This was said by Dr Olive Shisana, the president and chief executive of the Human Sciences Research Council (HSRC), who was speaking at a SABCOHA breakfast on Tuesday, 11 August.

It is the third national survey undertaken by the HSRC and is intended as a mid-term review of the National Strategic Plan 2007-2011. The previous surveys were published in 2002 and 2005.

Dr Shisana said the fact that so many people had had HIV tests "is really good news as it means that South Africans are personalising the issue". The report is sub-titled "A turning tide among teenagers", as it shows a reduction in HIV prevalence in the teenage population - which contributed to the overall decline in HIV prevalence among youth.

According to the report, there is a "larger proportion of the population who reported using a condom at last sex and this has reached particularly high levels among youth aged 15 to 24 years. Reported condom use at last sex increased dramatically from 57% in 2002 to 87% in 2008 among young males and correspondingly from 46% to 73% among young females."

Another improvement is an increase in the percentage of the population reporting awareness of their HIV serostatus. Serostatus is the presence or absence of antibodies in a person's blood serum.

"The percentage of people aged 15 to 49 years who were aware of their HIV status doubled between 2005 and 2008. This was found to be true for both males and females, although the rates among females were significantly higher than those of males," the report states.

Dr Shisana noted that in South Africa, young females had three to four times the prevalence of HIV than their same-age male peers and that HIV prevalence was overall higher for females and peaked at an earlier age than in males.

"Women in the age group of 25 to 29 years have a massive problem. One in three, or 32,7%, were found to be HIV-positive in 2008," Dr Shisana said. "This has remained consistent over the last three surveys."

Behavioural determinants such as the age of sexual debut, intergenerational sex and multiple sexual partners are important factors in the spread of HIV. The report notes that "the finding that there had been an increase in the percentage of young females aged 15 to 19 who had older sexual partners in 2008 when compared to 2005 is a matter of concern".

Shifts

Brad Mears, the chief executive of SABCOHA, said: "There is some evidence from the HSRC survey that shifts are happening but there is a very long way to go. For every person who is put on treatment, there are two people waiting behind them. Strong leadership is required - not only from the government but from the private sector as well."

According to the HSRC, South Africa's HIV epidemic has levelled off at a prevalence of 10,9% for people aged two years and older, with 5,2 million people estimated to be living with HIV in 2008. HIV prevalence has also declined among children aged two to 14, from 5,6% in 2002 to 2,5% in 2008; a decline in new infections has also been noted among teenagers aged 15 to 19.

"This latest survey provides us with an opportunity to understand the HIV epidemic over time, and there are promising findings of a changing pattern of HIV infection among children and youth," said Dr Shisana. "The good news is that the change in HIV prevalence in children is most likely attributable to the successful implementation of several HIV-prevention interventions."

These interventions were related to addressing HIV in early childhood, particularly programmes to prevent mother-to-child transmission in the Western Cape, which had the largest decline of six percentage points.

Professor Thomas Rehle, the other principal investigator of the study, emphasised that "we may witness for the first time a decrease in HIV incidence among teenagers".

Indirect HIV incidence estimates were mathematically derived from single year age prevalence in 15 to 20 year olds. "This method is best applicable in younger age groups when the effect of AIDS-related mortality on HIV prevalence levels is still minimal," Rehle explained.

Successes

Successes recorded in the study:

• A reduction in HIV prevalence in the teenage population, which indicated an overall decline in HIV in the teenage population of 15 to 19 years in 2008.

• HIV prevalence among adults aged 15 to 49 declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape and the Free State, with the largest decline of 7,9 percentage points in the Western Cape.

• The percentage of people in the age group 15 to 49 who reported awareness of their HIV status doubled from 2005 to 2008. This is attributable to multisectoral communication and programmes that promoted knowledge of HIV status and the substantial increase in the availability of voluntary counselling and testing services (VTC) over the period.

• The proportion of the population who reported using a condom at their last sexual encounter was particularly high among young people aged 15 to 24 years: from 57% in 2002 to 87% in 2008 among young males, and from 46% to 73% among young females. This trend was also obvious in condom use among people in the 25 to 49 age group, where condom use among males at last sex nearly doubled, while among females in the same age group tripled. This may indicate a shift in power relations between males and females, but also an understanding of the value of condoms as in important prevention measure.

• There was an increase in the population reached by at least one national HIV communication programme between 2005 and 2008. This trend is in an upwards direction, and is particularly clear among youth, where 90% reported that they had been reached by at least one programme. Although reach of the main national HIV/AIDS communication programmes increased over time, the government's Khomanani Programme had the lowest reach in comparison to other programmes. Reach of all programmes was low for people aged 50 years and older, with 37,8% of people in this age group not being reached by any programme.

"Communication programmes are not reaching all sectors of the population," said Dr Warren Parker, a co-investigator on the study. "The lack of reach into older age groups has been raised repeatedly in previous studies, yet nearly four out of 10 people aged 50 years and older are not reached by any programme."

Click here to read the HSRC press release.

Click here to download the report.