National Health Insurance
The HIV Epidemic by Province

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A significant feature of the epidemic in South Africa has been the very different levels of infection by province. This has long been known through the annual antenatal clinic surveys by the Department of Health. The ASSA2003 provincial model has been used to provide a report and detailed figures of the epidemic for each of the provinces. “The projections show that the prevalence in the country and in most provinces is reaching a plateau, with KwaZulu-Natal the highest (estimated antenatal plateau of around 40%), Western Cape the lowest (estimated antenatal plateau of around 17%) and Northern Cape and Limpopo slightly higher than the Western Cape. The other provinces are expected to level off or peak at an antenatal prevalence of 30-35%.”

The two graphs below illustrate the rate of new infections (i.e. incidence) and the rate of total cases (i.e. prevalence) across the provinces, as a percentage of the total population in that province.

This means there is a wide disparity in the need for treatment by province and this argues for a risk-adjusted payment to the provinces which includes HIV/AIDS as a risk factor.

Figure 3: HIV Incidence Rate by Province from 1985 to 2025 using ASSA2003

Figure 4: HIV Prevalence Rate by Province from 1985 to 2025 using ASSA2003

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