20091213

The face of HIV/AIDS in KwaZulu-Natal is a woman in her thirties living in eThekwini, according to a study released this week.

Urban women in the province are far more likely to be HIV positive than their rural sisters, while over half (54%) of all pregnant women in their thirties were HIV positive.

Some 47% of pregnant women living in eThekwini who attended government clinics between May 2008 and April 2009 were HIV positive. This was followed closely by 45% in Umgungundlovu.

In contrast, women from the more rural districts of Amajuba (38%), Zululand (37%) and Umkhanyakude (35%) recorded significantly lower rates of HIV than their urban sisters.

The study, conducted by Dr Christiane Horwood from the University of KwaZulu-Natal's Centre for Rural Health, was aimed at finding out the HIV prevalence of mothers and babies as well as the HIV transmission rate.

Despite levels of poverty being higher in the rural districts, social scientists believe that there is more social cohesion in rural communities that protects against women against HIV.

The large HSRC-Nelson Mandela Household surveys conducted among the general South African population since 2002 have consistently found that people living in informal settlements have the highest HIV prevalence.

"The mobility and transient nature of life in informal settlements, rather socio-economic status, makes those living in these areas most vulnerable to HIV," explained the HSRC CEO Dr Shisana.

Men living in informal settlements were much more likely to have more than one sexual partner in a year than those living in tribal areas, while urban youth were significantly more sexually experienced, according to the household studies.

Horwood's study found that KwaZulu-Natal has managed to slash HIV transmission from mothers to their newborn babies by almost two thirds -- to seven percent - since it started giving pregnant women and their babies two antiretroviral drugs.

However, the transmission rate was highest in eThekwini with one in 10 pregnant women passing HIV onto their babies. Amajuba had the lowest transmission rate with just 4.3 percent of babies from HIV positive moms getting infected.

Interestingly, the study showed that nevirapine alone was relatively ineffective at preventing mothers from infecting their babies.

Since 2002, pregnant HIV positive women have been given the ARV nevirapine to prevent her from passing HIV on to her baby. This followed research in Uganda and South Africa that showed nevirapine could cut HIV transmission by about 30 percent.

But a 2004 study in the province found that about 20 percent of pregnant HIV positive women who got nevirapine were still passing the virus on to their babies.

In Horwood's study, 13.5 percent of women who only got nevirapine passed HIV on to their babies, which is only marginally better than the 15 percent transmission rate from moms who got no ARVs at all to their babies.

But the transmission rate for those on dual therapy was dramatically reduced to only 5.6 percent, while only 5 percent of mothers on triple therapy passed HIV to their babies.

"It's hard to say why nevirapine was so ineffective in comparison to the earlier research, but perhaps it was the difference between a research setting and operational setting," said Horwood.

Horwood's study also measured the infant mortality rate in the districts, and found that babies fared worst in eThekwini followed closely by Amajuba. In eThekwini, 85 babies per 1000 died before their first birthday.

"The infant mortality rate has tripled in the province over the past 10 years because of HIV/AIDS, so it is very exciting to see the impact of dual therapy, which will make massive strides to prevent the deaths of babies and children," said Horwood.

Health MEC Sibongiseni Dhlomo welcomed the results of the study, but appealed to all pregnant women to report to their local clinics as soon as they knew they were pregnant.

"HIV positive women who are pregnant need to get dual therapy from 14 weeks of pregnancy but most of them only go to the clinic when they are in their last trimester of pregnancy," said Dhlomo.

"We call on all community leaders to encourage pregnant women to go to their clinics early so they can be tested for HIV," he added.