Mpumalanga has surpassed KwaZulu-Natal to become the province with the highest HIV prevalence in South Africa. In 2022, Mpumalanga’s HIV prevalence rate reached 17.4%, translating to an estimated 890,000 individuals living with HIV in the province. This marks a significant shift, as KwaZulu-Natal had previously been the most concerning province for health authorities.
The data, provided by the Human Sciences Research Council (HSRC) in their report on the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI), reveals that HIV prevalence was 7.8% among youths aged 15 to 24. Within this group, males had a prevalence of 9.8%, compared to 6.3% for females. For adults aged 25 to 49, the prevalence was notably higher at 26.4%, with females at 31.9% and males at 19.9%.
HIV rates varied geographically, with the highest prevalence found in rural formal areas (21.1%) and rural informal areas (18.4%), while urban areas had a lower rate of 15.5%. An alarming trend was observed among older adults, with HIV prevalence peaking at 40.8% for those aged 45 to 49 in 2022, up from 39% in 2017 for individuals aged 35 to 39. The survey also indicated a decrease in prevalence among those aged 15 to 44 and highlighted regional disparities, with Gert Sibande having the highest rate at 20.5%, followed by Ehlanzeni at 16%, and Nkangala at 13.1%.
Increased Antiretroviral Treatment Coverage
In response to the epidemic, Mpumalanga achieved a notable increase in antiretroviral treatment (ART) coverage, reaching 81.8% in 2022, up from 65.4% in 2017. This translates to around 630,000 individuals living with HIV in the province receiving ART. Coverage varied by age: 56.4% of adolescents and young adults aged 15 to 24 were on ART, compared to 83.9% of those aged 25 to 49. ART coverage for females aged 15 to 24 was 58.6%, compared to 85.2% for those aged 25 to 49, while males aged 15 to 24 had a coverage rate of 54.8%, and those aged 25 to 49 had a rate of 81.6%.
Concerns Over HIV Status Awareness
The survey data revealed that the majority of individuals aged 25 to 49 in Mpumalanga were either unaware of their HIV status (62.3%), knew their status but were not on ART (63.5%), or were on ART but not achieving viral suppression (63.4%). In contrast, adolescents and young adults aged 15 to 24, making up only 9.4% of the HIV-positive population, faced significant treatment gaps: 16.9% were aware of their status, 16.7% knew their status but were not on ART, and 13.7% were on ART but lacked viral suppression.
Key Drivers of the Epidemic
Mpumalanga showed the lowest rate of early sexual activity among provinces, with the percentage of adolescents and young adults aged 15 who had sex before age 15 dropping from 13.3% in 2017 to 5.4% in 2022. Despite this, early sexual debut was higher among males (6.1%) compared to females (4.8%) in the 15 to 24 age group. Additionally, 5.1% of individuals aged 15 and older reported having multiple sexual partners in 2022, down from 7.9% in 2017, with males nearly three times more likely to report multiple partners than females.
Condom use remained steady, with 46.1% of individuals using condoms with their most recent partner in 2022, compared to 46.3% in 2017. Condom use was significantly lower in rural formal or farm areas (26.0%) compared to urban areas (50.1%), and 32.4% of individuals reported never using condoms with their most recent partner. “Only 11% consistently used condoms, while nearly 50% of young people reported using condoms occasionally or not at all.”