last week.

You can
- Download full report
- Download Key findings: P0309.3 -
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Stats SA Mortality Report Shows that We Need to Improve Access to HIV and TB Treatment. 26/10/08

TAC Newsletter 26/10/08

Statistics South Africa released the Mortality and causes of death in South Africa, 2006: Findings from death notification report last week. The statistical release presents data on mortality and causes of death based on all death notification forms received from the Department of Home Affairs for deaths that occurred in 2006.
The previous mortality report included deaths up to and including 2005. This one updates that report by including 2006. The report confirms the effects of the HIV epidemic that have already been shown in previous mortality reports:

· Most South Africans are dying in the age-group 30-39.
· The three leading causes of recorded death, TB, pneumonia and influenza and intestinal diseases, have increased several-fold over the last decade. As the report states, it provides "indirect evidence that HIV may be contributing to the increase in the level of mortality for prime-aged adults, given the increase in the number of deaths due to associated diseases."
· The number of female deaths has gradually reached the number of male deaths over the last decade. In 1997, 56% of recorded deaths were male. In 2006, 51% of deaths were male.
· Deaths have increased dramatically over the last decade, well beyond what one would expect from population growth and improved registration. In 1997 there were 316,559 recorded deaths. This grew by 92% over the next decade to 607,184 in 2006. The steep rise in infant deaths over the last decade is particularly concerning and not easily explained. Interestingly, unnatural deaths (accidents, murders etc) have declined slightly in this period.

The ASSA2003 demographic model developed by the Actuarial Society of South Africa (ASSA) estimates the number of HIV-related deaths to be in the region of 350,000 in 2006, or nearly half of all deaths (including unrecorded ones). ASSA and other demographers will hopefully be able to use the Stats SA mortality data to update their models and describe the epidemic with even greater detail and accuracy.
The rate at which deaths are increasing is slowing down. This indicates that AIDS-related mortality is peaking, albeit at an extremely high number. The rollout of ARV treatment to several hundred thousand people has had a striking impact on mortality and helped to stabilise it. This is a vindication of the effort that has gone into demanding and implementing the ARV programme.
Nevertheless, the trebling of recorded TB deaths over the last decade and the huge effect of HIV on mortality, including infant mortality, shows that despite the numbers on ARV treatment, deaths are still extremely high. We have not yet provided treatment to enough people to reduce the burdens of disease and death on the public health system; we have only slowed their growth. That is why we call on the Minister of Health and the South African National AIDS Council to take urgent action to increase the numbers of people on treatment and improve uptake of all components of the mother-to-child HIV transmission prevention programme. Our high mortality due to TB is unnecessary- TB is an entirely curable disease. TB and HIV services must be integrated and people with HIV should be screened for TB every six months and people with TB should be offered HIV tests routinely.


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The 2007 National HIV and Syphilis Prevalence Survey. 12/09/08

About the Survey:
The report was released on the DOH website on the 29th of August 2008.
According to the preface of the preface the “2007 report on the National HIV and Syphilis Antenatal Prevalence Survey show that South Africa may be making some real progress in its response to the HIV epidemic.” These are also the first results to show a comparison of the impact of HIV infection between districts over two consecutive years.
Download the Report here.
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Gauteng Hails Lower Antenatal HIV Rate. 12/09/08


Johannesburg - HIV prevalence rates among pregnant women dropped 2.3 percent in Gauteng between 2004 and 2006, a provincial public health profile report has found.

"One of the provincial government's successes was the expansion of HIV services to 59 000 people on anti-retrovirals, said Gauteng health MEC Brian Hlongwa.  "This target almost doubled to 110 000 people in 2007," he said.  The decrease was based on the national health department's 2006 ante-natal survey, which suggested the epidemic was about to show a downward trend in the general population.  "We can say, with great caution, that we seem to be making progress in the war against HIV and Aids," said Hlongwa.

Of the patients who had started anti-retroviral treatment in April 2004, 62 percent were still on the treatment by September 2007 while the other 38 percent had either died or could not be traced.  The leading cause of death in the province was tuberculosis (TB) which accounted for 9.8 percent of the total deaths.  Pneumonia accounted for 8.1 percent, other forms of heart disease for 4.4 percent, cerebrovascular diseases 3.9 percent and intestinal infectious diseases 3.5 percent.  Using Statistics South African information, the survey observed that the number of deaths in the province had steadily increased between 2003 and 2005.  This was partly due to population growth, a larger elderly population and improvements in death records. 

 However, it was also likely to be the result of HIV-related mortality, the report found.  "Gauteng had a 'quadruple burden of disease' with individuals affected by communicable diseases, non-communicable diseases, injuries, and HIV and Aids.  "The large number of deaths in the 15 to 49-year age group was indicative of the impact of HIV and Aids."  The report suggested that the number of actual Aids deaths was likely to be higher than official estimates at about 50 percent of all deaths.  HIV was not a notifiable disease and it was likely that many Aids deaths were not recorded as such.  The report indicated that many deaths put down other causes, such as TB, could be Aids-related. - Sapa


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Questions about New Prevalence Survey. 09/09/08

IRIN PlusNews

JOHANNESBURG, 9 September (PLUSNEWS) - Several prominent demographers and scientists have vigorously refuted Health Minister Manto Tshabalala-Msimang's claim that South Africa's HIV epidemic is declining and that the country "may be making some real progress in its response to the HIV epidemic".

Tshabalala-Msimang's statement was based on a national survey of HIV prevalence among pregnant women, which researchers are describing as deeply flawed.

The report, posted on the health department's website on 29 August, states that prevalence among pregnant women fell from 29.1 percent in 2006 to 28 percent in 2007.

Prof Rob Dorrington, a demographer at the University of Cape Town, and his colleague, Prof David Bourne, point out in a letter published in the South African Medical Journal (SAMJ) this week that the 2007 survey employed a methodology not only radically different from that used in 2006, but also "manifestly wrong".

