HSRC Study on HIV & AIDS PowerPoint Presentation

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Nelson Mandela/HSRC Study of HIV/AIDS South African National HIV Prevalence,Behavioural Risks and Mass MediaHousehold Survey 2002

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A collaborative effort of The Human Sciences Research Council (HSRC) Medical Research Council (MRC) Centre for AIDS Development, Research and Evaluation (CADRE) Agence Nationale de Recherches sur le Sida (ANRS)

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This report is funded by The Nelson Mandela Foundation (NMF) Swiss Agency for Development and Cooperation (SDC) The Nelson Mandela Children’s Fund (NMCF) The Human Sciences Research Council (HSRC)

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Introduction South Africa has a serious HIV/AIDS epidemic, with millions of its people living with the disease. Accurate information and a comprehensive understanding of the epidemic is needed in order to deal effectively with the problem. In particular, it is crucial to understand the social, cultural, political and economic context that contributes to vulnerability to HIV infection.

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Cont./ Introduction To date HIV prevalence in the country has been based on the Department of Health’s (DOH) annual antenatal survey of pregnant women. This study augments the antenatal survey through a population-based sample of South Africans including men, women, children, all races and ethnic groups, people living in urban areas, rural areas and farms, as well as hostel residents.

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Cont./ Introduction This is the first systematically sampled national community-based survey of the prevalence of HIV in South Africa. The survey reviewed risk, risk reduction, HIV/AIDS knowledge, mass media and communication, psychosocial and socio-cultural aspects of HIV/AIDS

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Survey Method 1. Define target population – all people in SA 2. Define sample frame – 2001 census 3. Define Primary Sampling Unit (PSU) 2001 census EAs 4. Define explicit strata – Provinces and geography type 5. Define reporting domain – province, locality-type and population group 6. Define Secondary Sampling Unit (SSU) – visiting point 7. Define Measure of Size (MOS) – 2001 estimate of visiting points 8. Define Ultimate Sampling Unit (USU) – all individuals 2+ years of age 9. Allocation of sample – disproportional to province, population group & locality-type The steps in the sample design

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Cont./ Survey Method 1. Selection of PSUs – 1000 EAs 2. Produce aerial photos and data kits of EAs 4. Selection of SSUs – 11 visiting points per EA 5. Selection of USUs – 3 people per VP The steps in the drawing of the sample

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Cont./ Survey Method Location of master sample PSUs in South Africa

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Cont./ Survey Method Location of unrealised EAs in the survey

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Sample 13 518 individuals who were selected and contacted for the survey 9 963 (73.7%) persons agreed to be interviewed 8 428 (62.5%) gave a usable specimen for an HIV test

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HIV testing The OraSure® HIV-1 Oral Specimen Collection Device was used to collect oral mucosa transudate (oral fluid) specimens. Vironostika test kits were utilised for conducting antibody tests. Used internationally since 1986, and in Africa since 1990. Approved by FDA for all HIV clades. Studies on sensitivity and specificity show high correlations with blood results (98%-100%)

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Questionnaires adults aged 25 years and older youth aged 15–24 years children aged 12–14 years caregivers of children aged 2–11 years

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Results

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National prevalence The HIV prevalence in the population of South Africa is 11.4% - 4.5 million people (Confidence Interval (CI): 10.0%–12.7%) 15.6% of persons in the 15–49 age group were HIV positive (CI: 13.9%–17.5%)

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Provincial HIV prevalence HIV Prevalence by province, South Africa 2002

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Corroborating Evidence on HIV prevalence based on the MRC workplace studies

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Provincial prevalence Comparison of HIV prevalence levels by province with the DOH 2001 antenatal survey

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Comparison between DOH Survey and NM/HSRC survey 24% of the 244 pregnant women in the study were HIV VS 24.8% in the DOH antenatal survey sample were HIV+

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Locality-type prevalence HIV prevalence in adults (15–49 years) by Locality-type, South Africa

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Age group prevalence Prevalence of HIV by age, South Africa 2002

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Age and sex distribution of HIV infection Prevalence of HIV by sex and age, South Africa 2002

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Race and HIV prevalence HIV Prevalence among Adult (15-49 years) by Race, South Africa 2002

