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Nelson Mandela/HSRC Study of HIV/AIDS

Nelson Mandela/HSRC Study of HIV/AIDS. South African National HIV Prevalence, Behavioural Risks and Mass Media Household Survey 2002. A collaborative effort of. The Human Sciences Research Council (HSRC) Medical Research Council (MRC)

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Nelson Mandela/HSRC Study of HIV/AIDS

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  1. Nelson Mandela/HSRC Study of HIV/AIDS South African National HIV Prevalence,Behavioural Risks and Mass MediaHousehold Survey 2002

  2. A collaborative effort of The Human Sciences Research Council (HSRC) Medical Research Council (MRC) Centre for AIDS Development, Research and Evaluation (CADRE) Agence Nationale de Recherches sur le Sida (ANRS)

  3. This report is funded by The Nelson Mandela Foundation (NMF) Swiss Agency for Development and Cooperation (SDC) The Nelson Mandela Children’s Fund (NMCF) The Human Sciences Research Council (HSRC)

  4. Introduction • South Africa has a serious HIV/AIDS epidemic, with millions of its people living with the disease. • Accurate information and a comprehensive understanding of the epidemic is needed in order to deal effectively with the problem. • In particular, it is crucial to understand the social, cultural, political and economic context that contributes to vulnerability to HIV infection.

  5. Cont./ Introduction • To date HIV prevalence in the country has been based on the Department of Health’s (DOH) annual antenatal survey of pregnant women. • This study augments the antenatal survey through a population-based sample of South Africans including men, women, children, all races and ethnic groups, people living in urban areas, rural areas and farms, as well as hostel residents.

  6. Cont./ Introduction • This is the first systematically sampled national community-based survey of the prevalence of HIV in South Africa. • The survey reviewed risk, risk reduction, HIV/AIDS knowledge, mass media and communication, psychosocial and socio-cultural aspects of HIV/AIDS

  7. Survey Method • The steps in the sample design 1. Define target population – all people in SA 2. Define sample frame – 2001 census 3. Define Primary Sampling Unit (PSU) 2001 census EAs 4. Define explicit strata – Provinces and geography type 5. Define reporting domain – province, locality-type and population group 6. Define Secondary Sampling Unit (SSU) – visiting point 7. Define Measure of Size (MOS) – 2001 estimate of visiting points 8. Define Ultimate Sampling Unit (USU) – all individuals 2+ years of age 9. Allocation of sample – disproportional to province, population group & locality-type

  8. Cont./ Survey Method • The steps in the drawing of the sample 1. Selection of PSUs – 1000 EAs 2. Produce aerial photos and data kits of EAs 4. Selection of SSUs – 11 visiting points per EA 5. Selection of USUs – 3 people per VP

  9. Cont./ Survey Method • Location of master sample PSUs in South Africa

  10. Cont./ Survey Method • Location of unrealised EAs in the survey

  11. Sample • 13 518 individuals who were selected and contacted for the survey • 9 963 (73.7%) persons agreed to be interviewed • 8 428 (62.5%) gave a usable specimen for an HIV test

  12. HIV testing • The OraSure® HIV-1 Oral Specimen CollectionDevicewas used to collect oral mucosa transudate (oral fluid) specimens. • Vironostika test kits were utilised for conducting antibody tests. • Used internationally since 1986, and in Africa since 1990. • Approved by FDA for all HIV clades. • Studies on sensitivity and specificity show high correlations with blood results (98%-100%)

  13. Questionnaires • adults aged 25 years and older • youth aged 15–24 years • children aged 12–14 years • caregivers of children aged 2–11 years

  14. Results

  15. National prevalence • The HIV prevalence in the population of South Africa is 11.4% - 4.5 million people (Confidence Interval (CI): 10.0%–12.7%) • 15.6% of persons in the 15–49 age group were HIV positive (CI: 13.9%–17.5%)

  16. Provincial HIV prevalence HIV Prevalence by province, South Africa 2002

  17. Corroborating Evidence on HIV prevalence based on the MRC workplace studies

  18. Provincial prevalence Comparison of HIV prevalence levels by province with the DOH 2001 antenatal survey

  19. Comparison between DOH Survey and NM/HSRC survey • 24% of the 244 pregnant women in the study were HIV VS • 24.8% in the DOH antenatal survey sample were HIV+

