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National HIV surveillance in South Africa--1993-1995
H G Küstner1, J P Swanevelder, A van Middelkoop
1Health Systems Research, Department of Health, Pretoria.
Objective:
To determine the point prevalence of HIV infection by serological examination which, performed consistently over several years, serves to monitor the distribution and trend of the HIV epidemic in South Africa.
Design:
Annual cross-sectional surveys conducted nationally, in October/November.
Setting:
South Africa, including areas that used to be known as self-governing and independent national states.
Subjects:
Pregnant women in the age group 15-49 years who attend antenatal clinic services provided by the public health services.
Outcome Measures:
HIV positivity as determined serologically.
Results:
The rising trend found previously continues: HIV positivity in South Africa was found to be 4.25% in 1993, 7.57% in 1994 and 10.44% in 1995. In 1995 the highest rate was recorded in KwaZulu-Natal (18.23%) and the lowest in the Western Cape (1.66%). On the basis of certain assumptions it is estimated that these rates are indicative of 1.7 million sexually active adults having been infected with HIV by October/November 1995, plus a cumulative total of 40,000 infants. Women in their 20s had the highest age-specific prevalence rates, viz. 13.12% (20-24 years) and 11.03% (25-29 years). HIV positivity in pregnant teenagers was 9.5%.
Conclusions:
The HIV epidemic is firmly established in South Africa with a wide variation in provincial prevalence rates. Of particular public health significance is the finding of a high and rising prevalence rate in pregnant teenagers. The observed prevalence rate for 1995 is lower than expected, giving rise to guarded hope that provinces with the highest recorded rates are moving away from the exponential growth found hitherto.