Ongoing high HIV prevalence in pregnant women from rural KwaZulu-Natal

30 September 2015

Data from CAPRISA’s epidemiological  studies highlight that, despite substantial progress in the delivery of HIV prevention programs, some communities continue to experience unprecedentedly high HIV rates, which exceed 40% in women aged 20-24 years and exceed 50% in women aged 25-34 years.

This analysis  on the trends of HIV infection in the rural community of Vulindlela between 2001 and 2013  was recently published in the Journal of AIDS.  Annual, anonymous cross-sectional HIV sero-prevalence surveys conducted among first visit prenatal clinic attendees, show that the overall HIV prevalence has increased from 35.3% [95% confidence interval (CI) 32.3-38.3] in the pre-antiretroviral (ART) era (2001-2003) to 39.0% (CI: 36.8-41.1) in the early ART era (2004-2008) to 39.3% (CI: 37.2-41.4) in the contemporary ART (2009-2013) roll-out period (Figure 1).

In young women below the age of 20 years, HIV prevalence has declined from 22.5% (CI: 17.5-27.5) in 2001-2003 to 17.2% (CI: 14.3-20.2) in 2009-2013. In women 30 years and older, HIV prevalence has increased significantly, largely due to survival following ART scale up. Teenage girls with male partners 20-24 and ≥25 years had a 1.7-fold (CI: 1.3-2.4; p=0.001) and 3-fold (CI: 2.1- 4.3; p<0.001) higher HIV prevalence respectively.

These surveys highlight the consistently high burden of HIV infection borne by
young pregnant women in this rural community, which may be explained at least in part
by young women engaging in high-risk sexual intercourse.

Targeted interventions for teenagers,
especially for those in age-disparate relationships, are needed to impact this HIV
epidemic trajectory.

For further reading see:
Kharsany A et al. Trends in HIV prevalence in pregnant women in rural South Africa. J Acquir Immune Defic Syndr. 2015; DOI: 10.1097/QAI.0000000000000761.

Figure 1: HIV in pregnant women in South Africa, 2001-2013