The authors detected a problem when they noticed that changes in prevalence by age group did not tally with the change in overall prevalence, and that district figures were inconsistent with provincial estimates.

They deduced that in 2006 the results from district antenatal clinics were simply totalled to derive prevalence estimates for the country's nine provinces, but in 2007 the health department began weighting provincial figures according to age groups, based on general population estimates for age distribution.

Dorrington and Bourne describe the new methodology as "clearly problematic" because the age distribution of women attending antenatal clinics is very different from that of the female population as a whole.

"Since the prevalence of HIV also has a distinct age pattern, and prevalence is lower in the youngest and oldest age groups, using the population of all women to reweight the data will inevitably underestimate the prevalence of women attending public antenatal clinics," they wrote.

After recalculating the 2007 figures, using the same method applied to the 2006 data, the authors estimated HIV prevalence among pregnant women at 29.4 percent. Antenatal prevalence figures are used in combination with other surveys and mathematical models to determine HIV prevalence in the overall population, but the revised figure suggests that the number of South Africans living with HIV has probably not declined.

Dorrington and Bourne also recalculated the estimates for each of the provinces and found that the age weighting had given rise to "absurd results", particularly for the Western Cape, where prevalence dropped from 15.1 percent in 2006 to 12.6 percent in 2007, according to the survey.

In reality, only two districts in the province showed small declines and, after totalling data from all the districts, the authors estimated a prevalence rate of 15.3 percent.

The Treatment Action Campaign (TAC), a national AIDS lobby group, released a statement on Monday saying that the health department had "made a mistake or misled the public" by failing to state the change of methodology in the 2007 report.

TAC spokesperson Lesley Odendal recommended that the health minister's claims of a drop in HIV prevalence "be treated with scepticism".

She also pointed out that even a slight increase in prevalence would not necessarily indicate that the HIV epidemic had worsened. "It has become extremely difficult to interpret the meaning of prevalence in recent years for two reasons: the HIV epidemic has matured into an AIDS epidemic [with more people dying], and antiretroviral treatment is helping people with HIV to live much longer."

In their letter to the SAMJ, Dorrington and Bourne note that the survey was "surprisingly silent" on the impact of life-prolonging antiretroviral (ARV) treatment on prevalence.

About 500,000 HIV-positive South Africans have benefited from the roll-out of ARV treatment, which could actually cause prevalence to increase, depending on mortality rates, but the 2007 survey revised the total number of people living with HIV down from 5.41 million in 2006 to 5.27 million in 2007.

Dorrington and Bourne conclude that "analysis of these data appears to be becoming increasingly beyond the skills of the Department of Health" and recommend that the government enlist the help of the broader scientific community to help interpret future figures on prevalence.

The Department of Health said it will release a statement responding to the criticisms.

© IRIN. All rights reserved. HIV/AIDS news and analysis:


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HIV at Tertiary Level in the Spotlight. 27/08/08

August 27, 2008 Edition 1
Lee Rondganger

South Africa's universities and technikons have no idea how many of their students and staff are infected with HIV/Aids, and this scare them.

The 23 higher learning institutions spread across the country believe that because they do not know exactly how many of their students - the future of the South African economy - are affected by the virus, they do not know if the programmes they have in place to deal with the epidemic are adequate.

Earlier this month, the Higher Education HIV/Aids Programme (HEAIDS) embarked on one of the biggest HIV prevalence studies ever undertaken in South Africa.

The study is taking place at every university and technikon in an effort to get an in-depth picture of HIV infections by sampling 25 000 randomly selected students and staff.

Not only will the HEAIDS study gauge HIV infection at higher education institutions, it also aims to establish the knowledge, attitudes, perceptions and behaviour the students and staff possess of the disease.

Dr Mvuyo Tom, vice-chancellor of the University of Fort Hare, who is a member of the HEAIDS strategic advisory committee, said that despite campuses running voluntary counselling and HIV testing programmes, only 25 000 students out of 750 000 full-time and part-time students underwent voluntary HIV testing last year.

"The youth is the most exposed group to HIV. If we want to deal with HIV, we must have programmes that mitigate the disease and reduce infection. We cannot treat what we can't measure and this is why this study is important."

The study, which began at Stellenbosch University earlier this month, is being funded by the European Union to the tune of €20-million (R220-million).

Head of the research team, Dr Mark Colvin, said by sampling 25 000 people they would be able to get a reliable picture of HIV prevalence around campuses across the country.

Researchers would randomly sample clusters at each institution and every person sampled will have to fill out a questionnaire and a "dry spot" of their blood would be taken and linked to the questionnaire. Nobody would be required to give their names.

From this, they would be able to establish a person's knowledge of HIV against their status.

Mahlubi Mabizela, director of higher education at the Department of Education, said it was important for the country to know what the prevalence of HIV is at tertiary level.

"Students are a reflection of our society. Higher learning institutions produce the human resource to various sectors of our economy and it is important for us to know (what the rate of prevalence is) so we know what to do and how to allocate finances."



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40 000 Unnecessary Deaths. 13/03/08

Over 40 000 deaths could be prevented by better health services 
Kerry Cullinan

Health-e News

Gaps in healthcare system causes unnecessary deaths of mothers and babies, according to the report "Every death counts".

The deaths of up to 40 200 South African babies and children could be prevented every single year if gaps in the healthcare system, including poor patient care and lack of interventions to address HIV/AIDS, were addressed.

This is according to a report, “Every death counts”, that was presented to Health Minister Manto Tshabalala-Msimang today (Tuesday 11 March) at the conference “Priorities in Perinatal Care”.

Every year at least 20 000 babies are stillborn, another 22 000 die within the first month of their lives and 1 600 mothers die from complications of pregnancy and childbirth.

Some 75 000 children die before their fifth birthday, according to the report.

“The report makes for hard reading,” says Dr Mark Patrick, a paediatrician at Grey’s Hospital in Pietermaritzburg and one of the report’s authors.

“We are talking about a lot of deaths. Under five mortality appears to be increasing. Maternal mortality appears to be increasing. HIV infection amongst pregnant women appears to be increasing,” says Patrick.

