HIV rates fall in hard-hit South African communities

KwaZulu-Natal, South Africa, a city hard hit by the HIV epidemic, is starting to see improvements, with new cases of the virus declining according to two new studies, aidsmap reports.

Alain Vandormael, PhD, from the The School of Nursing and Public Health at the University of KwaZulu-Natal and colleagues conducted the first study, which was published in Nature Communications. They analyzed data from a survey of 11,000 households in the South African city. These households are visited each year by outreach workers who perform HIV testing.

Between 2005 and 2017, the annual number of people testing positive for HIV increased from 7,896 to 4,984. In 2012, the rate of new infections peaked at 4.95% among women and 2.49% among men. . The rate then declined by 59% for men, reaching 1.01% in 2017. For women, the rate did not start to drop significantly until 2014 and eventually fell by 37%, for s’ establish at 3.06%, in 2017.

Between 2010 and 2017, the proportion of HIV-positive women taking antiretrovirals (ARVs) increased from less than 25% to over 50%. In 2017, 45% of women infected with the virus had a completely suppressed viral load. During the same period, the proportion of men living with HIV who were on ARVs increased from 21% to 38%. HIV-positive men had a 33% viral suppression rate in 2017.

During the 2000s, condom use increased in the study population, so that 60% of women and 70% of men reported using condoms in 2011, figures which have remained stable thereafter.

The male circumcision rate increased from 3% in 2009 to 33% in 2006. (Voluntary medical male circumcision reduces the risk of female-to-male HIV transmission by about 60%.) The annual rate of new cases HIV rates among circumcised men decreased by 59% during this period, while they decreased by 42% among uncircumcised men.

Investigators concluded that “to further reduce the incidence of HIV, coverage of HIV prevention and treatment programs must be intensified and expanded.

The second study was led by Ayesha Kharsany, PhD, from Center for the AIDS Program of Research in South Africa, and published in JAMA Network Open Access. The study authors randomly selected households in KwaZulu-Natal and invited a person aged 15 to 49 to participate.

The investigators conducted a survey between 2014 and 2015 with 9,812 people and then a follow-up survey 14 to 24 months later with 4,539 HIV-negative participants under 35 years of age. Then they repeated this same process with 10,236 people and 5,307 people, respectively, starting the baseline survey from 2015 to 2016.

Between the 2014 to 2015 and 2015 to 2016 surveys, the proportion of people who had already been tested for HIV rose from 69% of men and 82% of women to 82% and 91% respectively.

In the first survey, 52% of men and 62% of women living with HIV were aware of this fact, numbers which rose to 63% and 73% in the second survey. The proportion of HIV-positive people on ARVs rose from 37% among men and 46% among women in the first survey to 49% and 59% respectively in the second survey.

Circumcision increased from 32% to 36% of men between surveys. 36% and 48% of women in each survey said their partners were circumcised. In each survey, 20% and 16% of women, respectively, reported that their partners used condoms.

There was no statistically significant drop in diagnosis rate, that is, a drop that was probably not due to chance, across the group of study participants in between. surveys, among all boys and men or among women over 20 years of age.

However, among girls and women aged 15 to 19, the rate of new HIV diagnoses decreased significantly by 43% between 2016 and 2017, from 4.6% to 2.7%.

To read the aidsmap article, Click here.

To read the Nature Communications summary, Click here.

To read the JAMA Network Open Access article, Click here.

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