Third South African National HIV Communication Survey

2012

Preliminary FindingsXIX INTERNATIONAL AIDS CONFERENCE

Third South African National HIV Communication Survey

2012

Preliminary FindingsXIX INTERNATIONAL AIDS CONFERENCE

Presenter: Lusanda N Mahlasela

24 July 2012

Presentation Overview

• Objective

• Methodology

• Key Findings:• HIV counselling and testing• Male circumcision• Condom use

• Conclusions

Objective

To evaluate the impact of HIV

communication programmes on the

key drivers of the HIV epidemic in

South Africa over time.

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

Key Findings

17.4 million South Africans have been tested for HIV

2009 2012

Weighted number

Percentage Weighted number

Percentage

Ever tested for HIV 14,947,451 54.7 17,393,824 64.3

Tested for HIV in the past 12 months

8,849,625 59.2 10,588,855 60.9

All men and women aged 16-55 yrs; n=9,728 in 2009 and n=10,034 in 2012

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

1 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.

Impact of HIV Communication Programmes on HIV testing

n= 6004 (16-55 yrs.); if had sex in the last 12 months; p<0.001; direct effect adjusted by logistic regression analysis

Level of Exposure to 19 HIV Communication Programs (deciles)

Impact of HIV communication programmes on HIV testing in the last 12 months 20 point

spread

37 39 4144

46 4850 53 55 57

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10Level of exposure to HIV communication programmes

(deciles)

Percent

n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis

Percent

13 point spread

People who knew that President Zuma had tested for HIV were more likely to discuss HIV testing with their sex partners

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

Percent

Impact of HIV communication on discussion of HIV testing with one’s sex partners

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

Discussion of HIV test with one’s sex partners

Percent

Impact of discussion of HIV testing with one’s sex partners on HIV testing in the last 12 months

30 point spread

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 survey2 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

Predictors of getting tested for HIV in the last 12 months

Positively related (more likely to get tested): Effect size/OR

1.Discussion of HIV testing with sex partner 3.49

2.Mpumalanga compared to Gauteng province 1.903.Female 1.504.Younger and middle age group 1.45 & 1.175.Perceived Social norms for HIV testing 1.06

6.Level of exposure to HIV communication programmes 1.03

n= 6,004 men and women ages 16-55 years who have had sex in the last 12 months; R2 =0.12.

Communication programmes have both a direct impact on testing and they influence other leading predictors of testing.

Impact of HIV communication programmes on male

circumcision

Key milestones in male circumcision in South Africa

King Goodwill Zwelithini promotes male circumcision

Communication programmes promote MMC nationally

Orange Farm MMC study

WHO recommendations

Knowledge of male circumcision for HIV risk reduction has increased

All men and women aged 16-55 years; n=10,034

Over half of South African men are now circumcised

2009 2012

Weighted number

Percentage Weighted number

Percentage

Circumcised5,546,372 42.6 7,078,980 55.3

Medical circumcision 1,796,685 32.7 3,380,259 48.1

Traditional circumcision 3,696,056 67.3 3,524,557 50.1

All men aged 16-55 yrs; n=4,065

No significant difference in condom use between circumcised and uncircumcised

men

n= 1,215; p =0.061

And the majority (85%) of people know that a man who is circumcised still needs to use a condom

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

Level of exposure to HIV communication programmes (deciles)

Impact of HIV communication on high intention and circumcision in the last 12 months

31 point spread

Percent

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.

Predictors of intention and circumcision

Positively related (more likely to get circumcised): Effect size/OR1.Standard 9 or above level of education 2.05; 2.26; 2.532.Younger age group 2.133.Being in a steady relationship 1.734.Using condom at first sex 1.455.Level of exposure to HIV communication programs 1.16

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

Communication programmes have a direct impact on intent to circumcise and on actual circumcision.

N = 8,198; 6,746; 7,068, respectively; p<0.001

Number of years ago that respondent first had sex

Pe

rce

nt

1995

Inflection point

68%

8.8%

Condom use at first sex by number of years ago one first had sex

Pe

rce

nt

Level of exposure to HIV communication programmes (deciles)

86%

72%

63%

44%

Impact of HIV communication on condom use by type of sexual relationship

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 1.Has more than one sex partner (MSP) 3.532.Single 2.85 3.Used a condom at first sex 2.834.Widowed or divorced 2.445.Has a steady (main) sex partner 2.256.Knows that one or more sex partners has other sex partners 1.56 7. Level of exposure to HIV communication 1.10

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

Communication programmes have a direct impact on condom use and they influence other leading predictors of condom use

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

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