“The fact that 260 mothers, babies and children die every day in South Africa should make people stop and think and ask why this is happening.”

A very high percentage of maternal deaths, stillbirths and child deaths are caused by inadequate care on the part of healthcare providers, described as “modifiable factors”.

“Modifiable factors” were identified in over half the cases of women who died in childbirth at clinics as well as over half the child deaths.

Over two-thirds of stillbirths had “avoidable factors”, including the failure of healthworkers to attend to some of the pregnant women’s high blood pressure.

Proper monitoring during labour could save most of the 7 300 babies dying each year either during childbirth or shortly afterwards, according to the report.

Little babies under the age four months of age are falling through a gap between maternal and child care programmes, with only about a quarter of these babies going to the clinic for a check-up.

Another serious gap is in HIV testing, with only around two-thirds of pregnant women being tested for HIV.

“Coverage of key HIV interventions drops at the time of childbirth and postnatal care, when it is most crucial,” notes the report.

During pregnancy and early childbirth is the only time that interventions with antiretroviral medicine can be made to prevent mothers with HIV from passing the virus on to their babies.

In addition, HIV positive mothers need to choose to either exclusively breastfeed their newborn babies or give them formula milk to prevent them from getting HIV.

“Support to sustain (these) feeding choices is especially crucial,” notes the report.

Gaps were also identified in healthcare workers’ skills, including the ability to resuscitate newborns and provide emergency care, identify and treat children at risk for malnutrition and give proper counselling to HIV positive mothers on feeding options.

The report is a synthesis of three reports, called “Saving Mothers”, “Saving Babies” and “Saving Children” and was compiled by a number of the country’s top health researchers including Professors Debbie Bradshaw and Mickey Chopra.

“While the numbers are hard, the fact that we have identified the gaps offers a serious opportunity for all role players to get stuck in and make a difference to save the lives of mothers, babies and children,” says Patrick.

Last month, the Health Minister appointed three committees to look into maternal mortality, perinatal mortality and infant mortality.

“Every maternal, perinatal and under five death will be recorded by these committees. They are going to record cause of death, the contributing factors and classify that death incident accordingly. They will thereafter make recommendations of the measures that need to be taken to address preventable causes and factors,” said Tshabalala-Msimang.

“We expect these recommendations to include identification of improvements in the delivery of health services and protocols or guidelines to better manage cases within the health system. In cases where contributing factors are outside of the health system, we will have to engage with responsible sectors to ensure that such challenges are addressed.”

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South African HIV Statistics - 2007 and Earlier

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HIV/AIDS Deaths Up 231%. 08/11/07

November 08, 2007 

Deaths of young adults have increased by 213 percent since 1997 and this can be attributed to the HIV/Aids pandemic, the SA Institute of Race Relations said.

The number of people who died in the age-group 30-34 in 1997 was 18 983, but by 2005, this number had risen to a staggering 59 360, the latest edition of the institute's annual survey said.

"The huge upswing in deaths of young adults can only be attributed to the progressing HIV/Aids pandemic in SA," said Marco MacFarlane, head of research at the institute.

"Unfortunately that is not the worst of it, as the latest estimates show that HIV/Aids will soon account for more deaths per year than every other cause of death combined," he added.

HIV/Aids not just a health issue
MacFarlane said while the latest figures do show a decrease in infection rates, it was too early to start celebrating.

"We saw a decrease in 1999 and there were comments back then that the epidemic had stabilised, but the following year the statistics showed a large increase again and they have increased every year again until 2006," he said.

HIV/Aids was not only a healthcare issue; it was an economic issue, an infrastructure issue and a social and community issue, added MacFarlane.

"This disease needs to be fought on every front with equal vigour, by both the private and the public sectors, and by individuals themselves."

The survey also showed that, on the latest estimates, more than 18 percent of the total workforce was infected with HIV. –(Sapa)

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SA Mortality Statistics. 19/6/2007

New statistics have been released by Statistics South Africa on Mortality rates in South Africa. Download publication (PDF: 1056KB)

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SA Deaths up by 3%. 18/6/07

Health 24

Last updated: Monday, June 18, 2007 Aids-related illnesses were among the major causes of death in South Africa in 2005, with the country posting a 3.3 percent jump in the total number of deaths, South Africa's statistical office said.

Mortality figures released by Statistics South Africa showed that TB, influenza and pneumonia were the biggest killers in the country in 2005, with experts suggesting that these were probably the result of the country's HIV/Aids pandemic.

"There are no big surprises in the report. It's very clear that what is driving these deaths is HIV," said Francois Venter, head of South Africa's HIV Clinicians Society.

Continuing to rise

"What is worrying is that the number of deaths is continuing to rise."

South Africa has one of the world's highest HIV infection rates, with 12 percent of the country's 47 million people believed to be infected by the deadly epidemic.

Researchers say on average 1 000 people in the country die from Aids while 1 500 new HIV cases are reported every day.

According to the statistical office, tuberculosis - which is a common HIV-related opportunistic infection - accounted for 12.5 percent of the 590 000 deaths recorded in the country in 2005, up from 12.3 percent in 2004.

Influenza and pneumonia, which can also be HIV-related, were responsible for a combined 7.7 percent, a slump from 8.0 percent posted in 2004.

HIV itself was blamed for 2.5 percent of natural deaths during the year, up from 2.3 percent in 2004.

3.3% increase

The total number of deaths increased by 3.3 percent.

"In percentage terms it is definitely a significant increase, especially when we also take into account that during that period the increase in deaths was faster than the increase in the population at just over 1 percent," said Stats SA's Kefiloe Masiteng.

As part of the move to try to curb the severe human and economic toll of the epidemic, the government said in March it would expand access to life-saving AIDS drugs and HIV-testing and counselling services.

