UNAIDS 2014 SOUTH AFRICA HIV EPIDEMIC PROFILE

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1 UNAIDS 214 SOUTH AFRICA HIV EPIDEMIC PROFILE

2 214 SOUTH AFRICA Overview The Republic of South Africa (RSA) is the southern most country on the continent of Africa. To its north lie the neighbouring countries of Namibia, Botswana and Zimbabwe; to the east are Mozambique and Swaziland; and within lies Lesotho, an enclave surrounded by South African territory. The 211 Census results released by Statistics South Africa (StatsSA) in November 212, estimated the country s population at 51.7 million people. South Africa is ranked as an upper-middle income economy by the World Bank and is considered a newly industrialised country. Despite having the seventh highest per capita income in Africa, poverty and inequality are widespread. About a quarter of the population is unemployed and lives on less than US$1.25 a day. The South African government provides most of the funding for its HIV response, with donor agencies contributing less than 25%. However, based on targets set by the government in the National Strategic Plan for , the gap between funding requirements and actual funds for HIV, Sexually Transmitted Infections (STIs) and TB is expected to grow. Table 1 HIV epidemic indicators People living with HIV 6 1 [ ] 6 3 [6 6 5 ] New HIV infections Adult 15+ new HIV infections AIDS-related deaths HIV prevalence (adults aged 15-49) HIV incidence (adults aged 15-49) Children (-14 years) living with HIV Children (-14 years) newly infected with HIV Adults 15+ living with HIV Women 15+ living with HIV HIV prevalence among young women (15-24 years) HIV prevalence among young men (15-24 years) New HIV infections among young women (15-24 years) New HIV infections among young men (15-24 years) HIV-positive incident TB cases* Percentage of men circumcised (adults aged 15-49) 44 [41 47 ] 42 [4 46 ] 41 [38 44 ] 18.9% [ %] 1.79% [ %] 4 [36 44 ] 15 [14 17 ] 5 7 [ ] 3 4 [ ] 14.8% [ %] 4.4% [ %] 12 [11 13 ] 5 [38 6 ] 33 [27 39 ] 4.6% (25) 34 [31 37 ] 33 [3 36 ] 2 [17 22 ] 19.1% [ %] 1.36% [ %] 36 [32 39 ] 16 [14 19 ] 5 9 [ ] 3 5 [ ] 13.1% [ %] 4.% [ %] 9 [81 1 ] 36 [28 44 ] 33 [27 39 ] (212) 46.4% (212) Sources: UNAIDS 213 HIV estimates; * WHO Global TB Report, 213; Global AIDS Response Progress Report, UNAIDS 214 Gap Report and unpublished estimates of the Gap Report 2

3 Fig. 1 HIV prevalence by geographical region Limpopo North West Gauteng Mpumalanga Free State KwaZulu-Natal Northern Cape Western Cape Eastern Cape Source: Shisana, O et al (214). South African National HIV Prevalence, Incidence and Behaviour Survey, 212. Cape Town, HSRC Press. Table 2 HIV prevalence among populations at high risk of infection Population group HIV Prevalence Sex workers 59.6% [26 6%] (213) Men who have sex with men ~ 1.4% %* People who inject drugs 19.4% Sources: Global AIDS Response Progress Report, 213; * SANAC 213: Estimating the size of sex workers population in South Africa, SANAC, Pretoria; Anova Health Institute 213, Rapid Assessment of HIV Prevention, Care and Treatment Programming for MSM in South Africa report, Anova Health Institute, Johannesburg; Scheibe, A, Brown, B, dos Santos, M (214). Draft Report: Rapid assessment of HIV and related risk factors among people who inject drugs from five South African cities, Pretoria, MRC. Table 3 HIV programme data Number of adults living with HIV receiving ART June Number of children living with HIV receiving ART Adult ART coverage (of all adults living with HIV) 13% [12 14%] 42% [4 43%] Child ART coverage (of all children living with HIV) 13% [11 14%] 44% [4 48%] Number of women receiving PMTCT services Number of women needing PMTCT services 27 [25-29 ] 26 [23 28 ] PMTCT coverage 94%[86 >95%] 9% [83 - >95%] Sources: UNAIDS 213 HIV estimates; UNAIDS 214 Global AIDS Response Progress Reporting. 3

4 HIV trend data Fig. 2 Number of people living with HIV Fig. 3 Number of new HIV infections Millions Thousands Number of people living with HIV increased from 57 [5 64 ] in 199 to 6 3 [6 6 5 ] in 213. Source: UNAIDS 213 estimates New HIV infections declined to less than 34 [31 37 ] people in 213, from about 68 [64 73 ] people in 21. Source: UNAIDS 213 estimates Fig. 4 Number of AIDS-related deaths Fig. 5 Prevalence (%) among young people (15 24) Thousands HIV-related deaths declined by almost 5% from around 38 [35 42 ] in 25 to less than 2 [17 22 ] in 213. Source: UNAIDS 213 estimates men women Prevalence among young women fell from 19.1% [ ] in 21 to 13.1% [ ] in 213. Source: UNAIDS 213 estimates Fig. 6 Fig. 7 ART coverage (%) of all people living ART coverage (%) of children living with HIV with HIV About 4 out of 1 people living with HIV received antiretroviral therapy in 213. Source: UNAIDS 213 estimates About 4 out of 1 children living with HIV received treatment in 213. Source: UNAIDS 213 estimates 4

