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The impact of HIV/AIDS on Southern Africa's Children

5. Gender differences in infection at different ages
 
In HIV/AIDS epidemics driven by heterosexual contacts, females tend to exhibit higher HIV prevalence rates than males. This is because women are biologically and culturally more at risk and more vulnerable to contracting the HI Virus.

The table below is an extrapolation of HIV prevalence from pregnant women attending ante-natal clinics to the general population. It is estimated that 300 000 more women are infected than men in South Africa.

Table 3: Extrapolation of HIV prevalence amongst ANC attendees to the general population: South Africa, 2000

Gender Age grouping Number of HIV+ individuals
Female 15 – 49 years 2.5 million
Male 15 – 49 years 2.2 million
Babies   106 109
Total   4.7 million

(Source: National HIV and Syphilis Sero-Prevalence Survey of Women Attending Public Antenatal Clinics in South Africa, 2000)

HIV prevalence is not spread uniformly amongst women. Apart from socio-economic and geographical variations, different age cohorts are affected and infected differently. The tables below show HIV prevalence for various age cohorts in South Africa, Botswana, Namibia and Swaziland.

Table 4: HIV prevalence trends by age among ANC attendees in South Africa 1994—2001

Age Group Estimated HIV-positive
1994 1995 1996 1997 1998 1999 2000 2001 (95% CI)
<20 6.47 9.5 12.9 12.9 21.0 16.5 16.1 15.4 (13.8-16.9)
20-24 8.94 13.12 17.74 17.74 26.1 25.6 29.1 28.4 (26.5-30.2)
25-29 8.63 11.03 15.33 15.33 26.9 26.4 30.6 31.4 (29.5-33.3)
30-34 6.37 8.05 12.2 12.2 19.1 21.7 23.3 25.6 (23.5-27.7)
35-39 3.72 7.37 9.71 9.71 13.4 16.2 15.8 19.3 (17.0-21.5)
40-44 5.28 4.36 10.16 10.16 10.5 12.0 10.2 9.1 (6.2-11.9)
45-49 0.41 7.45 5.83 5.83 10.2 7.5 13.1 17.8 (4.3-31.4)

(Source: National HIV and Syphilis Sero-Prevalence Survey of Women Attending Public Antenatal Clinics in South Africa, 2000 and 2001)

Table 5: Botswana HIV prevalence amongst women attending ANCs according to age: 1992—2001

Age cohort Year
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
15-19 16.4 21.8 20.7 32.4 27.2 28.0 28.6 21.5 25.3 24.1
20-24 20.5 27.1 31.5 34.8 40.9 41.4 42.8 38.7 41.0 39.5
25-29 19.4 24.2 30.2 32.6 34.0 41.0 45.2 43.3 52.6 48.4
30-34 16.5 16.8 18.0 33.5 32.0 33.3 38.2 42.0 49.6 44.1
35-39 8.0 12.6 16.2 23.2 22.2 25.6 27.2 33.3 41.6 39.0
40-49 9.3 9.4 8.0 15.0 20.0 23.1 23.9 25.5 34.9 26.7

(Source: Botswana 2000 and 2001 HIV sero-prevalence sentinel survey amongst pregnant women and men with sexually transmitted diseases.)

Table 6: Namibia HIV prevalence amongst women attending ANCs according to age: 1994—2000

Age cohort Year
1994 1996 1998 2000
15-19 6 11 12 12
20-24 11 18 20 20
25-29 9 17 22 25
30-34 9 18 19 21
35-39 3 8 12 15
40-44 1 12 14 9
45+ 12 1 13 8

(Source: Report of the 2000 HIV Sentinel Sero Survey, Ministry of Health and Social Services, Republic of Namibia.)

Table 7: Swaziland HIV prevalence amongst women attending ANCs according to age: 1994—2000

Age cohort Year
1994 1996 1998 2000
<20 18.4 24.7 25.2 25.9
20 – 24 18.8 33.1 38.4 42.5
25 – 29 14.3 28.0 38.0 40.7
30 – 39 10.3 18.8 23.7 25.4

(Source: Ministry of Health and Social Welfare, October 2000. The Kingdom of Swaziland 7th HIV Sentinel Surveillance Report.)

If a comparison of HIV prevalence by age cohort is made between males and females, HIV prevalence is higher amongst girls and young women than boys and young men. The number of females infected between the age of 15-24 is markedly higher than for males. Female infection levels are highest for those aged between 20-24, whilst the highest levels of infection for men are in the 30-39 age group (see the figure below). This is largely because females tend to become sexually active far younger than males.

Figure 5: Age and sex distribution of HIV infections, Zambia


(Source: The POLICY Project, 2001)

There are a number of reasons why females are believed to become sexually active at a younger age than males, including:
  • older males tend to have more financial resources at their disposal and can afford to have partners, the “sugar daddy” phenomenon,
  • men consciously seek younger and younger female partners to reduce the likelihood the partner being HIV positive,
  • female, and particularly younger girls are often coerced into sex as they have little power to refuse and even less power to negotiate safe sex.
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