Three times more South African females than males are HIV-positive, national UNC-led survey shows

The survey also looked at the extent to which both males and females engage in risky behaviors, including multiple partners and inconsistent condom use, which contributes to the high infection rates. However, it also showed that youth who participated in South Africa’s national HIV prevention program for youth, called loveLife, were less likely than others to be infected with HIV.

Photograph of Dr. Audrey Pettifor

“South African youth have the highest rate of HIV infection in the world,” said Dr. Audrey E. Pettifor, an epidemiology faculty member at UNC’s School of Public Health and lead author of the journal article. “But the results of our survey are a hopeful sign that the country’s efforts to find ways to curb the spread of the HIV epidemic, specifically through loveLife, may be making a difference in the lives of these young people.”

The survey, “Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a national representative household survey,” is based on the largest nationally representative survey of HIV infection and sexual behavior among young people in South Africa to date. It examined the prevalence of HIV infection, risk factors for HIV infection and the effect of prevention programs.

The findings have important implications for prevention programs in South Africa and potentially beyond and will be used to better tailor programs to address the risks for HIV identified through the survey, in particular the need to reach young women with prevention programs and the barriers that prevent young people from practicing safer behaviors. Such barriers include a lack of education, negative social norms around HIV testing and condom use and gender power inequalities.

loveLife was designed to help overcome some of those barriers, said Pettifor. Organized under the auspices of leading South Africans in government, public health and nonprofit organizations, loveLife combines youth-friendly services in government clinics and sustained outreach programs in schools and through a national network of more than 150 community-based organizations and uses a high-profile HIV education and awareness campaign to help drive young people to services.

loveLife’s major financial supporters include the South African Government, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Kaiser Family Foundation.

The survey also found that:

• 85 percent of young men and women ages 15 through 24 were aware of “loveLife.”
• More than one-third of those reported participating in at least one of the activities in the program.
• Young people participating in loveLife were less likely to be infected with HIV compared to their counterparts not participating in loveLife, even after controlling for other factors such as education, race, age, urban-rural residence, marriage and participation in other prevention programs.

Because the survey was a cross-sectional national survey, it was not able to identify the causes of HIV infection. In addition, the authors highlighted the limitations of self-reported sexual behavior data among young people. The authors said that while they could not make any causal conclusions about the association between loveLife participation and reduction in HIV infection, the findings are consistent with the hypothesis that loveLife is having an effect on HIV risk among young people.

The survey was conducted from March through August 2003. A nationally representative, household sample of all young people ages 15 through 24 years in the nine provinces of South Africa were surveyed.

One eligible youth in each household was randomly selected and 11,904 (68.2 percent) completed the interview. All young people were asked to take part in an interviewer-administered questionnaire that covered a range of topics including socio-demographic, sexual risk behaviors, attitudes and norms around HIV-AIDS and awareness and exposure to the loveLife program. HIV testing was conducted but testing was anonymous.

Participants were informed that they would not receive the results of their test as no personal identifiers were collected and were referred to the nearest clinic for Voluntary Counseling and Testing (VCT).

Other authors of the survey were Dr. Helen V. Rees, Dr. Catherine MacPhail and Lindiwe Hlongwa-Madikizela, all of the Reproductive Health Research Unit, department of obstetrics and gynecology, University of the Witwatersrand; Dr. Immo Kleinschmidt, Medical Research Council, Durban, South Africa; Annie Steffenson, department of health policy, Harvard University; Kerry Vermaak, Development Research Africa, Durban; and Dr. Nancy S. Padian, AIDS Research Institute, University of California at San Francisco.

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Note: Contact Pettifor at (919) 966-7439 or apettif@email.unc.edu for comments and/or explanation of methodology. In South Africa contact Rees at +27-11-933-1228 or h.rees@rhrujhb.co.za.

For further information please contact Ramona DuBose, director of communications for the UNC School of Public Health, by telephone at 919-966-7467 or by e-mail at ramona_dubose@unc.edu.