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HIV testing in South Africa rises by 45% in 12 years

Hester Phillips

01 July 2020

The proportion of South Africans ever testing for HIV increased from 30% to 75% between 2005 and 2017 – but differences remain in who is getting tested

A delivery cyclist in Johannesburg
Photos are used for illustrative purposes. They do not imply health status or behaviour. Credit: iStock/Vladan Radulovic (RSA)

An analysis of four national surveys conducted among South African households over 12-years suggests HIV testing has increased by 45%.

The study analysed large-scale surveys conducted in 2005, 2008, 2012 and 2017. It is the first to examine the trends and factors associated with HIV testing in South Africa over such a long period.

The results show the proportion of people in South Africa reporting ever taking an HIV test rose from 30% in 2005 to 50% in 2008, 65% in 2012, and 75% in 2017.

Despite the proportion of people testing for HIV increasing across all socio-demographic characteristics, young people, men, never-married people, people with lower education levels, unemployed people, and people living in rural areas are less likely to test for HIV than others.

The findings suggest adults aged 25–49 are more likely to test for HIV than young people (aged 15–24). Yet people aged 50 and above are less likely to get tested than those aged 25– 49.

The difference in testing between young people and adults may be due to older people having had more opportunities to test over the years. But as younger people are now more likely than any other age group in South Africa to get HIV, this discrepancy is cause for concern.

In earlier surveys, white and Asian people were more likely than black people to have tested for HIV, but this had reversed by 2017. This is due to HIV testing substantially increasing among black South Africans, rising by around 50% between 2005 and 2017. In comparison, the proportion of white and Asian people having ever tested for HIV increased by 16% and 17%, respectively, over the same period.

Being a women, married, educated to at least secondary school level, living in an urban area or having a job were all significantly associated with testing for HIV. This suggests there is a need to target men, people with no or little formal education, unemployed people and people living in rural areas to reach more first-time testers.

All those who took part in the surveys were tested for HIV. People with HIV positive results were more likely to have tested for HIV before, suggesting they would have been aware of their status.

People with accurate knowledge on how to prevent the sexual transmission of HIV and who rejected misconceptions about HIV transmission were more likely to have tested for HIV than those with inaccurate knowledge. People who saw themselves as having a heightened risk of infection were also more likely to have tested.

The analysis provides some indication that South Africa’s HIV testing programme is reaching high-risk groups. In 2005, around 30% of people with a sexual partner who was at least five years older then them had tested for HIV, compared with around 90% in 2017. The proportion of people with two or more sexual partners who reported testing for HIV rose from 35% in 2005 to 83% in 2017. But the analysis did not report on HIV testing among certain key population groups, such as sex workers, people who use drugs, transgender people and men who have sex with men.

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