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the success of vertical transmission prevention efforts Study’s strengths and limitations
introduced almost 15 years ago. These findings are similar
to those reported in the CMS annual report of 2015–2016. An important limitation of this study is the fact that data
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Furthermore, the adults in our cohort are ageing, and those were obtained from only one PMB. Generalisations may,
with the highest prevalence rates of HIV are moving out therefore, be inappropriate. Furthermore, the data we have
of the child-bearing category, namely, most are aged been able to obtain are restricted to broad demographic
40+ years. categories and excludes other data with a specific clinical
interest, for example, long-term survival, morbidity and so
A review of the demographics of adolescents (age 10–19 on. The data are also limited by its retrospective nature/
years) and young adults in this study indicates that this capture. Nevertheless, the data provide an important
group is not represented adequately. This is not surprising overview of the incidences and prevalence of HIV infection
for a country (such as South Africa) where one-third of in the SA private sector, namely, a large South African PBM
youth aged below 30 years is unemployed and up to 50% of company. The number of PLWH registered with companies
school leavers cannot find work, that is, cannot access that supply PMBs and provide disease management
private healthcare. This group is nonetheless a high-risk programmes has increased significantly during the last
group for HIV transmission, infection and failure of HIV- decade, that is, this sector is important for the successful
management. delivery of HIV care to the nation. Indeed, the provision of
PMBs – strength of programme – highlights positive benefits
The highest HIV prevalence occurred amongst middle-aged that members are able to access.
and older persons, namely, 40–70 years old. Figure 4 clearly
indicates that this group has consistently accounted for 80% – Conclusion
90% of HIV-infected population managed by private medical
schemes. Figure 4 also provides graphically the annual new Our study indicates an increase in the number of SA-PLWH
incident infections in this age group. If these data are accessing treatment in private healthcare sector and utilising
duplicated in all SA medical schemes, then the private sector PMBs. The latter has proven to be successful in managing
must begin to view their 40+-year-old HIV-infected patients HIV or AIDS in the private medical schemes’ environment.
as a key population for whom the message of HIV prevention The growing prevalence of middle-aged and older adults
must become a priority. with HIV or AIDS warrants further studies as this group is
sexually active and presents an opportunity to re-emphasise
The 40–70-year age group is at risk of comorbid diseases. HIV-prevention messages. In addition, this group is at risk of
These include diabetes, hypertension, renal dysfunction, comorbid diseases that would affect their risk-profile
neurocognitive decline, life-threatening cardiovascular assessments and their long-term survival.
events, fragility fractures and non-AIDS defining cancers.
These may occur a decade earlier than occurring in uninfected Acknowledgements
peers and result from the persistently inflammatory milieu
that cannot be corrected currently by ART. 17,18,19 Our data The authors thank the Statistical Consultation Services,
indicate that the adult HIV-infected group is ageing and is North-West University, Potchefstroom Campus, for statistical
likely to develop one or more comorbid conditions. While assistance, and Anne-Marie Bekker for administrative
this condition cannot be fully reversed, it could be mitigated support concerning the database.
with, for example, changes in medication, lifestyle and
dietary changes, and regular medical assessments to evaluate Competing interests
risk. Long-term consequences of comorbid disease in PLWH
means greater exposure to drug–drug interactions, drug The authors have declared that no competing interests exist.
toxicities and increased healthcare costs. The 40+-year age
group needs to be monitored closely in this regard. Authors’ contributions
All authors contributed equally to this work.
According to the 2017–2018 CMS annual report, maximum
number of healthcare service providers, healthcare-related
visits and beneficiaries were found in Gauteng, followed Funding information
by the Western Cape. Mpumalanga, the Northern Cape, The authors acknowledge the North-West University and the
Western Cape and Limpopo consistently have lower Water Foundation and National Research Foundation (NRF)
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proportions. Each of the other provinces made up less for financial support.
than 10% of covered beneficiaries. Disparity in medical
scheme coverage according to province is likely to reflect Data availability statement
the urban–rural divide, employment status and lack of
opportunity of those in rural areas. It is to be noted that Data sharing is not applicable to this article because the data
membership of a medical scheme is linked with the source, the PBM, does not allow it according to the current
availability of employment. contract.

http://www.sajhivmed.org.za 263 Open Access