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Distribution of the Sample Similar to 1996 census in terms of age, sex, race, province, Locality type

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Those not tested for HIV are not different from those tested in terms of: Condom use during last sex Proportion of non-sexually active, abstainers, one partner or multiple partners Sexually transmitted infections Predicted HIV prevalence

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Sexually transmitted infections and HIV A strong link between STIs and HIV was confirmed in this study 38.9% of those who reported an STI in the past three months were HIV positive, compared with 13.2% The availability of STI treatment services was known by 79% 10% of these had used the services 93% of those said they were satisfied with services

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Orphans Definition of orphans: lost mother or father or both before 15 years From all causes of death 13.0% of children aged 2–14 years had lost a mother, father, or both parents 3% had lost a mother 8.4% had lost a father

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Child-headed households 3.0% of households were determined to be child-headed Child-headed household in South Africa: 3.1% in urban formal areas, 4.2% in urban informal areas, 2.8% in tribal authority areas and 1.9% in farms

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What the HIV prevalence results mean HIV is a generalised epidemic in South Africa It affects people of all races, all ages and in all localities It affects women more than men 5.6% HIV prevalence among children aged 2-14 years was unexpected and requires further investigation(CI: 3.7%-7.4%)

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Sexual activity in the past 30 days was low for youth 29% of youth 15-24 had not had sex in the past 30 days, and a further 41% had sex 1-4 times Partner turnover amongst youth and adults is low 84.7% of youth and 93.5% of adults had only one partner in the past year Secondary abstinence – previously sexually active, but no sex in the previous 12 months – was 23.4% in the 15–24 year age group Sexual frequency and partner turnover

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90% of youth and adults reported easy access to condoms if they needed one Condom use at last sexual intercourse was higher amongst Africans than other race groups 13.2% traditionally married adults 25-49 years, and 15.8% of those in civil marriages used condoms Condom access and use

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Condom access and use Primary sources of condoms, South Africa, 2002

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Condom use during last sex act

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Self-reported behaviour change 40.2% of youth and adults reported changing their behaviour as a result of HIV/AIDS

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Behaviour Change among sexually active women between 2002 NM/HSRC survey and 1998 SADHS

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Knowledge of HIV/AIDS Information Good overall knowledge of key aspects of HIV/AIDS information 81.2% of youth and 79.3% of adults agreed that HIV causes AIDS 89.2% of youth and 92.8% of adults agreed that AIDS cannot be cured by sex with a virgin. 49.5% of youth and 56.1% of adults agreed that a baby could become HIV+ through breastfeeding

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Awareness of HIV status 62% knew where to get VCT services 76% of South Africans who were HIV positive were not aware of their HIV status 63% of these who were not aware of their HIV positive status did not perceive themselves to be at risk Of those who had not been tested, 59.4% said they would consider a test if confidentiality was maintained, whilst 28.5% would be motivated by the accessibility, cost and quality of services

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Sources of HIV/AIDS information (%)

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Condom-use messages were best recalled – 90.8% of youth and 86% of adults Amongst adults, messages about faithfulness (58.2%), abstinence (44.5%) and partner reduction (44.8%) also rated highly PLWA rights (14.8%), care for PLWA (9.8%) and religious or cultural values (8.2%) were less well noted There was a need for more detailed information on most HIV/AIDS topics Unprompted recall of messages

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Percent who have taken HIV more seriously

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Public Perceptions: political leadership, resource allocation Public perceptions of commitment to dealing with AIDS and resource allocation by race, South Africa, 2002

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Should Gov provide ARV’s for PMTCT? 96.5% said yes

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Should Govt provide ARVs for PLWA? 95% said yes.

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Conclusions

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Conclusion HIV/AIDS is a serious problem in SA South Africans are responding to prevention campaigns They are knowledgeable about HIV/AIDS The epidemic and mass media are making South Africans to take AIDS seriously South Africans are changing their behaviour They believe the politicians are committed to dealing with AIDS, publicly recognise it,and are not allocating sufficient resources. They think the govt should make ARVs available for PMTCT and treatment. There is hope for the country to deal with HIV/AIDS