  20. Locality-type prevalence HIV prevalence in adults (15–49 years) by Locality-type, South Africa

  21. Age group prevalence Prevalence of HIV by age, South Africa 2002

  22. Age and sex distribution of HIV infection Prevalence of HIV by sex and age, South Africa 2002

  23. Race and HIV prevalence HIV Prevalence among Adult (15-49 years) by Race, South Africa 2002

  24. Distribution of the Sample Similar to 1996 census in terms of • age, • sex, • race, • province, • Locality type

  25. Those not tested for HIV are not different from those tested in terms of: • Condom use during last sex • Proportion of non-sexually active, abstainers, one partner or multiple partners • Sexually transmitted infections • Predicted HIV prevalence

  26. Sexually transmitted infections and HIV • A strong link between STIs and HIV was confirmed in this study • 38.9% of those who reported an STI in the past three months were HIV positive, compared with 13.2% • The availability of STI treatment services was known by 79% • 10% of these had used the services • 93% of those said they were satisfied with services

  27. Orphans • Definition of orphans: lost mother or father or both before 15 years From all causes of death • 13.0% of children aged 2–14 years had lost a mother, father, or both parents • 3% had lost a mother • 8.4% had lost a father

  28. Child-headed households • 3.0% of households were determined to be child-headed • Child-headed household in South Africa: 3.1% in urban formal areas, 4.2% in urban informal areas, 2.8% in tribal authority areas and 1.9% in farms

  29. What the HIV prevalence results mean • HIV is a generalised epidemic in South Africa • It affects people of all races, all ages and in all localities • It affects women more than men • 5.6% HIV prevalence among children aged 2-14 years was unexpected and requires further investigation(CI: 3.7%-7.4%)

  30. Sexual frequency and partner turnover • Sexual activity in the past 30 days was low for youth • 29% of youth 15-24 had not had sex in the past 30 days, and a further 41% had sex 1-4 times • Partner turnover amongst youth and adults is low • 84.7% of youth and 93.5% of adults had only one partner in the past year • Secondary abstinence – previously sexually active, but no sex in the previous 12 months – was 23.4% in the 15–24 year age group

  31. Condom access and use • 90% of youth and adults reported easy access to condoms if they needed one • Condom use at last sexual intercourse was higher amongst Africans than other race groups • 13.2% traditionally married adults 25-49 years, and 15.8% of those in civil marriages used condoms

  32. Condom access and use Primary sources of condoms, South Africa, 2002

  33. Condom use during last sex act

  34. Self-reported behaviour change 40.2% of youth and adults reported changing their behaviour as a result of HIV/AIDS

  35. Behaviour Change among sexually active women between 2002 NM/HSRC survey and 1998 SADHS

  36. Knowledge of HIV/AIDS Information • Good overall knowledge of key aspects of HIV/AIDS information • 81.2% of youth and 79.3% of adults agreed that HIV causes AIDS • 89.2% of youth and 92.8% of adults agreed that AIDS cannot be cured by sex with a virgin. • 49.5% of youth and 56.1% of adults agreed that a baby could become HIV+ through breastfeeding

  37. Awareness of HIV status • 62% knew where to get VCT services • 76% of South Africans who were HIV positive were not aware of their HIV status • 63% of these who were not aware of their HIV positive status did not perceive themselves to be at risk • Of those who had not been tested, 59.4% said they would consider a test if confidentiality was maintained, whilst 28.5% would be motivated by the accessibility, cost and quality of services

  38. Sources of HIV/AIDS information (%)

  39. Unprompted recall of messages • Condom-use messages were best recalled – 90.8% of youth and 86% of adults • Amongst adults, messages about faithfulness (58.2%), abstinence (44.5%) and partner reduction (44.8%) also rated highly • PLWA rights (14.8%), care for PLWA (9.8%) and religious or cultural values (8.2%) were less well noted • There was a need for more detailed information on most HIV/AIDS topics

  40. Percent who have taken HIV more seriously

  41. Public Perceptions: political leadership, resource allocation Public perceptions of commitment to dealing with AIDS and resource allocation by race, South Africa, 2002

  42. Should Gov provide ARV’s for PMTCT? • 96.5% said yes

  43. Should Govt provide ARVs for PLWA? • 95% said yes.

  44. Conclusions

  45. Conclusion • HIV/AIDS is a serious problem in SA • South Africans are responding to prevention campaigns • They are knowledgeable about HIV/AIDS • The epidemic and mass media are making South Africans to take AIDS seriously • South Africans are changing their behaviour • They believe the politicians are committed to dealing with AIDS, publicly recognise it,and are not allocating sufficient resources. • They think the govt should make ARVs available for PMTCT and treatment. • There is hope for the country to deal with HIV/AIDS

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