CAPE TOWN, South Africa — The number of new HIV infections among South African teens has dropped significantly, prompting hope that national efforts to tackle the epidemic have finally turned a corner after years of denial and delay.
A report by the Human Sciences Research Council released Tuesday said that although young people continue to have multiple sexual partners — which drives South Africa’s epidemic — they are increasingly heeding advice to use a condom.
“There is clearly light at the end of the tunnel,” said Health Minister Dr Aaron Motsoaledi. “There is real light.”
Motsoaledi, a respected medical doctor, became health minister last month. He must overcome the legacy of former President Thabo Mbeki, who denied the link between HIV and AIDS, and his health minister Manto Tshabalala-Msimang, who mistrusted conventional anti-AIDS drugs and promoted beetroot and lemon.
“Unfortunately we spent a lot of time fighting each other. I am quite sure that we are going to stop fighting each other and start fighting the disease,” said Motsoaledi. “I am hoping that in the next few years the results will be much more encouraging than this,” he said.
During nearly 10 years of neglect, new HIV infections reached a peak of 1,000, with nearly 1,000 deaths from AIDS every day. The council’s report estimated that around 5.2 million South Africans were living with HIV last year — the highest number of any country in the world.
The report said that HIV prevalence in children between 2 and 14 fell from 5.6 per cent in 2002 to 2.5 per cent last year, mainly thanks to the spread of drugs to prevent women passing on the virus to their children.
Young women continue to bear the brunt of the epidemic; nearly one third of women aged 20 to 34 are infected with the virus, the report said. Infection rates peak later in men.
The survey of more than 23,000 people was entitled “A Turning Tide Among Teenagers?” In rare good news, it said that HIV incidence — the number of new infections — among teens was falling. For instance, incidence among 18-year-olds halved between 2005 and 2008 to 0.8 per cent. In 20-year-olds it decreased from 2.2 per cent to 1.7 per cent.
Olive Shisana, head of the research council and one of the report’s authors, said this was because of an increase in condom use among young males aged between 15 and 24, from 57 per cent in 2002 to 87 per cent in 2008. In females of the same age, there was also an increase of condom use, from 46 per cent to 73 per cent. Condom use among males aged 25 to 49 doubled and among women it tripled.
“Young men have made a decision that they are going to run around, but they are going to use a condom. They have made a decision that they will have a lot of sex with a lot of different people, but they are going ... to make sure they are protected,” she said.
Every year the government distributes many millions of condoms free of charge as part of its anti-AIDS campaign and — to loud applause — health minister Motsoaledi indicated he would be willing to increase the condom budget further.
But on the downside, the survey showed that messages that young people should abstain, delay their first sexual encounter and have only one partner, were falling largely on deaf ears. This was the approach traditionally promoted by the U.S. President’s Emergency Plan for AIDS Relief, which is the biggest foreign donor of South Africa’s anti-AIDS drive.
Funding from that plan paid for the survey, the third conducted since 2002.
It said the percentage of 15-59-year-old males who had more than one partner in the past year increased from 9.4 per cent in 2002 to 19.3 per cent in 2008.
It said there was an increase in the problem of teens having older partners who would buy them food, clothes and pay for transport. This is particularly risky because older men have a higher HIV rate than teenage boys, and often the teenage girls do not have the bargaining power to insist that they wear a condom.
Shisana said that in poor areas, girls came under pressure from their families to stay in such relationships despite the risk.
Even more worryingly, the survey showed a decrease in the proportion of people who understood about HIV prevention from 66.4 per cent in 2005 to 44.8 per cent in 2008. More people understood the need for condoms and the need to dispel previously widespread myths that sex with babies cured AIDS, but this was offset by a big increase in the people who thought there was no risk in having multiple partners.
Motsoaledi said the government would try to strengthen its AIDS prevention campaigns — long weakened because of bureaucracy and mixed messages in the health department.
“It is clear our work is well cut. We can’t pretend that we don’t know what to do,” he said.