South African HIV Infection and Mortality
The National Antenatal Sentinel HIV and Syphilis Prevalence Survey, South Africa 2008
The South African National Department of Health conducts an annual survey among pregnant women attending antenatal care at selected sites in all nine provinces of the country. Although an antenatal survey should be scrutinised because it may be unrepresentative of the entire population, it does give a good indication of the trend of the epidemic.
According to the 
National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa, 2004:
- HIV prevalence among pregnant women was 29.5% in 2004, up from 27.9% in 2003, and 26.5% in 2002.
- HIV prevalence was highest among pregnant women in KwaZulu-Natal (40.7%), followed by Gauteng (33.1%) and Mpumulanga (30.8%)
| HIV Prevalence By Province Among Antenatal Clinic Attendees, South Africa: 2001 — 2004 | |||
| Province | 2002 | 2003 | 2004 |
| KwaZulu-Natal | 36.5% | 37.5% | 40.7% |
| Mpumalanga | 28.6% | 32.6% | 30.8% |
| Free State | 28.8% | 30.1% | 29.5% |
| North West | 26.2% | 29.9% | 26.7% |
| Gauteng | 31.6% | 29.6% | 33.1% |
| Eastern Cape | 23.6% | 27.1% | 28.0% |
| Limpopo | 15.6% | 17.5% | 19.3% |
| Northern Cape | 15.1% | 16.7% | 17.6% |
| Western Cape | 12.4% | 13.1% | 15.4% |
| South Africa | 26.5% | 27.9% | 29.5% |
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Source: SA National Department of Health. National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa, 2004. Note: These values fall within a 95% confidence interval. |
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Reporting Tip: How many South Africans are HIV-positive?
The SA National Department of Health study cited above extrapolated that 5.6-million South Africans were HIV-positive by the end of 2003, including:
- 3.1-million women (15 to 49 years)
- 2.4-million men (15 and 49 years)
- 96 228 babies
But this was a survey of pregnant women who attend ante-natal clinics. Although this is not a representative sample of all South Africans, researchers can extrapolate this information and estimate how many people in South Africa have HIV. In 2003, the researchers acknowledged four assumptions:
- Assumption 1: The prevalence rate of HIV infection in all pregnant women in South Africa is the same as the prevalence rate in women attending public antenatal clinics.
- Assumption 2: The prevalence rate of HIV infection in all women aged 15 to 49 years is the same as the prevalence rate in pregnant women.
- Assumption 3: Estimate of males infected = 85% of infected females.
- Assumption 4: The mother- to-child transmission rate = 30%.
Possibly the most contentious assumption is that the prevalence rate of pregnant women is the same as that of all women of child-bearing age. Pregnant women are by definition practicing unsafe sex, placing them at a higher risk of HIV-infection. Yet studies have also shown that HIV lowers fertility, perhaps balancing the equation (source).
3.2 Nelson Mandela / HSRC Study of HIV/AIDS (2002 and 2005)
The South African National HIV Prevalence, Behavioural Risks and Mass Media Household Survey was conducted in 2002 by the Human Sciences Research Council (HSRC), Medical Research Council (MRC), Centre for AIDS Development Research and Evaluation (CADRE) and Agence Nationale de Recherches sur le Sida (National French Agency for AIDS Research or ANRS).
The survey sampled people living in households and hostels throughout South Africa and provides detailed information on HIV infection rates by age, race, sex, province and locality-type as well as information on knowledge, attitudes and behaviours.
Estimates for the entire population are based on applying findings to the census. The wide confidence intervals indicate that in some cases the sample sizes were quite small. The Actuarial Society of South Africa cautioned that this may have resulted in bias in relation to prevalence rates relating to province, race and amongst children aged 2-14 (AIDS Analysis Africa, 2003).
