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Epidemiology of HIV in South Africa--results of a national, community-based survey.

OBJECTIVE
To determine HIV prevalence in the South African population and to investigate risk factors for HIV.


METHODS
A national sample of 10 197 households was selected. One child (aged 2 - 14 years), one youth (15 - 24 years) and one adult (25 years and older) were randomly selected from each household. Consenting respondents were interviewed about their socio-demographic characteristics and asked to give an oral mucosal transudate sample to test anonymously for HIV. Differential response rates were compared using unweighted data. The Orasure HIV-1 device in combination with the Vironostika HIV UNI-Form II plus O enzyme-linked immunosorbent assay kits were used to collect oral fluid specimens for HIV testing. HIV prevalence within subgroups was compared using Rao and Scott's adjusted chi-square. Relative risk was calculated using Poisson regression. All analysis was on the weighted data.


RESULTS
Of the 10 197 households selected, 7 249 (71.1%) were included in the study. Of the 13 518 individuals selected, 9 963 (73.7%) were interviewed. Of these, 8 428 (62.3%) agreed to HIV testing and had valid results. HIV prevalence in the general population was 11.4% (12.8% in females and 9.5% in males). Blacks had the highest prevalence (12.9%), compared with whites (6.2%), coloureds (6.1%) and Indians (1.6%). Informal settlements in urban areas had the highest HIV prevalence (21.6%). The findings of this study are consistent with South African Department of Health estimates based on the 2002 antenatal survey.


CONCLUSION
The Nelson Mandela/Human Sciences Research Council survey included all race, sex and age groups. It is therefore the most reliable and valid source of information on the extent and distribution of the HIV epidemic in South Africa.