The annual Antenatal Survey of women attending public health facilities, which is designed to give general trends in HIV infection over time, shows that in 2006, there are pleasing signs of changes in the right direction even though HIV remains an important public health challenge in South Africa.
The report shows a trend towards a decrease in the prevalence of HIV amongst pregnant women who use public health facilities (29.1% in 2006 compared to 30.2% in 2005), suggesting that this may be the beginning of a decline in the HIV prevalence rates. These are positive news for our country.
An encouraging observation is that the HIV prevalence trends among pregnant women under the age of 20 years continued to show a significant decline from 16.1% in 2004 to 15.9% in 2005 and to 13.7% in 2006.
A decline in prevalence in this age group is suggestive of a decline in HIV incidence (new infections) and is a good indicator of the impact of the country?s prevention programmes. This is the age group that has most recently become sexually active.
There was also a significant decline in prevalence in the 20 ? 24 year age group. The decline in these two age groups is important also because the reduction of HIV prevalence in the 15 ? 24 year age group is one of the key indicators for the Millennium Development Goals (MDGs).
The findings of the report suggest that a sustained change in behaviour among young people – including abstinence, being mutually faithful as well as condom use – may be taking place. In order for this trend to be sustained, it is important that we continue to strengthen our prevention programmes targeting the youth and sustaining safer sexual behaviour.
We also need to ensure a concerted focus on the 30-39 year old group where declines have not been observed in the 2006 survey. Whilst this may be a result of cohort factor, it is a concern that HIV rates are high in these age groups.
Following the 2005 survey, the Department of Health collaborated with UNAIDS, WHO and other groups in South Africa involved in mathematical modelling to estimate the HIV prevalence in the general population. Using the spectrum model, the number of people who are estimated to have HIV infection is in the region of 5.41 million. Whilst the number of people living with HIV infection is high, this estimate is lower than the previous estimate of 5.54 estimated in 2005.
The overall picture suggests that HIV prevalence in South Africa may be at the point where we should begin to witness a downward trend. This downward trend has been predicted in the UNAIDS spectrum model and other independent South African models.
The gains that we are making need to be consolidated by scaling up the implementation of all the components of the National Strategic Plan for HIV and AIDS and STI for 2007 ? 2011.
Differences in the HIV prevalence amongst pregnant women attending public antenatal care in various geographical areas of the country are still present. This is seen in the different prevalence rates observed between provinces and even between districts of the same province.
The district prevalence rates that were obtained for the first time in the South African antenatal survey provide important planning information in support of the response to HIV and AIDS at a district level.
Syphilis infection is an important indicator of possible high-risk behaviour of the infected individual, such as engaging in unprotected sex within a relationship that may not be monogamous. The 2006 antenatal survey has shown a decrease in rates of syphilis in women who attend antenatal care facilities from 2.7% to 1.8%.
Overall, syphilis has shown a downward trend since 1998. This decline may be attributed to a number of intervention activities and in particular good quality of STI management and treatment in public health facilities.
This antenatal study has provided useful information on trends in HIV and syphilis infection. It provides valuable information to assist Government and its partners alike to further strengthen HIV and AIDS programmes and to ensure that the prevalence of HIV remains on the downward trend.