The United Nations says the government needs to back these measures up by encouraging male circumcision, abstinence and social programmes designed to combat violence against women. – (ReutersHealth)

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Mortality Figures Point to AIDS Toll. 15/6/07

JOHANNESBURG, 15 June (PLUSNEWS) - Deaths are on the rise in South Africa, with the latest government mortality figures showing a 3.3 percent increase between 2004 and 2005.

According to a media statement from Statistics SA, the government agency which published the report, the latest figures are consistent with a continuous increase in South Africa's mortality rates since 1997. In that year, 316,000 deaths were recorded, compared to 591,000 in 2005.

The higher figures could partly be attributed to improvements in death registration and population growth, the report said, but they also provided "indirect evidence that HIV may be contributing to the increase in the level of mortality for prime-aged adults, given the increase in the number of deaths due to associated diseases."

The three leading causes of death in 2005 were tuberculosis (TB), influenza and pneumonia, all common opportunistic diseases associated with HIV and AIDS.

"We know that of the people who have got TB, more than half are co-infected with HIV, and that many people who are dying of TB don't even know their HIV status," Prof Glenda Gray, co-director of the Perinatal HIV Research Unit at the University of Witwatersrand in Johannesburg, told IRIN/PlusNews.

HIV is ranked as the nation's tenth biggest killer, but Dr Francois Venter, president of the Southern African HIV Clinicians Society, also attributed most of the pneumonia and TB mortality to HIV, making it "probably number one in reality".

Experts also described demographic trends in the mortality figures as pointing unmistakably to South Africa's heavy HIV/AIDS burden.

The highest numbers of deaths were among children younger than four years, and in the 30 to 34 age group.

"The only thing that could account for this change in child mortality must be HIV/AIDS," said Gray, commenting on the 12 percent rise in infant deaths between 2004 and 2005. "We know that less than 17 percent of women are accessing PMTCT (prevention of mother-to-child transmission services), so this is not surprising."

"Often, when the mother is asked what was wrong, she'll say diarrhea and vomiting," said Gray, explaining why intestinal infectious diseases rather than HIV was listed as the leading cause of death in children aged 1 to 4 years. "Many children die before they get an HIV test," she added.

In the 20 to 34 age group more women than men died and, overall, there was a greater increase in female deaths than male deaths. This is in keeping with 2005 HIV prevalence figures from South Africa's Human Sciences Research Council, indicating that women aged 15 to 24 were four times more likely to be HIV positive than men of the same age.

KwaZulu-Natal, the province with the highest HIV prevalence, also recorded the highest number of deaths in 2005, followed by Gauteng, the nation's economic hub.

"It's a very sad and horrific report, and I hope people are reflecting on it," Gray said.

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The National HIV and Syphilis Prevalence Survey South Africa 2006. 07/06/2007

The report was launched by the National Department of Health in Parliament.

The Summary report can be downloaded. (PDF)  The complete report was made available in the beginning of August and can be downloaded in sections here.  Various news articles were published about the survey.
You can read more about the annual survey and download earlier and later reports here.
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HIV Prevalence Stabilising. 11/06/07

JOHANNESBURG, 11 June (PLUSNEWS) - HIV prevalence in South Africa appears to have stabilised and may even be declining, according to the latest figures in the government's 2006 National HIV and Syphilis Survey.

The Department of Health study estimated that 29.1 percent of pregnant women were living with HIV in 2006, compared to 30.2 percent in the previous year.

Among pregnant women under the age of 20, HIV prevalence dropped from 15.9 percent to 13.7 percent, and fell from 30.6 percent to 28 percent among women aged between 20 and 24 during the same period.

However, experts at the Human Sciences Research Council (HSRC) told IRIN/PlusNews that the drop was statistically too insignificant to warrant celebration.

"It is too small to even indicate a clear reason for the reduction. Besides, new HIV infections are still occurring at alarming rates," said Dr Olive Shisana, executive director of the HSRC.

She pointed out that more than 500,000 new infections had occurred in South Africa during 2005 alone, and cautioned the government against becoming over-confident of the success of its prevention campaigns.

South African Health Minister Manto Tshabalala-Msimang recently told parliament that reductions in HIV prevalance, especially among pregnant women, was mainly as a result of "our continued focus on prevention as the mainstay of our response to combat HIV and lead to an HIV-free society".

"As important as these [prevention] interventions are, it is still too early to base a decline in HIV prevalence on them," she said. "This is especially true when considering the high rate of teenage pregnancies that still takes place. What does this say about prevention messages and the need for safer sex?"

A recent report by the Department of Social Development, published in the March 2007 edition of the HSRC magazine, Review, found that teenage mothers (women younger than 20) made up 13 percent of the country's more than 45 million population.

According to the 2006 National HIV and Syphilis Survey, around four out of 10 pregnant women seeking care in the public sector in KwaZulu-Natal Province were estimated to be HIV positive.

Shisana noted that the new study covered twice as many women as previous surveys, and samples had been collected from more than three times as many clinics.

"There is a chance that the increase in respondents might have also influenced results, as some of the added sites could have been located in areas with lower HIV prevalence," she argued.

The 2006 survey was based on a sample of 33,033 women attending 1,415 antenatal clinics in all nine of South Africa's provinces, which was double the number in the 2005 study.

Although acknowledging the tiny reduction as a much-needed boost to the morale of a nation hard-hit by HIV and AIDS, Shisana commented that "we are not out of the woods just yet".


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Survey Shows Decline in HIV among Pregnant Women. 7/6/07

by Anso Thom 

Health-e News 

Government has claimed first evidence of a decline in South Africa’s HIV/AIDS epidemic after its annual survey among pregnant women showed a “statistically significant reduction” of HIV prevalence between 2005 and 2006.

According to the latest survey the national HIV prevalence among pregnant women stands at 29,1%, compared to 30,2% in 2005.

Health minister Dr Manto Tshabalala-Msimang announced the results during her budget speech in Parliament yesterday (Wed). The minister claimed the decline was mainly as a result of “our continued focus on prevention as the mainstay of our response to combat HIV and lead to an HIV free society”.

