Meredith Evans

New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012

This article presents key findings from the 2012 HIV prevalence, incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002, 2005, 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4–13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25–49 years were most affected, 25.2% [95% CI: 23.2–27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8–11.6] in 2008 to 12.2% [95% CI: 11.4–13.1] in 2012 (p < 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p < 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87–1.27], with the highest incidence among Black African females aged 20–34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15–24 years, and was significantly higher among male youth than female (16.7% vs. 5.0% respectively, p < 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p < 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p < 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However, there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical, behavioural, social and structural prevention interventions to reverse the tide in the fight against HIV.

Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa

Introduction: Age‐disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age‐disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age‐disparate sex and HIV status among young women aged 15–24 in South Africa.

Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey

ABSTRACT South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N = 17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV-positive compared to all other marital spouses groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV-positive were found to be lower among married individuals who lived with their spouses compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socio-economic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships.

Contraception coverage and methods used among women in South Africa: A national household survey

BACKGROUND Globally, family planning services are being strengthened and the range of contraceptive choices expanded. Data on contraceptive coverage and service gaps could help to shape these initiatives. OBJECTIVE To assess contraception coverage in South Africa (SA) and identify underserved populations and aspects of programming that require strengthening. METHODS Data from a 2012 SA household survey assessed contraception coverage among 6 296 women aged 15 - 49 years and identified underserved populations. RESULTS Two-thirds had an unintended pregnancy in the past 5 years, a quarter of which were contraceptive failures. Most knew of injectable (92.0%) and oral contraception (89.9%), but fewer of intrauterine devices (56.1%) and emergency contraception (47.3%). Contraceptive prevalence was 49.1%, and 41.8% women used modern non-barrier methods. About half had ever used injectable contraception. Contraception was lower in black Africans and younger women, who used a limited range of methods. CONCLUSION Contraception coverage is higher than many previous estimates. Rates of unintended pregnancy, contraceptive failure and knowledge gaps, however, demonstrate high levels of unmet need, especially among black Africans and young women.

HIV Risk Among Men Who Have Sex With Men, Women Who Have Sex With Women, Lesbian, Gay, Bisexual and Transgender Populations in South Africa: A Mini-Review

Background: The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. Objectives: This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. Method: Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. Results: In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. Conclusion: Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.

The association between psychological distress, alcohol use and physical non-communicable diseases in a nationally representative sample of South Africans

This study examines the associations between symptoms of mental disorders and diabetes and hypertension in a nationally representative sample of South Africans. We examined unadjusted and adjusted associations of socio-demographic characteristics, alcohol use and psychological distress with diabetes and hypertension. Multivariate logistic regression revealed that hypertension is significantly associated with age, while diabetes is significantly associated with age, population group and psychological distress. The association between psychological distress and diabetes found here suggests the usefulness of additional research using more detailed measures of psychiatric disorders in local studies and reinforces clinical calls for attention to psychiatric screening in patients with diabetes.

P4.43 Socio-economic status of men engaging in age disparate sex: a secondary analysis of nationally representative data in south africa

Introduction Studies have highlighted the increased risk in contracting HIV for young women who engage in age disparate sexual partnerships. However, there is a dearth of evidence about the socioeconomic profile of men who engage in these types of sexual partnerships. This study focuses on men who engage in age disparate sex and specifically whether there are socioeconomic-status (SES) asymmetries between those who engage in age disparate sex compared to those who do not engage in age disparate sex. Methods The data for this study comes from the third National HIV communication Survey (NCS) of South Africa conducted in 2012. The sample consists of 4065 randomly selected men between the ages of 16 and 55 years. Respondents were interviewed by means of a structured questionnaire. Men were classified according to the types of sexual partnerships they had engaged in during the previous 12 months. Multiple logistic regression models were used to assess the association between SES and sexual partnership type, controlling for potential confounders. Results Sixty percent of men had been involved in only age similar partnerships, 31% in at least one age disparate partnership (partner is 5 to 9 years younger) and 10% in relationships where the female partner is 9 years or more years younger. The results indicate that household wealth is not significantly related to the likelihood of men engaging in age disparate sex or intergenerational sex. Interestingly, experiencing deprivation in informal urban areas increases men’s likelihood of engaging in age disparate sex (AOR: 1.3, p<0.05). Conclusion The results reveal that it is poorer men in informal urban settlements who are engaging in age disparate sex. Literature suggests that young women primarily engage in transactional sex with older men to support their basic needs. However, these data do not support this hypothesis and future research must identify the full range of factors fueling age disparate relationships.