In 2002, a population-based study of HIV prevalence in South Africa was conducted by a research consortium consisting of the HSRC, MRC, CADRE and ANRS. A key finding of the study was that the epidemic seriously affects South African children aged 2–14 years,
with an overall HIV prevalence among 2 350 children of 5.6% (95% CI: 3,7%–7.4%) (Nelson Mandela/HSRC Study of HIV/AIDS 2002). This was much higher than expected and could not be adequately explained by the data at hand. Following presentation of the data, both Mr Nelson Mandela and the Free State Department of Health expressed interest in addressing the question: ‘Why were so many children infected with HIV?’ A research study was therefore designed to investigate all possible routes of HIV transmission among 2–9 year old children, and the research area selected was public health services in the Free State. The aim of this study was to identify risk factors among children aged 2–9 years old, other than those associated with vertical transmission from their mothers. The objectives of the study were: To estimate the proportion of HIV-positive children aged 2–9 years whose biological mother was known to be HIV-negative; To estimate the prevalence of HIV infection among children aged 2–9 years served by public health services in the Free State;
To assess exposure to risk for HIV infection in children aged 2–9 years inside and outside these facilities; To identify the risk factors in the Free State public health sector for acquiring HIV in children aged 2–9 years whose mothers were known to be HIV-negative;
To identify the breaks in infection control (IC) practices that could lead to the transmission of HIV in the health care services; To identify practices in traditional and social settings which may facilitate the transmission of HIV.