Third South African National HIV Communication Survey 2012

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Third South African National HIV Communication Survey 2012 Preliminary Findings XIX INTERNATIONAL AIDS CONFERENCE

Third South African National HIV Communication Survey 2012 Preliminary Findings XIX INTERNATIONAL AIDS CONFERENCE Presenter: Lusanda N Mahlasela 24 July 2012

Presentation Overview • Objective • Methodology • Key Findings: • HIV counselling and testing

Presentation Overview • Objective • Methodology • Key Findings: • HIV counselling and testing • Male circumcision • Condom use • Conclusions

Objective To evaluate the impact of HIV communication programmes on the key drivers of

Objective To evaluate the impact of HIV communication programmes on the key drivers of the HIV epidemic in South Africa over time.

Methodology • A cross sectional survey was conducted in all 9 provinces of SA

Methodology • A cross sectional survey was conducted in all 9 provinces of SA between February and May 2012 • 10 034 males and females aged 16 to 55 years representative of 28 million people • Data analysis: • Description of key outcomes over time • Impact of the HIV Communication programmes

Key Findings

Key Findings

HIV Counselling and Testing (HCT)

HIV Counselling and Testing (HCT)

17. 4 million South Africans have been tested for HIV 2009 2012 Weighted number

17. 4 million South Africans have been tested for HIV 2009 2012 Weighted number Percentage Ever tested for HIV 14, 947, 451 54. 7 17, 393, 824 64. 3 Tested for HIV in the past 12 months 8, 849, 625 59. 2 10, 588, 855 60. 9 HCT campaign testing data indicates that 10, 700, 276 people were tested in the past 12 months 1 Source: NDo. H, 2011 in Global AIDS Response Progress Report, 2012 1 Calculated by dividing number of people tested in 15 months (13, 375, 345) by 15 and multiplying by 12. NDo. H data not restricted to 16 -55 year olds. All men and women aged 16 -55 yrs; n=9, 728 in 2009 and n=10, 034 in 2012

Impact of HIV Communication Programmes on HIV testing

Impact of HIV Communication Programmes on HIV testing

Impact of HIV communication programmes on HIV 20 point testing in the last 12

Impact of HIV communication programmes on HIV 20 point testing in the last 12 months spread Percent Level of Exposure to 19 HIV Communication Programs (deciles) n= 6004 (16 -55 yrs. ); if had sex in the last 12 months; p<0. 001; direct effect adjusted by logistic regression analysis

People who knew that President Zuma had tested for HIV were more likely to

People who knew that President Zuma had tested for HIV were more likely to discuss HIV testing with their sex partners Percent 13 point spread Awareness of President Zuma’s HIV test n= 6, 062 (16 -55 yrs. ); if had sex in the last 12 months; p<0. 001; adjusted by logistic regression analysis

Impact of HIV communication on discussion of HIV testing with one’s sex partners Percent

Impact of HIV communication on discussion of HIV testing with one’s sex partners Percent 16 point spread Level of exposure to HIV communication programmes (deciles) n= 6, 062 (16 -55 yrs. ); if had sex in the last 12 months; p<0. 001; adjusted by logistic regression analysis

Impact of discussion of HIV testing with one’s sex partners on HIV testing in

Impact of discussion of HIV testing with one’s sex partners on HIV testing in the last 12 months Percent 30 point spread Discussion of HIV test with one’s sex partners n= 6, 062 (16 -55 yrs. ); if had sex in the last 12 months; p<0. 001; adjusted by logistic regression analysis

Stigma has declined • Of those tested, 16, 375, 012 (94. 1 %) know

Stigma has declined • Of those tested, 16, 375, 012 (94. 1 %) know their HIV status – 14, 130, 561 (86. 3%) were comfortable revealing their HIV status – 1, 657, 527 (11. 2%) were HIV positive 1 – 1, 297, 438 (78. 5%) were taking ARVs 2 1 HIV prevalence 15 -49 years : 16. 9% (2008) Source: HSRC survey 2 NDo. H statistics indicate that 1. 7 million South Africans are on ART Men and women aged 16 -55 yrs ever tested for HIV; n= 6, 079

Predictors of getting tested for HIV in the last 12 months Positively related (more

Predictors of getting tested for HIV in the last 12 months Positively related (more likely to get tested): Effect size/OR 1. Discussion of HIV testing with sex partner 3. 49 2. 3. 4. 5. 1. 90 1. 50 1. 45 & 1. 17 1. 06 Mpumalanga compared to Gauteng province Female Younger and middle age group Perceived Social norms for HIV testing 6. Level of exposure to HIV communication programmes 1. 03 Communication programmes have both a direct impact on testing and they influence other leading predictors of testing. n= 6, 004 men and women ages 16 -55 years who have had sex in the last 12 months; R 2 =0. 12.

