While KwaZulu-Natal has the highest number of people living with HIV in South Africa, the province also has the highest percentage of viral load suppression due to antiretroviral (ARV) therapy, which means that the possibility of transmitting the virus is low.
This is according to members of the Human Sciences Research Council who met in Durban on Wednesday to unpack the results of the sixth South Africa HIV Prevalence, Incidence, Behaviour and Communication Survey.
It found that KZN still has the highest HIV prevalence in the country among adults aged 15 and older.
The panel included the overall principal investigator, Professor Khangelani Zuma, project director Dr Musa Mabaso, and US Centers for Disease Control and Prevention South Africa country director, Dr John Blandford.
The survey found that KZN has the highest percentage of HIV prevalence at 21.8% followed by Mpumalanga at 20.8, Free State with 19.1% and Eastern Cape at 18.8%. However, the viral load suppression among adults aged 15 and older living with HIV in KZN is 86.7%.
Zuma said overall the numbers from 2017 to 2022 have been dropping, which is good, but the numbers need to be looked at in terms of exposure to ARVs and viral suppression.
“Even though these provinces have the largest numbers of people living with HIV, other than Eastern Cape, most of them are virally suppressed which means the risk of transmitting HIV from this group to another group of people is much less in these provinces, even though you are more likely to find an HIV positive person in that particular province,” he said.
He said provinces like North West, Limpopo, Western Cape and Northern Cape have fewer people living with HIV, but also fewer of those people are virally suppressed, which means they are more likely to transmit the virus.
Mabaso said with regard to drivers of HIV in KZN, the epidemic is concentrated in impoverished communities where there is low educational attainment, driven by socio-cultural norms and gender power dynamics.
He said the stats show that women are more affected by HIV than men, but men are the ones that engage in sexual relationships with younger women.
“We can do a whole lot in the HIV community in terms of responding to the epidemic but there are also other things where the government will need to intervene. It’s not just about HIV, but about these structural drivers, the socio economic conditions under which people live which is a bigger challenge for our government,” said Mabaso.
Mabaso added that men need to change their mindset when it comes to their health.
“It all starts with men’s health, we are sick with other diseases and we are the last people to go to seek help and I think that’s where the challenge is because, if we deal with that, then we will have more men testing. We want to have more people testing and knowing their status to get people on ARVs,” he said.
Blandford said the messaging needs to change for men. “The promise of a normal life if you are on ARVs is much more compelling.”
He said the messaging is different this year from five years ago in that when a person living with HIV has a viral load that is fully suppressed, they will not transmit the virus.
However, he emphasised that safe sex practices still need to be adhered to.
Blandford said the second most important preventative intervention is Pre Exposure prophylaxis or Prep for those who are HIV negative but who are at risk of infection.
“With those two modalities when we see this disparity, the concern is we need to help especially young women who are HIV negative to get on Prep to protect themselves and for their sexual partners to get tested and, if HIV positive, seek treatment,” he said.