About 29% 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%, against 29.3% in 2008 and 29.4% in 2007.
Prevalence among 15-24 year-olds also remained the same as in 2008 at 21.7%. Also following the trend of previous surveys, prevalence among older women continued to increase. In 2009, an estimated 41.5% of pregnant women aged 30 to 34 were living with HIV, up from 40.4% in 2008 and 39.6% in 2007. In the 35-39 age group, prevalence increased by 6% over four years to reach 35.4% 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.
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% of pregnant women testing positive in 2009 against 38.7% 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% of pregnant women were HIV-infected.
In contrast, the Western Cape had a prevalence of 16.9% and zero infections were found among pregnant women in the Northern Cape district of Namaqua.
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% 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 generalised epidemic that has stabilised 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% in 2002 to 13.7% in 2009. - (PlusNews, November 2010)