DOI: 10.14749/1400830395
title: South African HIV/AIDS, Behavioural Risks, Sero-status, and Mass Media Impact Survey (SABSSM) 2002: Adult and youth data - All provinces

description: Description: 
 The adult and youth data of the SABSSM 2002 study cover information from adults and youths 15 years and older on topics ranging from biographical information, media and communication, male circumcision, marital status and marriage practice, partner and partner characteristics, sexual behaviour and practices, voluntary counseling and testing (VCT), sexual orientation, interpersonal communication, practices around widowhood, knowledge and perceptions of HIV and AIDS, stigma, hospitalisation and health status.

 The data set consists of 643 variables and 9788 cases.
Abstract: 
 Background: This is the first in a series of national HIV household surveys conducted in South Africa. The survey was commissioned by the Nelson Mandela Children's Fund and the Nelson Mandela Foundation. The key aims were to determine the HIV prevalence in the general population, identify risk factors that increase vulnerability of South Africans to HIV infections, to identify the contexts within which sexual behaviour occurs and the obstacles to risk reduction and to determine the level of exposure of all sectors of society to current prevention. The Nelson Mandela Children's Fund requested the HSRC to assess the impact of current HIV and AIDS education and awareness programmes designed to slow down the epidemic, including infection rates, stigma, care and support for affected individuals and families.

 Methodology: Sampling methods: multi-stage cluster stratified sample stratified by province, settlement geography (geotype) and predominant race group in each area. A systematic sample of 15 households was drawn from each of 1 000 census enumeration areas (EAs). In each household, one person was randomly selected in each of four mutually exclusive age groups (2-11 years; 12-14 years; 15-24 years; 25+ years). Field workers administered questionnaires to selected respondents and also collected oral fluid specimens for HIV testing.

 Results: This study sampled a cross-section of 9 963 South Africans aged two years and older. HIV is a generalised epidemic in South Africa that extends to all age groups, geographic areas and race groups.

 It showed 11.4 % were HIV positive, 15.6 per cent of them aged between 15 and 49. Women (12.8% HIV positive) were more at risk of infection than men (9.5% HIV positive). Urban informal settlements have the highest incidence of HIV infection (21.3%). Free State showed the highest prevalence (14.9%) with Eastern Cape having the lowest (6.6%). Higher rates of infection (5.6%) are also found in children aged 2-14 and Africans (10.2%). Awareness of HIV status was low. Only 18.9% reported that they were previously tested. Fewer women (3.9%) reported more than one sexual partner as compared to men (13.5%). Condom use at last sex was low among both women (24.7%) and men (30.3%).

 Knowledge of HIV and AIDS is generally high, with sexual behaviour changes taking root in encouragingly low numbers of sexual partners and high levels of abstinence among the youth. There is still great uncertainty of the relationship between HIV and AIDS and popular myths. South Africans from all walks of life are at risk. In particular, wealthy Africans have the same levels of risk as poorer Africans - whereas in other race groups, poorer people are more vulnerable to infection.

 Conclusions: The study recommended the expansion of voluntary counselling and testing. Prevention programmes ought to focus on reduction on multiple partners and increased condom use. It further recommended, inter alia, that HIV/AIDS prevention programmes be intensified for people living in informal settlements, campaigns be implemented using mass media to address myths and misconceptions and that information needs in rural communities and poorer households due to lack of access to mass media channels, should be attended to.
description: Clinical measurements
description: Face-to-face interview
description: Focus group
description: Observation
description: South African population, 2 years and older from urban formal, urban informal, rural formal, rural informal settlements.
description: This project used the HSRC's master sample (HSRC 2002). A master sample is defined as a selection, for the purpose of repeated community or household surveys, of a probability sample of census enumeration areas throughout South Africa that are representative of the country's provincial, settlement and racial diversity. The sampling frame that was used in the design of the master sample was the 2001 census Enumerator Areas (EAs) from Statistics South Africa (Stats SA).