A total of 33 033 women from 1 415 health facilities participated in the survey – this is double the number of 2005.

The report said the HIV prevalence rates had been stable for several years, evidence of a decline.

According to the survey there were statistically significant decreases in three provinces – Mpumalanga, NorthWest and Gauteng. The Free State was the only province which remained stable, but showed a tendency towards an increase.

In KwaZulu-Natal around four out of 10 pregnant women seeking care in the public sector are estimated to be HIV positive.

HIV prevalence in the under twenties was at 13,7% in comparison to 15,9% in 2005. The health department said this reduction indicated a decline in new infections in the population.

Similarly HIV prevalence in the 20 to 24 year age group was at 28%, almost two percent lower than 2005.

The department expressed some concern over the slight increase in the older age groups, but said the increases were not statistically significant. 

After causing a fracas at the Durban AIDS conference by withdrawing at the last minute, Tshabalala-Msimang wished the conference successful deliberations, discussions and outcomes.

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Aids Strikes SA's rich. 30/01/07

Rapid increase in HIV infections in professional people and those with full-time employment
30/01/2007 17:18-(SA)  

News 24

Johannesburg - South Africa's Aids epidemic, often regarded by health workers as a disease of the poor, is in fact spreading quickly among the country's richest and best educated people, researchers said on Tuesday.

The study by the Markinor polling firm and the University of South Africa (Unisa) showed a rapid increase in HIV infections in professional people and those with full-time employment - both key to South Africa's hopes to spur economic development.

"The high risk group is growing, it is getting older and it is getting richer," said Carel van Aardt, director of Unisa's Bureau of Market Research. "This could represent a whole new wave of the epidemic."

Tracy Hammond, Markinor's project manager for the study said: "If we thought the Aids epidemic was having bad economic effects already, this could take us to the crisis point."

"This time it is not the employees, it is the employers. It is not the people without bank accounts, it is the people who make investments," Hammond said.

Young people greatest risk

The study challenges widespread assumptions about South Africa's HIV/Aids crisis, which is often described as a disease of the rural poor who lack access to information, treatment and basic health services.

South Africa now has some 5.5 million HIV-positive people out of a total population of some 45 million, giving it an estimated overall prevalence rate of about 11% and one of the worst Aids caseloads in the world.

The new study examined some 3500 South Africans between the years of 2002-2005, a poll engineered to reflect the country's racial and economic demographics.

Overall, the study identified young people below the age of 30 as being at greatest risk for HIV, as most previous research has done. But it also found infections rising at alarming rates in the rich and better educated - groups not previously singled out as being at risk.

"We are on the eve of a very scary reality unless we start making some changes," said Hammond.

Up the social ladder

Researchers said there were many possible factors behind the spread of HIV among upper levels of society, among them confused government messages about HIV/Aids, greater disposable income and leisure, and general apathy about safe sex practices.

But whatever the reason, Aids is certainly climbing the social ladder for both black and white South Africans.

Among South Africa's professionals, for instance, the study found a 34% jump in estimated HIV prevalence, rising to 8.3% in 2004 from 6.2% in 2002.

People with full-time jobs - who in South Africa account for only about half the working population - saw estimated HIV-prevalence rise to 19.2% in 2005 from 14.4% in 2002.

Unemployed people, while seeing a bigger percentage jump in HIV prevalence, remained lower in terms of actual prevalence rates with just 18.4% estimated infected in 2005 compared with 11% in 2002.

Hitting people as careers take off

In a further piece of alarming news, the study said HIV infection was growing most quickly in those aged between 30-34, threatening people just as their careers take off.

Overall, the richest third of South Africa's population still has a lower estimated HIV-prevalence than the poorest third, at 8.5% compared with 23.4%.

But the study said new infections were increasing most rapidly in this demographic, rising by 39% between 2002-2005 against only a 14% increase for their poorest compatriots.


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South Africa has Most AIDS Orphans. 18/01/07

Louise Flanagan | Johannesburg, South Africa
18 January 2007 06:56

South Africa has the most Aids orphans in the world, according to a United Nations Children's Fund (Unicef) report released this week.

The report focused on data from 2005. It found that a total of 15,2-million children around the world had lost at least one parent to HIV/Aids. Most of these children were in sub-Saharan Africa -- and 1,2-million were in SA. These are not the only South African orphans.

Unicef estimated that 2,5-million South African children under 18 had lost at least one parent due to any cause, with about 450000 having lost both parents.

For those countries with data, only seven had more children who had lost both parents -- China, Democratic Republic of Congo, Ethiopia, India, Nigeria, Uganda and Zimbabwe.

Unicef said orphans often lost out on schooling, food and clothing, they may suffer anxiety, depression and abuse, and they had a higher risk of exposure to HIV.

"Orphans due to Aids are not the only children affected by the epidemic. Many more children live with parents who are chronically ill, live in households that have taken in orphans due to Aids or have lost teachers and other adult members of the community to Aids."

Unicef estimated that about 240000 South African children under 15 were HIV-positive, a figure matched globally only by Nigeria. About 28% of these needed antiretroviral (ARV) treatment but only 18% of those who needed it were getting it.

About one third of an estimated 250000 HIV-infected pregnant mothers received ARVs. About a third received ARVs for prevention of mother-to-child transmission, which Unicef said showed progress as this had increased from 22% the year before.

Only about 64000 of the babies born to HIV-infected mothers -- about a quarter of them -- started cotrimoxazole prophylaxis, to prevent opportunistic infections that can be fatal.

Unicef said the virus progressed rapidly in children, with about a third dying before their first birthday and half dead before their second birthday. Last year about 380000 children died around the world from Aids-related causes.

"The vast majority of these deaths were preventable, either through treating opportunistic infections with antibiotics or through antiretroviral treatment."

The World Health Organisation recommends giving cotrimoxazole to HIV-positive children and to babies born to HIV-positive mothers.

Unicef said South Africa was one of a few countries which had been able to scale up HIV treatment of children by integrating this into sites for adults.

