1. 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

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

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

5. 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

6. Key Findings

8. 17.4 million South Africans have been tested for HIV 20092012 Weighted number Percentage 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 59.210,588,85560.9 All men and women aged 16-55 yrs; n=9,728 in 2009 and n=10,034 in 2012 HCT campaign testing data indicates that 10,700,276 people were tested in the past 12 months 1 Source: NDoH, 2011 in Global AIDS Response Progress Report, 2012 1Calculated by dividing number of people tested in 15 months (13,375,345) by 15 and multiplying by 12. NDoH data not restricted to 16-55 year olds.

9. Impact of HIV Communication Programmes on HIV testing

10. n= 6004 (16-55 yrs.); if had sex in the last 12 months; p<0.001; direct effect adjusted by logistic regression analysis Level of Exposure to 19 HIV Communication Programs (deciles) Impact of HIV communication programmes on HIV testing in the last 12 months 20 point spread Percent

11. n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis Percent 13 point spread People who knew that President Zuma had tested for HIV were more likely to discuss HIV testing with their sex partners Awareness of President Zuma’s HIV test

12. n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis Percent Impact of HIV communication on discussion of HIV testing with one’s sex partners 16 point spread Level of exposure to HIV communication programmes (deciles)

13. n= 6,062 (16-55 yrs.); if had sex in the last 12 months; p<0.001; adjusted by logistic regression analysis Discussion of HIV test with one’s sex partners Percent Impact of discussion of HIV testing with one’s sex partners on HIV testing in the last 12 months 30 point spread

14. 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 NDoH 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

15. 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.Mpumalanga compared to Gauteng province 1.90 3.Female 1.50 4.Younger and middle age group1.45 & 1.17 5.Perceived Social norms for HIV testing 1.06 6.Level of exposure to HIV communication programmes1.03 n= 6,004 men and women ages 16-55 years who have had sex in the last 12 months; R2 =0.12. Communication programmes have both a direct impact on testing and they influence other leading predictors of testing.

16. Impact of HIV communication programmes on male circumcision

17. Key milestones in male circumcision in South Africa King Goodwill Zwelithini promotes male circumcision Communication programmes promote MMC nationally Orange Farm MMC study WHO recommendations

18. Knowledge of male circumcision for HIV risk reduction has increased All men and women aged 16-55 years; n=10,034

19. Over half of South African men are now circumcised 20092012 Weighted number Percentage Weighted number Percentage Circumcised 5,546,372 42.6 7,078,98055.3 Medical circumcision 1,796,68532.73,380,25948.1 Traditional circumcision 3,696,05667.33,524,55750.1 All men aged 16-55 yrs; n=4,065

20. No significant difference in condom use between circumcised and uncircumcised men n= 1,215; p =0.061 And the majority (85%) of people know that a man who is circumcised still needs to use a condom

21. 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 Level of exposure to HIV communication programmes (deciles) Impact of HIV communication on high intention and circumcision in the last 12 months 31 point spread Percent

22. 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.

23. Predictors of intention and circumcision Positively related (more likely to get circumcised): Effect size/OR 1.Standard 9 or above level of education 2.05; 2.26; 2.53 2.Younger age group 2.13 3.Being in a steady relationship 1.73 4.Using condom at first sex 1.45 5.Level of exposure to HIV communication programs 1.16 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 Communication programmes have a direct impact on intent to circumcise and on actual circumcision.

25. N = 8,198; 6,746; 7,068, respectively; p<0.001 Number of years ago that respondent first had sex Percent 1995 Inflection point 68% 8.8% Condom use at first sex by number of years ago one first had sex

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

27. Predictors of condom use with one or more of one’s three most recent sex partners Positively related (more likely to use condoms): Effect size/OR 1.Has more than one sex partner (MSP) 3.53 2.Single 2.85 3.Used a condom at first sex 2.83 4.Widowed or divorced 2.44 5.Has a steady (main) sex partner 2.25 6.Knows that one or more sex partners has other sex partners 1.56 7. Level of exposure to HIV communication 1.10 n= 6051 men and women ages 16-55 years who have had sex in the last 12 months; R2 =0.20; correctly classified = 71%; under ROC curve, 0.79 Communication programmes have a direct impact on condom use and they influence other leading predictors of condom use

28. 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

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