Prevalence of HIV among those 15 and older in rural South Africa

Abstract

A greater knowledge of the burden of HIV in rural areas of Southern Africa is needed, especially among older adults. We conducted a cross-sectional biomarker survey in the rural South African Agincourt Health and Socio-demographic Surveillance site in 2010-2011 and estimated HIV prevalence and risk factors. Using an age-sex stratified random sample of ages 15+, a total of 5037 (65.7%) of a possible 7662 individuals were located and 4362 (86.6%) consented to HIV testing. HIV prevalence was high (19.4%) and characterized by a large gender gap (10.6% for men and 23.9% for women). Rates peaked at 45.3% among men and 46.1% among women - both at ages 35-39. Compared with a similar study in the rural KwaZulu-Natal Province, South Africa, peak prevalence occurred at later ages, and HIV prevalence was higher among older adults - with rates above 15% for men and 10% for women through to age 70. High prevalence continues to characterize Southern Africa, and recent evidence confirms that older adults cannot be excluded from policy considerations. The high prevalence among older adults suggests likely HIV infection at older ages. Prevention activities need to expand to older adults to reduce new infections. Treatment will be complicated by increased risk of noncommunicable diseases and by increasing numbers of older people living with HIV.

Figure 1.

Location of the Agincourt HDSS in Southern Africa.

Figure 2.

Boundary of the Agincourt HDSS study site in the subdistrict.

Figure 3.

Flowchart of age-sex stratified random sample of 2009 Agincourt population, based on eligibility, being located for potential interview, consenting to interview, and consenting to HIV testing.

Figure 4.

HIV prevalence by sex and age of: (A) Agincourt 2010 estimates; (B) KwaZulu-Natal estimates; and (C) Swaziland DHS estimates from 2006 to 2007. ∗Age group 60–64 includes everyone aged 60 +.