ARVs for children now cost about $60 a year (about R430). Unicef estimated that 5% of South African boys aged 15 to 24 years and 15 percent of the girls that age were HIV-positive.

About 18% of the country's adults were estimated to be HIV-positive.

Unicef said child grants helped.

"In South Africa, for example, the country with the largest number of orphans due to Aids, more than 7,1-million children under 14 living in poverty -- 79% of those eligible -- were benefiting from the child-support grant by April 2006.

"This represents a two-thirds increase since 2004 and a 20-fold increase since 2000.

"More than 325000 children were benefiting from foster care grants in 2006." - Sapa


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HIV/AIDS Havoc in South Africa. 01/12/06

JOHANNESBURG, 1 December (PLUSNEWS) - HIV/AIDS continues to wreak havoc in South Africa, with the nation's youth appearing to be hardest hit, researchers said on 1 December, World AIDS Day.

The nation's 15-year-olds now had a 56 percent chance of dying before the age of 60, compared to a 29 percent chance of dying of an AIDS-related illness in 1990, according to 'The Demographic Impact of HIV/AIDS in South Africa: National and Provincial Indicators for 2006', a joint study issued every two years by the Actuarial Society of South Africa (ASSA) and the Medical Research Council (MRC).

Leigh Johnson, a senior ASSA researcher, warned that the youth were facing a bleak future, and much still had to be done to protect and support this vulnerable group. "Even with current youth-directed prevention campaigns being rolled out, approximately 250,000 of all new infection this past year occurred among the 15 to 24 age group," he told IRIN/PlusNews.

Overall, in 2006 there were 950 AIDS-related deaths per day in South Africa, and approximately 1,400 new HIV infections daily - a total of 530,000 new infections per year. Johnson said there was an urgent need to strengthen existing efforts to respond to the epidemic.

The government's anti-AIDS strategy, often at the centre of international criticism for its snail-paced approach to tackling the pandemic, has been revamped, with the Health Department emphasising that the key to success in the fight against AIDS was reducing the number of new infections among young people, while promoting delayed initiation of sex among youth aged 14 to 17 years.

Doctor Francois Venter, an HIV specialist at the University of Witwatersrand, in Johannesburg, warned that abstinence and delayed sexual debut might not be the most effective approaches to addressing the needs of adolescents.

"The greatest challenge is to develop new strategies for preventing HIV transmission, not just among youths but the population in general, and what is needed is for us [government and civil society]: to all go back to the drawing board on our current approaches," Venter said.

ASSA suggested that high rates of AIDS mortality would persist in South Africa for at least the next decade, although projections were sensitive to assumptions regarding future access to antiretroviral (ARV) treatment. "That's why it is vital for the government to rapidly expand its ARV rollout programme to reach all people in need of immediate treatment," Johnson added.

A further challenge would be the provision of care and support to growing numbers of orphans, expected to double between 2006 and 2015 to an estimated 2.5 million children.

Venter and Johnson agreed that the recent reformation of the South African National AIDS Council and the restored spirit of co-operation between government and civil society would go a long way to addressing the points of concern highlighted in the report.

Access the full report at any of the following sites:

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HIV and Death Statistics. 07/09/06

Last updated: Friday, September 08, 2006

The South African government on Thursday linked a sharp increase in the death rate to the country's staggering Aids epidemic.

The government said the death rate for women aged 20 to 39 had more than tripled between 1997 and 2004 and had more than doubled for men aged 30 to 44. It noted those age groups had the highest incidence of death from Aids.

"Large increases in the death rates of women in their 20s and 30s since the late 1990s are thought to result mainly from HIV," the government statistical office said in its report. It gave no estimate for the increase in HIV deaths and said many Aids deaths were attributed to other causes.

It said levels of HIV infection have risen rapidly, that the average time from becoming infected to death was eight to 10 years and that it was likely that "HIV deaths will continue to increase in South Africa for some years."

Rise in HIV-positive mothers
The percentage of pregnant woman who are HIV-positive had risen from 15 in 1990 to 17% in 1997 and to 30% by 2004, the last year covered by the report.

Overall, the government has estimated more than 5.5 million South Africans are infected with HIV, a number second only to India and one that amounts to about an eighth of estimated cases worldwide. On average, more than 900 people die of the disease in South Africa each day.

South Africa 's government has come under mounting international criticism because of its handling of its Aids epidemic. President Thabo Mbeki once questioned the link between HIV and Aids, and both he and Health Minister Manto Tshabalala-Msimang have doubted the effectiveness of anti-retroviral drugs used to treat Aids.

More than 80 international Aids scientists, including an American Nobel laureate and one of the co-discoverers of the virus that causes Aids, released a letter to Mbeki on Wednesday that called South Africa's Aids policies inefficient and immoral and urged the president to fire his health minister.

Negligent government
Stephen Lewis, the UN Special Envoy for Aids in Africa, delivered a scathing attack on South Africa at the International Aids conference in Toronto last month, saying the government was "still obtuse, dilatory and negligent" about providing treatment.

"It is the only country in Africa whose government continues to promote theories more worthy of a lunatic fringe than of a concerned a compassionate state," he said.

South Africa called Lewis' comments "unacceptable" and claimed to have the largest HIV treatment programme in the world. It said it was treating 140 000 people in treatment programmes, a figure less than half of the 380 000 target it set in 2003. The Aids scientists said about 500 000 South Africans now need Aids drugs to survive.

In its report, the government said the increase in the country's death rates could not be attributed only to Aids, but also to nutritional deficiencies and other infectious diseases such as tuberculosis and malaria.

A bleak report
The increase in the death rate for almost every group in the study was particularly disturbing, because the worldwide trend is for the rates to decline over the period.

