SA compares well with US on some HIV metrics

In December the United States Centers for Disease Control and Prevention (CDC) published its latest Vital Signs report setting out the state of that country’s HIV response. Drawing on estimates from the Thembisa mathematical model of HIV in South Africa, we made some comparisons between the HIV response in the two countries.

Similarities in testing and treatment

Around 86% of people in the United States living with HIV were aware that they were living with the virus in 2017. In South Africa this number is estimated to have been slightly higher in 2017 at 89%. Today it is estimated to be at around 91% in South Africa.

It is however harder to find and test people living with HIV in the United States since only around 0.3% of the population is estimated to be living with HIV, compared to 12.9% in South Africa.

In the United States around 63% of people living with HIV were virally suppressed in 2017 (which means antiretroviral medicines have suppressed the virus to the extent that it is undetectable with standard tests). In South Africa this number is very similar, with around 65% of people living with HIV estimated to be virally suppressed in 2017 (rising to around 73% today).

Very different epidemics

While the above numbers are quite similar, the two countries do have very different epidemics in key respects.

An estimated 7.5 million people in South Africa are living with HIV. This is around 12.9% of the country’s population, which is around 59 million people (according to the population estimate used in Thembisa).

By contrast, only around 1.1. million people out of the United States’ population of 330 million are estimated to be living with HIV (around 0.3%). This 1.1. million number is lower than in KwaZulu-Natal (2 million) and Gauteng (1.9 million) – but more than in any of South Africa’s other provinces.

Thus, while the US certainly has a substantial HIV epidemic, it is smaller than that of the South African epidemic in absolute terms, and much, much smaller in percentage terms.

Rate of new infections

According to the CDC from 2013 to 2017 the rate of new infections in the US was relatively stable at around 38 000 per year.

In South Africa there is estimated to have been more than six times as many new HIV infections in 2017 at around 249 000.

But while new infections are relatively stable in the US, in South Africa there is a clear downward trend in recent years. The projected number for 2019 is just under 200 000.

*Note: We acknowledge that there are many other differences and nuances to the HIV epidemics in the two countries that are beyond the scope of this article.

Read more: See how South Africa’s provinces compare with each other here and the story of the country’s HIV epidemic told in seven graphs here.