Impact of HIV communication programmes on male circumcision

Impact of HIV communication programmes on male circumcision

Key milestones in male circumcision in South Africa King Goodwill Zwelithini promotes male WHO

Key milestones in male circumcision in South Africa King Goodwill Zwelithini promotes male WHO recommendations circumcision 250, 000 Orange Farm MMC study Number of men circumcised 200, 000 Communication programmes promote MMC nationally 150, 000 Medical Traditional 100, 000 50, 000 0 1992 1994 1996 1998 2000 2002 Year circumcised 2004 2006 2008 2010

Knowledge of male circumcision for HIV risk reduction has increased 47 50 40 30

Knowledge of male circumcision for HIV risk reduction has increased 47 50 40 30 20 30 30 14 14 8 10 2009 2012 0 No benefits Reduces the risk of HIV Keeps you clean and healthy All men and women aged 16 -55 years; n=10, 034

Over half of South African men are now circumcised 2009 2012 Weighted number Percentage

Over half of South African men are now circumcised 2009 2012 Weighted number Percentage 5, 546, 372 42. 6 7, 078, 980 55. 3 Medical circumcision 1, 796, 685 32. 7 3, 380, 259 48. 1 Traditional circumcision 3, 696, 056 67. 3 3, 524, 557 50. 1 Circumcised All men aged 16 -55 yrs; n=4, 065

No significant difference in condom use between circumcised and uncircumcised men 60 52 50

No significant difference in condom use between circumcised and uncircumcised men 60 52 50 48 40 And the majority (85%) of people know that a man who is circumcised still needs to use a condom 30 20 10 0 Circumcised Uncircumcised n= 1, 215; p =0. 061

Impact of HIV communication on high intention and circumcision in the last 12 months

Impact of HIV communication on high intention and circumcision in the last 12 months Percent 31 point spread Level of exposure to HIV communication programmes (deciles) n= 1, 647 not circumcised and 127 circumcised in the last year=1, 774 (16 -55 yrs. ); p<0. 001; adjusted by logistic regression analysis

Demand for circumcision is high • Among the 5 471 890 men who said

Demand for circumcision is high • Among the 5 471 890 men who said they were not circumcised: – Almost a million said they definitely intended to get circumcised in the next 12 months. – Of those that say they will definitely get circumcised, 80. 5% (803 690) intend to have a medical circumcision.

Predictors of intention and circumcision Positively related (more likely to get circumcised): 1. Standard

Predictors of intention and circumcision Positively related (more likely to get circumcised): 1. Standard 9 or above level of education 2. Younger age group 3. Being in a steady relationship 4. Using condom at first sex 5. Level of exposure to HIV communication programs Effect size/OR 2. 05; 2. 26; 2. 53 2. 13 1. 73 1. 45 1. 16 Communication programmes have a direct impact on intent to circumcise and on actual circumcision. n= 1, 327 not circumcised and 127 circumcised in the last year=1, 774 (16 -55 yrs. ); p<0. 001; adjusted by logistic regression analysis

Condom use

Condom use

Condom use at first sex by number of years ago one first had sex

Condom use at first sex by number of years ago one first had sex Percent 68% 1995 Inflection point 8. 8% Number of years ago that respondent first had sex N = 8, 198; 6, 746; 7, 068, respectively; p<0. 001

Impact of HIV communication on condom use by type of sexual relationship 86% Percent

Impact of HIV communication on condom use by type of sexual relationship 86% Percent 72% 63% 44% Level of exposure to HIV communication programmes (deciles)

Predictors of condom use with one or more of one’s three most recent sex

Predictors of condom use with one or more of one’s three most recent sex partners Positively related (more likely to use condoms): 1. Has more than one sex partner (MSP) 2. Single 3. Used a condom at first sex 4. Widowed or divorced 5. Has a steady (main) sex partner 6. Knows that one or more sex partners has other sex partners 7. Level of exposure to HIV communication Effect size/OR 3. 53 2. 85 2. 83 2. 44 2. 25 1. 56 1. 10 Communication programmes have a direct impact on condom use and they influence other leading predictors of condom use n= 6051 men and women ages 16 -55 years who have had sex in the last 12 months; R 2 =0. 20; correctly classified = 71%; under ROC curve, 0. 79

Contribution of HIV Communication Programmes in South Africa • HIV Testing – 17. 4

Contribution of HIV Communication Programmes in South Africa • HIV Testing – 17. 4 million people tested, 10. 6 million in the past year • Male Circumcision – Over 55% of men are circumcised – Nearly one million intend to get circumcised in the next year • Condom use – Increased to 68% at first sex in 2012

Acknowledgements • Funders: USAID/PEPFAR • Partners: Johns Hopkins Health and Education in South Africa,

Acknowledgements • Funders: USAID/PEPFAR • Partners: Johns Hopkins Health and Education in South Africa, love. Life, Soul City • Research team: – HDA: S Magni, S Johnson, K Mangold, B Bello – JHHESA: R Delate, L Mahlasela – JHUCCP: D. L. Kincaid, M. E. Figueroa • Data collection: Freshly Ground Insights • Survey respondents

THANK YOU

THANK YOU