According to the report, the death rate for women aged 20-24 increased from 331 in 1997 to 1 085 in 2004 per 100 000; for women aged 25-29 from 452 in 1997 to 1 985 in 2004; for women aged 30-34 from 489 in 1997 to 2 267 in 2004; and for women aged 35-39 from 526 in 1997 to 1 890 in 2004. For men aged 30-34, it increased from 817 per 100 000 in 1997 to 2,118 in 2004; for men aged 35-39 it rose from 916 in 1997 to 2 498 in 2004; and for men 40-44 it climbed from 1 136 in 1997 to 2 765 in 2004.

" South Africa is a member of a select, but undesirable, group of countries in which life expectancy at birth declined by 4 years or more between 1990 and 2001," the government said. It said all the countries are either in Africa or part of the former Soviet Union.

The only good news was that deaths due to murder, suicide and accidents had changed little and that the number of killings had actually declined since the late 1990s. But the government said South Africa probably still has "the second highest homicide rate in the world, trailing only Colombia." –AP

Statistics South Africa released their new report on "Adult mortality (age 15-64) based on death notification data in South Africa: 1997 - 2004" on 07/09/2006. This report has some indicators on HIV deaths that cause serious concern.  

The report is available here.


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HIV Infection Rate Stable? 21/07/06

HIV infection rate remains at same level

Issued by Department of Health. 21 July 2006

The Report on the National HIV and Syphilis Antenatal Sero-prevalence Survey in South Africa for 2005 was released by the Department of Health today and is available on here

The Department of Health conducted an HIV and syphilis prevalence survey in 2005 to estimate the HIV and syphilis prevalence. The survey estimates the national, geographical (provincial) and age distribution of HIV and syphilis. The information from the survey is also used to estimate HIV prevalence in the general population by means of a model.

In keeping with recent international trends to adjust HIV models and estimates on the basis of new empirical research evidence, the Department of Health applied the UNAIDS/ WHO model which has been designed to take into account the cumulative effects of interventions in estimating the number of people in the general population with HIV infection

Similar surveys have been conducted since 1990 to show yearly trends in HIV prevalence.

Survey results

The findings of the survey conducted during October 2005 show that HIV infection rates have remained at a similar level as they had been in the last year 2004 (29.5%) and in 2005 (30.2%).

The provincial estimates remain similar to the 2004 trends and the age estimates show that participants in the 20 to early 30 year age groups continue to have the highest infection rates.

The rate of HIV prevalence amongst teenagers has remained at a similar level in 2005 (15.9%) as it was in 2004 (16.1%).

With respect to population projections, it is estimated that 18.8% of persons in the 15-49 year age group have HIV infection. This is an estimated 4.9 million people who are in the age group 15 to 49 years. There is an estimated 235 060 children who are 14 years and younger living with HIV. The total population living with HIV is estimated at 5.54 million.

Syphilis prevalence for 2005 is 2.7%. The overall trend over time shows that syphilis is less prevalent compared to 1997.


HIV prevalence estimate show that HIV prevalence rates for 2004 and 2005 are very similar. The prevalence profile continues to confirm the expectation and projections of numerous groups whose models suggest that South Africa will begin to see a decline in the prevalence profile.

The studies conducted over the years have begun to show that intervention programmes, which emphasise prevention, have a very important role in moderating HIV prevalence and the epidemiology of HIV infections in general.

The study once again has provided useful information on trends in HIV infection and this information would assist government and partners alike to further strengthen HIV and AIDS programmes.

The Department of Health reaffirms its commitment to work together with all sectors of our society to strengthen HIV prevention programmes as a means to curb the spread of HIV infection and reduce the impact of AIDS on our society.

Contact: Sibani Mngadi @ 0827720161

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HIV Prevalence Stabilising. 11/06/06

JOHANNESBURG, 11 June (PLUSNEWS) - HIV prevalence in South Africa appears to have stabilised and may even be declining, according to the latest figures in the government's 2006 National HIV and Syphilis Survey.

The Department of Health study estimated that 29.1 percent of pregnant women were living with HIV in 2006, compared to 30.2 percent in the previous year.

Among pregnant women under the age of 20, HIV prevalence dropped from 15.9 percent to 13.7 percent, and fell from 30.6 percent to 28 percent among women aged between 20 and 24 during the same period.

However, experts at the Human Sciences Research Council (HSRC) told IRIN/PlusNews that the drop was statistically too insignificant to warrant celebration.

"It is too small to even indicate a clear reason for the reduction. Besides, new HIV infections are still occurring at alarming rates," said Dr Olive Shisana, executive director of the HSRC.

She pointed out that more than 500,000 new infections had occurred in South Africa during 2005 alone, and cautioned the government against becoming over-confident of the success of its prevention campaigns.

South African Health Minister Manto Tshabalala-Msimang recently told parliament that reductions in HIV prevalance, especially among pregnant women, was mainly as a result of "our continued focus on prevention as the mainstay of our response to combat HIV and lead to an HIV-free society".

"As important as these [prevention] interventions are, it is still too early to base a decline in HIV prevalence on them," she said. "This is especially true when considering the high rate of teenage pregnancies that still takes place. What does this say about prevention messages and the need for safer sex?"

A recent report by the Department of Social Development, published in the March 2007 edition of the HSRC magazine, Review, found that teenage mothers (women younger than 20) made up 13 percent of the country's more than 45 million population.

According to the 2006 National HIV and Syphilis Survey, around four out of 10 pregnant women seeking care in the public sector in KwaZulu-Natal Province were estimated to be HIV positive.

Shisana noted that the new study covered twice as many women as previous surveys, and samples had been collected from more than three times as many clinics.

"There is a chance that the increase in respondents might have also influenced results, as some of the added sites could have been located in areas with lower HIV prevalence," she argued.

The 2006 survey was based on a sample of 33,033 women attending 1,415 antenatal clinics in all nine of South Africa's provinces, which was double the number in the 2005 study.

Although acknowledging the tiny reduction as a much-needed boost to the morale of a nation hard-hit by HIV and AIDS, Shisana commented that "we are not out of the woods just yet".


