To describe the increasing prevalence of HIV infection in a rural district in South Africa, to compare this with a nearby urban setting, and to estimate the prevalence of infection in the general population of the rural district.
Serial anonymous cross-sectional HIV seroprevalence surveys among consecutive women attending antenatal clinics in the rural Hlabisa health district, and the urban King Edward VIII Hospital, Durban, South Africa.
Crude antenatal HIV seroprevalence in Hlabisa increased from 4.2% (95% confidence interval [95%CI], 3.0-5.7) in 1992, to 14% (95%CI, 10.4-18.4) in 1995 (p < 0.0001). Age-specific prevalence was highest in women aged 20 to 24 years (21.1% in 1995) and in the more urbanized areas of the district (29.5% in 1995). Prevalence in Durban, at 19% (95%CI, 16.5-21.7), was higher than in Hlabisa in 1995 (p = 0.046), in large part as a result of the higher prevalence in the 15 to 19 year age group in Durban (22.4% vs. 7.4%, p = 0.004). An estimated 5.6% (95%CI, 3.0-9.6) of the general population of the Hlabisa district was HIV infected in 1995.
The HIV epidemic, fueled by a high incidence in young people, has escalated rapidly in this part of rural South Africa. Lower crude rural than urban prevalence is largely a result of a lower prevalence in young rural women; the underlying social reasons for this need to be fully explored. South Africa urgently needs to implement effective prevention programs, to plan for the impact of HIV-related disease on the health service, and to develop community-based care strategies.
The prevalence of HIV infection in South Africa's rural population was assessed in cross-sectional studies conducted in 1992, 1993, and 1995 at the 10 antenatal clinics in the rural Hlabisa health district (KwaZulu/Natal province). Crude HIV seroprevalence among consecutive pregnant women presenting to these clinics in a 1-month period increased from 4.2% in 1992 (n = 884) to 7.9% in 1993 (n = 709) to 14% in 1995 (n = 314). In each year, the highest HIV prevalence was recorded among women 20-24 years of age (21.1% in 1995). HIV rates were consistently highest at the clinic serving the township located on the national road (29.5% in 1995). The corresponding HIV prevalence at an urban antenatal clinic in the same province--King Edward VIII Hospital in Durban--was 19% in 1995. This rate was highest in the 15-19 year age group (22.4%). Extrapolation of the data on pregnant women in Hlabisa to the rural district as a whole suggests there were 11,571 HIV cases (5547 women, 5547 men, and 477 children) in 1995, for a population prevalence of 5.6%. The rising incidence of HIV infection in South Africa's rural areas will have profound demographic, economic, and social implications. Of particular concern is the ability of health services in rural districts to respond to an increased demand for care.