Despite popular belief, HIV can affect anyone, regardless of a person’s race, ethnicity, age, gender, socioeconomic status or sexual orientation. That said, some people are more at risk of contracting the virus than others. By familiarizing yourself with both at-risk populations and risk factors, you can reduce your chance of contracting HIV and, in the process, slow the spread within your community.
South Africa bears the largest share of the global HIV Burden, with a 19.1% prevalence rate among its adult population. Though all South Africans are affected by the HIV epidemic, some populations account for the largest numbers of HIV infections. Below are a few of the hardest hit populations.
The prevalence rate for HIV among men who have sex with men (MSM) is disproportionately higher than the general population. In fact, despite MSM remaining an understudied, marginalized and hard-to-reach population, its prevalence rate for HIV is about nine times higher than that of general populations in medium-to-high risk countries.
According to three different epidemiological surveys, approximately 49% of men who identified as gay and who were between the ages of 20 and 24 were positive for HIV; 43.6% of the surveyed gay population in Durban and Johannesburg identified as HIV-positive; and, of the respondents who were surveyed in Cape Town, an overwhelming majority were Black or from traditionally Black townships.
JEMs conducted another study that involved 285 participants. Of the participants, 88% were African, two-thirds were under the age of 25, 78% self-identified as gay or homosexual, 19% identified as bisexual and just 2% identified as heterosexual or straight. Another 2% were self-identified transgenders. The HIV prevalence rate among the 266 participants who agreed to test — which was adjusted to account for just the MSM population — was 38.3%, which is about twice as high what one would expect among the general population.
The HIV epidemic disproportionately affects Black Africans, with prevalence rates of approximately 17% among Black African males and 24% among Black African females. For Black African males, the risk of contracting HIV is higher when they are within the age group 25 to 49 years old or over the age of 50, compared to their younger counterparts between the ages of 15 and 25.
Black African females have the highest overall HIV prevalence rates among any other racial group. This seems to correlate with findings from across the globe. For instance, in American, African American women have prevalence rates that are 15 times higher than white female Americans.
Poverty is an overarching factor that leads to increased prevalence rates among certain populations in South Africa. For instance, Black African women typically live in poor socio-economic conditions and have to deal with unequal power dynamics. Both these factors force them into relationships that expose them to men with heightened risks of HIV, as such men typically engage in transactional or intergenerational intercourse. Even in regions in which transactional or intergenerational sex is not so prevalent, Black African women still tend to be the population most affected by HIV. Consequently, this has contributed to their social, cultural and economic status throughout society.
Gender aside, poor socio-economic conditions correlate with high HIV prevalence rates among other groups as well. One group that is particularly affected is Black Africans. This is in large part due to the now bygone apartheid era in which Black Africans were segregated from white citizens. Though such segregation no-longer exists, the effects — which include but are not limited to poor-quality education, lack of employment opportunities, lack of healthcare and the breakdown of family structural norms — still linger. These aftereffects perpetuated high transmission rates among Black Africans.
Again, studies from other countries reveal that poverty correlates with high HIV rates across the globe. Using the United States again as an example, studies reveal that the racial disparity of HIV is heavily influenced by economic and social inequities that stem from social exclusion, disparities in access to healthcare and poverty.
Injection drug use (IDU) is another major contributing factor for HIV transmission. Though statistics for the general population are hard to find, data does show that as much as 45% of prisoners who engage in IDU are HIV positive, whereas just 22% of other arrestees can say the same.
Injection drug use becomes more dangerous when needle sharing is involved. It is not common knowledge in much of South Africa that HIV can survive outside of the body and on blood-contaminated instruments for several hours. As a result, needle sharing is prevalent among individuals who engage in IDU. It goes without saying, then, that HIV rates are high among drug users who share needles, reaching as high as 28% in Zanzibar.
Alarmingly, needle sharing and group needle ownership is common along the Kenyan coast and among individuals who are aware that they are HIV positive. As many as 27.6% of known HIV positive persons who also engage in IDU reported having shared a needle with someone else in the year leading up to the study.
Transgender women have an astounding risk for contracting HIV. In fact, transgender women in South African are 49 times more likely to live with HIV than adults of similar reproductive ages. It goes without saying, then, that HIV disproportionately affects women in the transgender community. Additional data from 2019 supports these findings, revealing that the HIV prevalence rate among transgender women throughout the country is between 45.5% and 63.4%.
In attempting to understand what contributes to such startling rates, researchers found that between 13% to 38% of transgender women sold sex in the past. Moreover, they are far more likely than just about any other group to experience discrimination and stigma, economic vulnerability, lack of emotional support and drug use. Undergoing gender-affirming surgery is also a risk factor, as the tissue of the neovagina becomes more susceptible to tearing, bleeding and infection.
Now that you know which populations are most at risk for contracting and transmitting HIV, it may help to familiarize yourself with HIV risk factors. In doing so, you can avoid or change certain behaviors and, in the process, reduce your risk.
Unprotected sex is the number one way in which HIV is transmitted. This is because, during sex, individuals exchange bodily fluids that often contain the virus. These bodily fluids can be exchanged through the genitals, rectum and mouth. You can reduce your risk of contracting HIV through intercourse by using a condom or some other means of protection every time.
Unfortunately, some groups of people have a higher risk of contracting HIV via intercourse than others. Some such groups are as follows:
Drug use — in particularly, injection drug use — is a major risk factor for HIV. The risk increases when individuals share needles or when needles are dirty, as HIV can pass from one person to the next when even trace amounts of blood are present.
Sadly, blood banks did not start testing for HIV until 1985, well after the epidemic began. As a result, the virus regularly passed through blood transfusions that used the blood of infected persons.
Today, HIV can still pass through blood transfusions when the blood comes from a person who recently contracted the virus. In these cases, the virus is transmittable but not yet detectable through testing.
HIV can also pass from one person to the next via certain operations. Though rare, organ transplantation, artificial insemination and tissue transplants have been known to result in HIV transmission.
Living with certain sexually transmitted diseases (STDs) increases a person’s risk of contracting HIV. This is because individuals with these diseases, or infections (STIs), may have open sores around their genitals. When bodily fluids come into contact with an open sore, such as what may happen during intercourse, the risk for transmission increases exponentially. Types of STIs that put a person at increased risk of contracting HIV are as follows:
If you live with one or several of these conditions, it is imperative that you take measures to protect yourself during intercourse.
People who work in certain fields are at risk of exposure if not daily, frequently. These individuals work around bodily fluids, including blood, and typically have jobs in the following fields:
It is critical to global health to combat HIV among populations that are either at a heightened risk or that engage in high-risk behaviors, as the virus can quickly propagate to the general populations via a processed called “bridging.” Though the likeliness that bridging will occur depends on the nature and extent of social networks and connections between certain populations, it can and does happen.
That said, evidence shows that educating at-risk populations on how the virus spreads and implementing behavior change and prevention interventions can slow or even curb the epidemic. However, such interventions must be delivered in a safe, judgment-free environment within a non-stigmatized facility that is operated by capable, friendly and understanding staff. Such facilities and services must be geographically, procedurally and financially accessible and utilize the following approaches:
In addition to meeting the above requirements, effective intervention programs offer key services to at-risk populations. Top services such programs should offer are as follows:
With robust outreach and education services, and by destigmatizing HIV, communities can take drastic measures to reduce the spread of the virus or, in the best circumstances, eliminate it entirely.