HIV prevalence and efforts to combat the pandemic
The estimated overall Human Immunodeficiency Virus (HIV) prevalence rate is approximately 12.6% among the South African population. The total number of people living with HIV is estimated at approximately 7.06 million in 2017. For adults aged 15 – 49 years, an estimated 18.0% of the population is HIV positive. Clearly, the situation is quite dire and still calls for urgent interventions.
Briefing Parliament on efforts being made to combat the HIV epidemic, the Medical Research Council (MRC) explained that HIV remains the highest cause of death in South Africa but there is a decline in the rate of infection in children aged below five years. Also, Mother to Child Transmission (MTCT) of the virus has reduced from about 6.4% to 1.5%. However, infection of children below 18 months increased due to engagement in breastfeeding by infected mothers who did not achieve a suppressed viral load.
The MRC explained some of the measures being taken to prevent new infections. A comprehensive prevention method would involve the combination of bio-medical, structural and behavioural factors. Some of the bio-medical interventions include the several researches being carried out on developing microbicides and vaccines to be used with existing interventions for preventing the acquisition of the virus. Although a lot of research is being done on microbicides and vaccines, they are not yet in use because further research is still being carried out on their usability and efficacy.
Furthermore, there is a need to strengthen prevention efforts particularly among young women. Dapirivine vaginal rings seem to be safe and effective, having the capability of reducing the risk of infection by between 27 and 31 percent. However, research is still ongoing and if the ring is approved, it would join the few range of choices for women controlled HIV prevention methods. The approval and go ahead to use the Dapirivine rings is expected in mid-2019.
With regards to vaccines, the major work funded by the MRC is on developing vaccines. It is hoped that there would be positive outcomes. Notably, the vaccine does not need to have a 100% efficacy rate and does not need to be administered on 100% of the population to be useful - if a vaccine has an efficacy rate of 30% and is administered on 20% of the population, about 5.5 million South African could be prevented from acquiring HIV. Also, a demonstration project on pre-exposure prophylaxis by the National Department of Health found that the pre-exposure prophylaxis worked better for men than women.
On behavioural change methods, studies show that young people are at risk of infection because of early sexual debuts and inconsistent use of condoms. Thus, most of the HIV prevention work focuses on schools and is enrolled in designing, aligning and implementing supports for schools. MPs point out that the socio-economic factors might be the major drivers of HIV prevalence. They reason that if the factors are addressed through rigorous research, there might be a reduction in new HIV infections.