0848 What is happening to antenatal HIV prevalence rates in South Africa?

Readers will no doubt be aware of the debate that raged in 2008 after the National Dept of Health (NDOH) published apparently-encouraging antenatal HIV prevalence statistics for 2007. The figures were challenged by Dorrington and Bourne, both prominent and experienced analysts of the epidemic. The latter researchers argued in particular that the survey results were artefactual as a result of methodological changes. This argument was rejected by the NDOH, which stood by its results. Using the same methodology that had been applied in 2006, Dorrington and Bourne have repeated the analysis and have shown that for 6 provinces the prevalence rates have remained fairly constant (± 0.1 – 0.4), while rates have increased in 3 provinces (Mpumalanga by 2.6%; North West by 1.7% and Northern Cape by 1.0%). KZN continues to lead the pack with a prevalence of 38.7%, followed by Mpumalanga at 34.6%. Free State, Gauteng and North West are around 31%. Northern and Western Cape are still around 16%. The overall prevalence rate is 29.4%. Most important, however is the explanation around the trends, with the authors arguing that results are affected by a) mortality in excess of new infections (leading to a fall in prevalence), and b) treatment leading to survival in HIV-positive individuals (leading to an increase). At this point it is not clear exactly where we are in this dynamic, but it is argued that both scenarios probably exist.

Read more:
S Afr Med J 2008; 98: 940-1 and 754-5
NDOH Directorate of Health Systems Research 2008, http://www.doh.gov.za/docs/antenatal-f.html