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Third South African National HIV Communication Survey 2012 Preliminary Findings

Third South African National HIV Communication Survey 2012 Preliminary Findings XIX INTERNATIONAL AIDS CONFERENCE. Presenter: Lusanda N Mahlasela 24 July 2012. Presentation Overview. Objective Methodology Key Findings: HIV counselling and testing Male circumcision Condom use

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Third South African National HIV Communication Survey 2012 Preliminary Findings

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  1. Third South African National HIV Communication Survey 2012 Preliminary Findings XIX INTERNATIONAL AIDS CONFERENCE Presenter: Lusanda N Mahlasela 24 July 2012

  2. Presentation Overview • Objective • Methodology • Key Findings: • HIV counselling and testing • Male circumcision • Condom use • Conclusions

  3. Objective • To evaluate the impact of HIV communication programmeson the key drivers of the HIV epidemic in South Africa over time.

  4. Methodology • A cross sectional survey was conducted in all 9 provinces of SA between February and May 2012 • 10 034 males and females aged 16 to 55 years representative of 28 million people • Data analysis: • Description of key outcomes over time • Impact of the HIV Communication programmes

  5. Key Findings

  6. HIV Counselling and Testing (HCT)

  7. 17.4 million South Africans have been tested for HIV HCT campaign testing data indicates that 10,700,276 people were tested in the past 12 months 1 Source: NDoH, 2011 in Global AIDS Response Progress Report, 2012 • Calculated by dividing number of people tested in 15 months (13,375,345) by 15 and multiplying by 12. NDoH data not restricted to 16-55 year olds. All men and women aged 16-55 yrs; n=9,728 in 2009 and n=10,034 in 2012

  8. Impact of HIV Communication Programmes on HIV testing

  9. Impact of HIV communication programmes on HIV testing in the last 12 months 20 point spread Percent Level of Exposure to 19 HIV Communication Programs (deciles) n= 6004 (16-55 yrs.); if had sex in the last 12 months; p<0.001; direct effect adjusted by logistic regression analysis

  10. People who knew that President Zuma had tested for HIV were more likely to discuss HIV testing with their sex partners Percent 13 point spread Awareness of President Zuma’s HIV test n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis

  11. Impact of HIV communication on discussion of HIV testing with one’s sex partners Percent 16 point spread Level of exposure to HIV communication programmes (deciles) n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis

  12. Impact of discussion of HIV testing with one’s sex partners on HIV testing in the last 12 months Percent 30 point spread Discussion of HIV test with one’s sex partners n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis

  13. Stigma has declined • Of those tested, 16,375,012 (94.1 %) know their HIV status • 14,130,561 (86.3%) were comfortable revealing their HIV status • 1,657,527 (11.2%) were HIV positive1 • 1,297,438 (78.5%) were taking ARVs2 1 HIV prevalence 15-49 years :16.9% (2008) Source: HSRC survey 2 NDoH statistics indicate that 1.7 million South Africans are on ART Men and women aged 16-55 yrs ever tested for HIV; n= 6,079

  14. Predictors of getting tested for HIV in the last 12 months Positively related (more likely to get tested):Effect size/OR Discussion of HIV testing with sex partner 3.49 Mpumalanga compared to Gauteng province 1.90 Female 1.50 Younger and middle age group 1.45 & 1.17 Perceived Social norms for HIV testing 1.06 Level of exposure to HIV communication programmes1.03 Communication programmes have both a direct impact on testing and they influence other leading predictors of testing. n= 6,004 men and women ages 16-55 years who have had sex in the last 12 months; R2 =0.12.

  15. Impact of HIV communication programmes on male circumcision

  16. Key milestones in male circumcision in South Africa King Goodwill Zwelithini promotes male circumcision WHO recommendations Orange Farm MMC study Communication programmes promote MMC nationally

  17. Knowledge of male circumcision for HIV risk reduction has increased All men and women aged 16-55 years; n=10,034

  18. Over half of South African men are now circumcised All men aged 16-55 yrs; n=4,065

  19. No significant difference in condom use between circumcised and uncircumcised men And the majority (85%) of people know that a man who is circumcised still needs to use a condom n= 1,215; p =0.061

  20. Impact of HIV communication on high intention and circumcision in the last 12 months Percent 31 point spread Level of exposure to HIV communication programmes (deciles) n= 1,647 not circumcised and 127 circumcised in the last year=1,774 (16-55 yrs.); p<0.001; adjusted by logistic regression analysis

  21. Demand for circumcision is high • Among the 5 471 890 men who said they were not circumcised: • Almost a million said they definitely intended to get circumcised in the next 12 months. • Of those that say they will definitely get circumcised, 80.5% (803 690) intend to have a medical circumcision.

  22. Predictors of intention and circumcision Positively related (more likely to get circumcised): Effect size/OR Standard 9 or above level of education 2.05; 2.26; 2.53 Younger age group 2.13 Being in a steady relationship 1.73 Using condom at first sex 1.45 Level of exposure to HIV communication programs 1.16 Communication programmes have a direct impact on intent to circumcise and on actual circumcision. n= 1,327 not circumcised and 127 circumcised in the last year=1,774 (16-55 yrs.); p<0.001; adjusted by logistic regression analysis

  23. Condom use

  24. Condom use at first sex by number of years ago one first had sex 68% Percent 1995 8.8% Inflection point Number of years ago that respondent first had sex N = 8,198; 6,746; 7,068, respectively; p<0.001

  25. Impact of HIV communication on condom use by type of sexual relationship 86% 72% 63% 44% Percent Level of exposure to HIV communication programmes (deciles)

  26. Predictors of condom use with one or more of one’s three most recent sex partners Positively related (more likely to use condoms):Effect size/OR Has more than one sex partner (MSP) 3.53 Single 2.85 Used a condom at first sex 2.83 Widowed or divorced 2.44 Has a steady (main) sex partner 2.25 Knows that one or more sex partners has other sex partners 1.56 7. Level of exposure to HIV communication 1.10 Communication programmes have a direct impact on condom use and they influence other leading predictors of condom use n= 6051 men and women ages 16-55 years who have had sex in the last 12 months; R2 =0.20; correctly classified = 71%; under ROC curve, 0.79

  27. Contribution of HIV Communication Programmes in South Africa • HIV Testing • 17.4 million people tested, 10.6 million in the past year • Male Circumcision • Over 55% of men are circumcised • Nearly one million intend to get circumcised in the next year • Condom use • Increased to 68% at first sex in 2012

  28. Acknowledgements • Funders: USAID/PEPFAR • Partners: Johns Hopkins Health and Education in South Africa, loveLife, Soul City • Research team: • HDA: S Magni, S Johnson, K Mangold, B Bello • JHHESA: R Delate, L Mahlasela • JHUCCP: D.L. Kincaid, M.E. Figueroa • Data collection: Freshly Ground Insights • Survey respondents

  29. THANK YOU

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