South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey, 2008: A Turning Tide Among Teenagers?

This report is the third in a series of population-based HIV seroprevalence surveys, which started in 2002 and were repeated in 2005 and again in 2008. The report seeks to assess the national HIV prevention response in relation to the goals set in the HIV & AIDS and STI Strategic Plan (NSP), in particular, to reduce HIV incidence by 50% by 2011. The research found that although the overall situation remains dire, some solid progress has been achieved in the fight against the disease over the past few years, especially among teenagers and children. The report also 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. In particular, findings show that there is a lack of reach into older age groups with nearly 4 out of 10 people aged 50 years and older not being reached by any communication programme.

According to the report, a wide range of national and sub-national HIV/AIDS communication programmes exist in South Africa. These include national communication programmes conducted by government and non-governmental organisations (NGOs); programmes within schools, universities, and workplaces; provincial government programmes; sub-national programmes led by NGOs; and interactive communication, including community-level campaigns such as door-to-door activities, community theatre, and events.

The research found that South Africa had achieved the following:

• 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 an 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.

The report states that although there has been an increase in reach between 2005 and 2008, youth aged 15–24 are most likely to be reached. In 2008, 9.8% of youth aged 15–24, 16.4% of adults aged 25–49, and 37.8% of older adults aged 50+ years were not reached by any programme. The Khomanani "Coming Together" programme of the national government has a low overall reach, given that it is intended to reach all populations in South Africa. Khomanani’s reach is lower than any of the other national programmes. According to the report, Soul City has a good overall reach, but among the most-at-risk populations (MARP), the reach of Soul City to males aged 50+ is low (at 43.3%), and the potential for reaching this group should be further explored. Soul Buddyz is intended for children aged 8–12, but also reaches into wider audiences – for example African females aged 20–34, but also other MARPs and older audiences. The authors suggest that the implications of this wider reach should be explored by programme strategists. Although loveLife has a youth-oriented focus, its reach has extended to MARPS and older age groups. The implications of this wider reach should also be explored by programme strategists.

In conclusion, the report recommends the need for:

• more carefully designed intervention programmes in some provinces;
• programmes to help people to have children without risking HIV;
• addressing high sexual partner turnover and intergenerational sex by focusing on changing norms at community level;
• implementing provider-initiated routine HIV testing at all health care facilities;
• increasing communication programme reach; and
• defining country-specific indicators including for most-at-risk populations.