Geneva, 29 November -- On 28 November, the Pretoria News published an article entitled “Alarm at hike in SA HIV infections”. The article states that “The World Health Organization […] sees worrying signs of accelerating incidence of the disease in some regions, notably in KwaZulu-Natal.” Further, it quotes the Director of the WHO HIV Department: “What is really of concern is that in certain parts such as KwaZulu-Natal there are still very high rates of transmission among very young people, among adolescents. It is in the range of 20-30 percent”.

In relation to this article, WHO wishes to clarify two points:

(1) Its statements on the trend of HIV infections were misinterpreted by the reporter and are wrong. While Dr Hirnschall did  point to high rates of new HIV infections in young women in Southern Africa, at no point was reference made to an increase in the rate of HIV infection in this group. On the contrary, WHO recognizes that overall the rate of new HIV infections in South Africa has come down significantly in the last years, both in the adult population (by 22% between 2009 and 2012, from 1.75 in 2009 to 1.37 in 2012) and among young people (HIV incidence for 15-24 years dropped from 2.2% in 2009 to 1.7% in 2012).[1]

In his statement, Dr Hirnschall pointed to a “range of 20-30 percent of HIV infections among young women”, referring to the prevalence of HIV infection. Omitting the latter part of his statement might lead to the erroneous impression of him referring to the rate of yearly new infections.

(2) Statements on South Africa were made in the context of the global launch of WHO’s new guidance on HIV and adolescents[2]. In response to a specific question on the situation in South Africa and the vulnerability of young women in particular, WHO pointed to the example of KwaZulu –Natal as a province with high rates of HIV incidence[3] (noting an incidence rate of close to 10% among unmarried women of less than 25 years in the recent VOICE trial[4]). While the incidence in this group is of particular concern, in the same press briefing, WHO praised the many courageous steps and initiatives taken in South Africa to reduce HIV infections among young people. Indeed, the guidelines launched were developed with colleagues from South Africa and do include a number of successful case studies from South Africa.

WHO has a close working relationship with the Ministry of Health in South Africa, and recently supported an independent evaluation of the South African HIV Programme. WHO explicitly recognizes the significant achievements of South Africa in scaling up HIV services and bringing down infection rates, including among young people.  In addressing high HIV incidence among young women, WHO reiterates concerns that have been previously voiced by the Government of South Africa: In 2013, the Government of South Africa stated in its UN Progress Report on the HIV targets: “The single biggest prevention priority for South Africa is to reduce new infections among young women and girls between the ages of 15 and 24”[5].

WHO welcomes the ambitious targets set by the country and is committed to continuing to provide active support to the implementation of the South African HIV Programme. 

References:

UNAIDS Spectrum Estimates
HIV and Adolescents: HIV testing and counselling, treatment and care for adolescents living with HIV. WHO, 2013.

2011 HIV antenatal HIV prevalence recorded in KwaZulu-Natal with an estimate of 37.4% (95% CI: 35.8 –. 39.0%)

By country, HIV incidence in the VOICE study ranged from 0.8 in Zimbabwe, to 2.1 in Uganda, to 7 percent in South Africa. At some South African sites in the KwaZulu-Natal Province, it was nearly 10 percent.  

Republic of South Africa Global AIDS Response Progress Report – Mid-term Review of Progress in achieving the 2011 UN General Assembly Political Declaration  on HIV/AIDS targets and elimination commitments in South Africa. Republic of South Africa, 2013.