A study in South Africa, a country worst hit by HIV/AIDS, showed the epidemic may have been leveling off but dire situation could persist as millions of HIV- positive people remain unaware of their risk of potentially infecting others, given a wide existence of unsafe sex and ignorance.
An estimated 4.8 million South Africans, or 10.8 percent of the country's total population, are living with HIV/AIDS, according to the national survey conducted by the Human Sciences Research Council (HSRC).
The results were published in Johannesburg on Wednesday, one day ahead of the annual World AIDS Day that once again singles southern Africa out as "epicenter" of global AIDS pandemic.
HIV prevalence among young adults in the 15-49 age group increased slightly from 15.6 percent in 2002 to 16.2 percent in 2005, which "may be an indication that the epidemic in the general population of South Africa has entered a phase of leveling off," said Olive Shisana, principal investigator and CEO of HSRC.
The HSRC figure was less than the South African health department's estimate of 6.3 million infections last year and some 5 million estimated by the United Nations (UN) most recently.
Shisana told a press briefing on Wednesday that the population- based HSRC survey was different from studies only among pregnant women, whose data could be limited by over-representation of poorer African females.
The UN AIDS agency UNAIDS said almost 30 percent of women attending antenatal clinics in South Africa were tested HIV positive in 2004.
In its 2005 AIDS report released recently, UNAIDS said the epidemic in South Africa has evolved at an "astonishing" speed, with national adult HIV prevalence of less than 1 percent in 1990 soaring to almost 25 percent within 10 years.
Young females, Africans and residents in poverty-stricken informal settlements run much higher risks of being infected with HIV than males, whites and those living in formal settlements, the HSRC study found.
MORTALITY INCREASES, IGNORANCE PERSISTS
Thomas Rehle, a health expert with HSRC, said while the HIV infection level may keep steady in next several years after a steep rise, AIDS-related mortality will continue to increase.
The estimate of HIV positive population by Actuarial Society of South Africa, from last year's 5 million to 5.2 million this year, also suggested HIV prevalence is leveling off in South Africa.
But Rob Dorrington, the society's AIDS committee member, said this was not because new infections were falling, but rather that the number of infected people dying was approaching the number of people who were getting infected, national newspaper Business Day reported.
The society estimated 530,000 South Africans were newly infected between mid-2004 and mid-2005 while 340,000 AIDS patients died during the same period, reducing the average life expectancy down to a mere 51 years.
The HSRC estimated 2.5 million children in South Africa were orphaned by HIV/AIDS and other diseases.
Shisana said the HSRC survey has nevertheless raised some concerns, particularly high HIV infection rate among young girls.
"Of great concern is the finding that young women in the 15-24 age group are up to four times more likely to be HIV positive than young men in the same group," she said.
Females in this group were almost 17 percent likely to get infected in 2005, compared with 12 percent in 2002. HIV prevalence could be as high as some 33 percent among women aged 25-29.
Having sex at young age, multiple sexual partnerships and having older sexual partners increased their risk of HIV infection.
Shisana said half of the respondents in the study who were tested HIV positive did not think they were at risk of HIV infection.
Put it in another way, more than two million South Africans walking on street are HIV positive but think they are not, which can be a big risk of potentially infecting others, she said.
Although overall basic HIV/AIDS knowledge is high, many South Africans are still uncertain about HIV causing AIDS, condoms preventing HIV infection or HIV transmission from mother to child, she said.
ACCEPTING HIV/AIDS AS REALITY
The HSRC study discovered nearly half of South Africans aged 15 and older finding nothing wrong with marrying an HIV-positive person and would not have a problem having sex with them.
"These results suggest that South Africans are accepting HIV/ AIDS as a reality in South Africa and that stigmatization in society is becoming less of a factor, especially in urban areas," said Shisana.
The study found that 90.7 percent of South Africans were willing to care for HIV-positive family members and that 79.8 percent were against the exclusion of HIV-positive children from schools.
Although South Africans acknowledged the government's efforts in dealing with HIV/AIDS, a significant number were unhappy with the financial and human resources allocated to dealing with the scourge, Shisana said.
UNAIDS said this month that at least 85 percent of South Africans who needed antiretroviral drugs were not yet receiving them by mid-2005.