 The target population for this study were all people in South Africa, excluding persons in so-called special institutions (e.g. hospitals, military camps, old age homes, schools and university hostels). The EAs were used as the Primary Sampling Units (PSUs). Although the 2001 census data are not yet available, it was decided to use the 2001 EAs for the master sample because the sampling units would remain relevant for future surveys conducted by the HSRC within five to ten years' time. In addition, the HSRC would soon have access to the most recent census statistics over this period for weighting of future survey results, including this study.

 The sample was designed with two main explicit strata, namely, provinces and the geography type (geotype) of the EA. In the 2001 census, the four geotypes are urban formal, urban informal, rural formal (including commercial farms) and tribal areas (i.e. the deep rural areas). In the formal urban areas, race was also used as a third stratification variable. What this means is that the Master Sample has been designed to allow reporting of results (i.e. reporting domain) at a provincial, geotype and race level.

 A reporting domain is defined as that domain at which estimates of a population characteristic or variable should be of an acceptable precision for the presentation of survey results. The census 2001 EA data provided by Stats SA for drawing the sample contained an estimate of the number of dwelling units (DUs) or visiting points (VPs). A visiting point is defined as a separate (non-vacant) residential stand, address, structure, and flat in a block of flats or homestead. The 2001 estimate of visiting points was used as the Measure of Size (MOS) in the drawing of the sample. The visiting point is the Secondary Sampling Unit (SSU) in each of the selected PSUs. In this study, all people in all the households resident at the visiting point were initially listed, after which the eligible individual was randomly selected in each of the following three age groups 2-14, 15-24 and 25 years and older. These individuals constituted the Ultimate Sampling Units (USUs) of this study. Having completed the sample design, the sample was drawn with 1 000 PSUs or EAs being selected throughout South Africa. These PSUs were allocated to each of the explicit strata. With a view to obtaining an approximately self-weighting sample of visiting points (i.e. SSUs), (a) the EAs were drawn with probability proportional to the size of the EA using the 2001 estimate of the number of visiting points in the EA database as a measure of size (MOS) and (b) to draw an equal number of visiting points (i.e. SSUs) from each drawn EA. An acceptable precision of estimates per reporting domain requires that a sample of sufficient size be drawn from each of the reporting domains. Consequently, a cluster of 11 VP was systematically selected on the aerial photography produced for each of the EAs in the master sample. Since it is not possible to determine on an aerial photograph whether a 'dwelling unit' is indeed a residential structure or whether it was occupied (i.e. people sleeping there), it was decided to form clusters of 11 dwelling units per PSU, allowing on average for one invalid dwelling unit in the cluster of 11 dwelling units. Previous experience at Statistics SA indicated a sample size of 10 households per PSU to be very efficient, balancing cost and efficiency.

 Overall, a total of 14 450 potential participants composed of 4 001 children, 3 720 youths and 6 729 adults were selected for the survey and 13 518 (93.6%) were actually visited. A small proportion (6.4%) of potential respondents could not be approached due to logistic constraints that were unavoidable in a study of such magnitude. Among the 13 518 individuals who were selected and contacted for the survey, 9 963 (73.7%) persons agreed to be interviewed, and 8 840 (65.4%) agreed to also give a specimen for an HIV test.

 The sample was designed with the view to enable reporting of the results on province level, on geography type area and on race of the respondent. The total sample size was limited by financial constraints, but based on other HSRC experience in sample surveys it was decided to aim at obtaining a minimum of 1 200 households per race group. In fact, the aim was to obtain 1 200 Indian households, 1 800 coloured households, 2 200 white households and 4 800 African households, a total thus of 10 000 households. The number of respondents per household for the study was expected to vary between one and three (one respondent in each of the three age groups). A 70% response rate was assumed and a HIV+ prevalence rate of 20%. However, the total refusal and non-contact rate was much higher than expected. Nevertheless, all cases where the interview could have been done were included in the analysis.