Why Has HIV Stabilized in South Africa, Yet Not Declined Further? Age and Sexual Behavior Patterns Among Youth

The authors undertook the current study to understand the stabilization in HIV prevalence in South Africa, and to learn why -- despite behavior change and apparently moderate risk behaviors -- prevalence has not further declined. They compared HIV prevalence and four HIV-related sexual behaviors in South Africans and Ugandans (ages 15-24) before and during HIV prevalence, stabilization, and decrease, respectively.

The South Africans have shown behavior change and moderate risk behaviors, according to standard indicators. HIV prevalence of the South African youth, however, is more than twice that of the Ugandan youth, despite two times greater condom use and an increase in secondary abstinence among young females. "We observed inconsistent use of condoms and an extended age distribution of risk together with age and partner mixing," the authors wrote. "These increase the cumulative risk beyond indicators which are based on sexual behavior in the last year and condom use at last sexual act. In addition, the extended age distribution of risk together with age and partner mixing, increase the cumulative risk beyond standard indicators which are based on sexual behavior in the last year and condom use at last sexual act."

"Comprehensive HIV prevention in South Africa needs to be intensified beyond individual age groups, for example youth; clearly promote consistent condom use and reduction in sexual partners; and focus on the transmission dynamics including older age groups," the authors concluded. "This should be based on careful behavioral analysis of the epidemic, which goes beyond standard indicators. This study shows the significant risks beyond apparently improving behavioral indicators in Southern Africa, and helps explain the seriousness of the epidemic in this region."

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