5 Fig. 8 PMTCT coverage (%) Fig. 9 Number of new child HIV infections Thousands In 213 about 9 out of 1 women and their infants had access to antiretroviral drugs during delivery and breastfeeding to prevent mother-to-child transmission of HIV. Source: UNAIDS 213 HIV estimates The number of new child infections has fallen by 52% between 29 and 213. Source: UNAIDS 213 HIV estimates Table 4 HIV knowledge, attitude and practice Men Women Total Percentage of young women and men aged who correctly identified ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission and prevention Percentage of young women and men aged who have had sexual intercourse before age 15 Percentage of adults aged who had sexual intercourse with more than one partner in the last 12 months Percentage of adults aged with more than one sexual partner in the past 12 months who reported the use of a condom during last intercourse Percentage of sex workers reporting the use of a condom with their most recent client Percentage of men reporting the use of a condom the last time they had anal sex with a male partner Percentage of women and men aged who received an HIV test in the last 12 months and who know their results. 23.2% 25.3% 16.7% 5.% 23.2% 5.1% 58.7% 49.7% 37.4% 52.6% 24.2% 1.7% 14.1% 57.1% 45% Source: Shisana, O et al (214). South African National HIV Prevalence, Incidence and Behaviour Survey, 212. Cape Town, HSRC Press. 5

6 Fig. 1 Gender equality Present at national level Integrating services for sexual and reproductive health and for HIV Women living with HIV participated in response review HIV plans and budgets in ministries responsible for gender Data on resources used for women s programmes Response budget for women s organization Available on project basis National Response gender review undertaken Women living with and affected by HIV participated in CEDAW monitoring Qualitative assessments conducted Funding gender-equity programmes for men and boys Disaggregated data available (age and sex) Data available on gender-based violence and HIV Social protection includes women living with HIV Female condoms procured and distributed Health sector policy on gender-based violence Not Available Source: South Africa Gender Score Card ( ). Completed by South African Department for Women, Children and People with Disabilities, April 214. Spending on HIV response Table 5 Amount spent annually on HIV programmes Year 27/28 South Africa Rand (ZAR) ZAR 7.9 Billion 28/29 ZAR 11 Billion 29/21 ZAR 12.9 Billion Fig. 11 Spending proportions by source of funding ZAR Billions Private funds International funds Public funds /8 28/9 29/1 Source: South Africa NASA, 27/1. 6

7 Fig. 12 Distribution per AIDS spending categories /8 28/9 29/1 Source: South Africa NASA, 27/1. Total Research Total Human Rights & Advocacy Total Human Capacity Building Total Programme Management Total Social Protection Total OVC Care & Support Total Treatment Total Prevention Commitment to HIV prevention, treatment and care The South African National AIDS Council (SANAC) was established by the national cabinet of the South African Government to build consensus across government, civil society and all other stakeholders to drive a comprehensive country response to HIV, TB and STIs (http://www.sanac.org.za/). In July 214, the South African Government committed to increasing treatment coverage for people living with HIV, as of January 215, according to the World Health Organization (WHO) guidelines published in 213. All HIV-positive pregnant women will be offered antiretroviral therapy (WHO Option B+) to prevent mother-to-child transmission, and antiretroviral therapy (ART) will be offered to all people living with HIV with a CD4 count < 5 cells/µl. Following a review of the National Strategic Plan (NSP) , the NSP for HIV, STIs and TB for was developed and approved in December 211. The NSP vision is to achieve zero new HIV and TB infections, zero new infections due to vertical transmission, zero preventable deaths associated with HIV and TB, and zero discrimination associated with HIV, STIs and TB. South Africa is committed to reaching the 1 global targets outlined in the 211 United Nations Political Declaration on HIV and AIDS. Achievements/progress in the national HIV response High level political commitment has been demonstrated by the government, who is providing 8% of the AIDS response budget. Impressive gains in adult life expectancy have been achieved as a result of scaling up the provision of antiretroviral therapy to people living with HIV. South Africa has the largest HIV treatment programme in the world, with more than 2.4 million people receiving antiretroviral treatment at the end of 213. Coverage rates for services to eliminate mother-to-child HIV transmission exceed 9%. AIDS-related deaths declined from 31 [29 35 ] in 23 to 2 [17 22 ] at the end of 213. The country was successful in its application for funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to increase access to HIV prevention, especially among key populations, and to address multi-drug resistant tuberculosis and HIV in prisons and mines. Challenges in the national HIV response The rate of new HIV infections remains high. Young women aged 15 to 24 years account for about one quarter of all new HIV infections in South Africa. Stigma and discrimination remains a problem while there is limited information on prevalence among identified key populations. Challenges in the HIV cascade need to be addressed to ensure increased uptake of HIV testing and counselling services, and to ensure that those eligible for treatment are receiving treatment, are retained in care, are adhering to treatment regimens and are virally suppressed. 7

8 UNAIDS Country Office 5th Floor, Metro Park Building 351 Francis Baard Street PO Box 12934, Tramshed 126 Pretoria Republic of South Africa Tel: UNAIDS Regional Support Team Eastern and Southern Africa Merafe House, 11 Naivasha Road Sunninghill 2157 Johannesburg Republic of South Africa Tel: unaids.org

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