South Africa has a generalised HIV epidemic, which has stabilised over the last four years at a national antenatal prevalence of around 30%. In 2009, an estimated 17.9% of the adult population was living with HIV. This is estimated to be 5.63 million people, including 3.3 million women and 334 000 children.
HIV infection fuels the tuberculosis epidemic, with more than 70% of patients co-infected with both infections. The highest prevalence of TB infection is among people aged 30-39 years who are living in townships and informal settlements.
South Africa currently ranks the third highest in the world in terms of the TB burden, with an incidence that has increased by 400% over the past 15 years. There is a wide variation in HIV and TB prevalence across age, race, gender, socio-economic status and geographical location. It is estimated that 80% of the South African population is infected with the TB bacillus. However, not everyone who is infected will progress to active TB disease. Certain populations are at higher risk of TB infection and re-infection. These include health care workers, miners, prisoners, prison officers and household contacts of confirmed TB patients. In addition, certain groups are particularly vulnerable to progressing from TB infection to TB disease. These include children, people living with HIV, diabetics, smokers, alcohol and substance users, people who are malnourished or have silicosis, mobile, migrant and refugee populations and people living and working in poorly ventilated environments. These groups are considered “key populations” for TB.
The TB infection rate places South Africa as the third country with the highest level of TB in the world after India and China. South Africa recorded 970 new infections per 100, 000 people in 2009. The number grew to 981 people newly-infected with TB out of every 100 000 in 2010 and 993 new infections per 100 000 in 2011.
Whilst STIs such as syphilis have decreased in most provinces over the past 10 years, the prevalence of herpes simplex, which is a co-factor in the acquisition for HIV, is still high in many sectors of the population.