In 2005, the second in this series of national surveys was conducted, the South African National HIV Prevalence Incidence Behaviour and Communication Survey, 2005. Although the survey questionnaire was similar to the 2002 study, a number of indicators were modified based on the 2002 study and a number of new indicators and modules were added. Below is a comparison of the key findings between the 2002 and 2005 studies.
| Comparison of Key Findings between 2002 and 2005 household prevalence studies | ||
| Category | 2002 | 2005 |
| Overall prevalence (2 years and older) | 11.4% (pg 58) | 10.8% (pg 77) |
| Males | 9.5% | 8.2% |
| Females | 12.8% | 13.3% |
| Total living with HIV | 4.5-million | |
| Estimated HIV prevalence per age group | (pg 59) | (pg 77) |
| Children 2-14 | 5.6% | 3.3% |
| Persons aged 15-24 | 9.3% | 10.3% |
| Adults 25+ | 15.5% | 15.6% |
| Overall HIV prevalence per province (2 years and older) | (pg 58) | (pg 79) |
| KwaZulu-Natal | 11.7% | 16.5% |
| Gauteng | 14.7% | 10.8% |
| Free State | 14.9% | 12.6% |
| Mpumalanga | 14.1% | 15.2% |
| North West | 10.3% | 10.9% |
| Eastern Cape | 6.6% | 8.9% |
| Limpopo | 9.8% | 8.0% |
| Northern Cape | 8.4% | 5.4% |
| Western Cape | 10.7% | 1.9% |
| HIV prevalence by race in SA (2 years and older) | (pg 60) | (pg 80) |
| Total | 11.4% | 10.8% |
| African | 12.9% | 13.3% |
| White | 6.2% | 0.6% |
| Coloured | 6.1% | 1.9% |
| Indian | 1.6% | 1.6% |
| Sources: | ||
3.3 Mortality
Graphic: Distribution of deaths by age and year of death, 1997-2002. Between 1997 and 2003, the number of deaths among people aged 20-49 has been rising steadily. AIDS-related deaths are the likely cause for most of the increase.
Source: Statistics South Africa. Mortality and causes of death in South Africa, 1997–2003.
Enlarge imageStatistics South Africa. Mortality and causes of death in South Africa, 1997-2003
It is difficult to get accurate estimates of AIDS mortality in South Africa because often the death isn't registered as AIDS-related on the death certificate. But the rising number of recorded deaths in South Africa, as well as the noted causes of death, do give us an indication of the effect HIV is having on mortality.
The study, published in 2005, found that the number of registered adult deaths in South Africa increased 63% from 272,221 in 1997, to 441,029 in 2002. The major cause of these increases is likely to be HIV/AIDS.
Although improved death registration and South Africa's population growth may have partly helped raise the figures, the uneven rises in deaths per age group has the signature of AIDS-related deaths. For instance, deaths among those aged 25-49, a high risk group for HIV, more than doubled from 92,479 in 1997 to 199,485 in 2002, an increase of about 116%. (source)
A normal mortality graph should generally rise with age. In South Africa, mortality peaks at 30-34, and then drops again. After studying the causes of death in the Statistics SA report, the Treatment Action Campaign found:
Fast Facts: Increase in Deaths in South Africa
63% rise in registered adult deaths in South Africa from 1997 to 2002. Source:Statistics SA, 2005
"Adding the largest causes of death most frequently associated with AIDS (tuberculosis, influenza and pneumonia, intestinal infections, HIV, immune disorders), the number of such deaths rose by 244% from 45 978 in 1997 to 170 531 in 2002. Obviously not all of these deaths are due to HIV. Likewise, these are not the only HIV-related deaths. However, after correcting for population growth and improved registration, most of the 244% increase can be assigned to HIV."
After analysing age of death distribution patterns, the Medical Research Council estimated that 61% of deaths relating to HIV had been wrongly attributed to other causes of death. According to the MRC results, HIV caused 112, 630 adult deaths (15-59yrs), and 40,727 child deaths (0-5yrs) in the year 2000-2001. (source)
