HIV epidemic in South Africa: a comparison of HIV epidemic patterns of two extreme provinces in South Africa

South Africa is experiencing one of the worst HIV epidemics, which varies by province and by districts within each province. The objective of this study was to explore and compare HIV trends and patterns between two provinces in South Africa. 'Know your epidemic' synthesis suggests that HIV prevalence is rising in older age groups and falling in younger people. Using secondary data analyses of population-based and antenatal care surveillance (ANC) surveys, we explored trends and patterns in HIV prevalence in KwaZulu-Natal and Western Cape. Even though KwaZulu-Natal has the highest HIV prevalence in the country, there is considerable recent decline in HIV prevalence in KwaZulu-Natal, compared with a 2% increase in the Western Cape, based on ANC data, in youth aged 15 to 24 years. These results are consistent with those from a population-based survey where a decline of 0.3% in HIV prevalence in KwaZulu-Natal was observed as compared with an increase of 0.7% in Western Cape youth. Both ANC results and population-based surveys conducted in different years show a decline in HIV prevalence amongst youth in KwaZulu-Natal compared with an increase in the same age group in the Western Cape. HIV infection in this age group is associated with recent infection, thus indicating an increasing epidemic in the Western Cape compared with KwaZulu-Natal. Interventions aimed at curbing infections such as sexual abstinence and condom promotion in this age group need to be implemented extensively in the Western Cape. These should include HIV counseling and testing campaigns.