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Measuring New HIV Infections Offers New Insights. 14/03/06

HSRC Media Brief

Ideally, HIV spread and changes over time should be tracked through measuring the number and distribution of new infections, or incidence, in a population. Incidence estimates reflect the underlying HIV transmission dynamics that are currently at work in South Africa. The availability of laboratory-based tests for recent HIV infection signals a new era in HIV surveillance, and now offers a direct measure for tracking the epidemic and evaluating the impacts of prevention interventions.

In an article by Thomas Rehle et al. in the March 2007 edition of the South African Medical Journal (SAMJ), an unparallelled large sample of 15 851 blood specimens was analysed to estimate HIV incidence on a national scale for South Africa. The detection of recent infections was performed on confirmed HIV-positive samples, using the BED capture enzyme immunoassay optimised for dried blood spot (DBS) specimens. BED HIV incidence calculations applied adjustment procedures that were recently revised and approved for subtype C blood specimens, the predominant HIV subtype in Southern Africa.

The analysis was based on data from the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005, commissioned by the Nelson Mandela Foundation with additional support from the US Centers for Disease Control and Prevention.

HIV incidence in the population aged two years and older was 1.4%, with 571 000 new HIV infections estimated for 2005, translating roughly into 1 500 new infections per day. An HIV incidence rate of 2.4% was found among individuals aged 15-49 years.

Of all new HIV infections, 34% occurred in young people in the 15-24 age group. The incidence rates among young women in the prime childbearing age are especially alarming. The HIV incidence in the age group 20-29, was 5.6%, 6 times more than in males of the same age (0.9%). Among young people in the 15-24 year age group, women accounted for 90% of all recent HIV infections.

‘These findings suggest that the current prevention campaigns do not have the desired impact, particularly among young women’, concluded Professor Thomas Rehle, Director in the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council (HSRC).

The incidence analysis also shows that a substantial number of new non-vertical infections (i.e. not transferred from mother to child) have occurred among children in South Africa, ’The causes of these non-vertical transmission still need further investigation using longitudinal designs that help us understand cause and effect’, said Dr Olive Shisana, President and CEO of the HSRC and a co-author of the paper.

Another important epidemiological aspect of the disease is place of residence. People living in urban informal settlements have by far the highest incidence rates (5.1%), followed by those living in rural informal areas (1.6%, rural informal areas (1.4%) and urban formal areas (0.8%). ‘These results suggest that poverty plays a significant role in increasing vulnerability to HIV.’ said Dr Shisana.

The analysis of condom use at last sex by age group illustrates that HIV incidence is a more appropriate measure than HIV prevalence to interpret the behavioural effects on HIV infection. ‘An encouraging finding of the study was that reported condom use at last sex in the younger age group is associated with substantially lower HIV incidence, particularly among young males’, emphasises Dr Victoria Pillay, a research specialist at the HSRC and a co-author of the paper.

A surprising finding was the high incidence among widowed individuals, who had a remarkably high incidence of HIV of 5.8%, especially among women.

Pregnancy is a significant risk factor for HIV. The article says the analysis supports recent findings from Uganda that suggest an increased risk of HIV acquisition during pregnancy. Of the women in the 15-49 age group who reported a current pregnancy, 5.2% were found to be newly infected, compared with 3.7% in the non-pregnant female population in this age group.

‘Incidence data provide critical new insights into the dynamics of the HIV epidemic and are a more appropriate measure to correlate biological data with recent behaviours or recent behavioural changes. The 2005 national HIV incidence estimates presented in this study will serve as benchmark figures for future assessments of the dynamics and trends of the South African HIV epidemic’ explained Professor Thomas Rehle. The national HIV incidence measures – new insights into the South African epidemic, Thomas Rehle, Olive Shisana, Victoria Pillay, Khangelani Zuma, Adrian Puren and Warren Parker (SAMJ, March 2007).

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Study Highlights Alarming HIV Incidence. 14/03/05

JOHANNESBURG, 14 March (PLUSNEWS) - HIV infection is on the rise in South Africa, and women continue to be most affected, the Human Sciences Research Council (HSRC) said on Wednesday.

In a new study, published in the March issue of the South African Medical Research Journal, which examined an unparalleled number of 15,851 blood specimens to assess national HIV incidence, the HSRC found that around 571,000 people had been newly infected with HIV in 2005 - about 1,500 new infections per day.

"The findings are certainly alarming, but even more worrying is that women and young adults continue to be the most affected," Dr Victoria Pillay, an HSRC research specialist and one of the study's authors, told IRIN-PlusNews.

HIV incidence among women aged 20 to 29 was a high 5.6 percent - six times more than men in the same age group, while women and young girls aged 15 to 24 accounted for 90 percent of all recent infections.

"There is a sense that current prevention campaigns are not yielding the expected results, especially among our female population," Pillay warned.

She attributed the incidence of HIV among women to the wide spectrum of socio-cultural attitudes, which were usually more prevalent in informal urban and rural settings.

According to the research article, people in urban informal settlements had the highest incidence (5.1 percent), followed by those in rural informal areas (1.6 percent) and urban formal areas (0.8 percent).

Pregnancy was also highlighted as a main risk factor in HIV infection: among women and young girls aged between 15 and 49, 5.2 percent of pregnant respondents were newly infected, compared to 3.7 percent of non-pregnant women.

"Current approaches need a rethink. There is also a great urgency for the presence of men as partners in curbing the impact of the disease on women and young girls," Pillay said.

Sharing her sentiments, officials at Sonke Gender Justice (SGJ), a local HIV/AIDS, gender and human rights nongovernmental organisation, said a patriarchal social culture was also to blame.

"Men continue to rule the roost and, as a result of age-old imbalances in power between the sexes, women are often left with little room to negotiate safer sex," SGJ co-director Bafana Khumalo commented.

Khumalo welcomed the new findings as a timely guide, saying the government planned to strengthen its anti-AIDS efforts and officials were finalising a draft of the 'National Strategic Plan on HIV/AIDS and Sexually Transmitted Infections for 2007 to 2011', which aimed to halve the rate of new HIV infections by 2011, particularly in the 15 to 24 age group.

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