HIV/AIDS in South Africa is a prominent health concern because South Africa is believed to have more people with HIV/AIDS than any other country.
The 2007 UNAIDS report estimated that 5,700,000 South Africans had HIV/AIDS, or just under 12% of South Africa's population of 48 million.[1] The number of infected is larger than in any other single country in the world. The other top five countries with the highest HIV/AIDS prevalence are all neighbours of South Africa.
In 2007, only 28% of people in South Africa with advanced HIV/AIDS were receiving anti-retroviral treatment (ART). In 2004, 2005 and 2006 the figures were 4%, 15% and 21% respectively.[2] By 2009, nearly 1 million or about 2% of all adult South Africans were receiving ART, of which 38% were children.[3]
In 2010, some 280,000 South Africans died of HIV/AIDS. In the decade up to 2010, between 42% and 47% of all deaths among South Africans were HIV/AIDS deaths.[4]
Although new infections among mature age groups in South Africa remain high, new infections among teenagers seem to be on the decline. HIV/AIDS prevalence figures in the 15–19 year age group for 2005, 2006 and 2007 were 16%, 14% and 13% respectively.[5]
The Human Sciences Research Council, a South African institution, estimates 10.9% of all South Africans have HIV/AIDS.[6] Additionally, the Central Intelligence Agency estimates that 310,000 individuals died in South Africa from HIV/AIDS in the year 2009. [7]
HIV/AIDS is more prevalent among female adults under the age of 40 in nearly all age groups. Roughly 4 in every 5 people with HIV/AIDS aged 20–24 are women, and only one third of people with HIV/AIDS aged 25–29 are men.[6] Although prevalence is higher among women in general, only 1 in every 6 HIV/AIDS infected people with multiple sex partners are women.[6]
Slightly more than 50% of sexually active South Africans have ever had at least one HIV/AIDS test. The spread between male and female for this statistic is roughly even.[6]
In 2008, life expectancy at birth was 41 years for males and 46.5 years for females.[8]
HIV prevalence among pregnant women is highest in the populous KwaZulu-Natal province (37%), and lowest in the Western Cape (13%), Northern Cape (16%) and Limpopo (18%) provinces. In the five other provinces (Eastern Cape, Free State, Gauteng, Mpumalanga and North West) at least 26% of women attending antenatal clinics in 2006 tested HIV-positive.
The latest HIV data collected at antenatal clinics suggest that HIV infection levels might be levelling off, with HIV prevalence in pregnant women at 30% in 2005, 29% in 2006, and 28% in 2007. The decrease in the percentage of young pregnant women (15–24 years) found to be infected with HIV also suggests a possible decline in the annual number of new infections.[9]
Between 2005 and 2008, the number of older teenagers with HIV/AIDS has nearly halved.[6] Between 2002 and 2008, prevalence among South Africans over 20 years old have increased whereas the figure for those under 20 years old have dropped somewhat over the same period.[6]
Condom use is highest among the youth and lowest among old people. More than 80% of men and more than 70% of women under 25 years old use condoms, and slightly more than half of men and women aged 25–49 claim to use condoms.[6]
More than 90% of young adults and more than 80% of older adults know the truth about HIV/AIDS. Knowledge about HIV/AIDS is lowest among people older than 50 years—less than two thirds know the truth about the disease.[6]
In 2008, more than half (55%) of all South Africans infected with HIV reside in the KwaZulu-Natal and Gauteng provinces.[8]
Between 2005 and 2008, the total number of people infected with HIV/AIDS have increased in all of South Africa's provinces except KwaZulu-Natal and Gauteng. Nevertheless, KwaZulu-Natal still has the highest infection rate at 15.5% In the province with the lowest infection rate, the Western Cape, the total number of people with HIV/AIDS doubled between 2005 and 2008.[6]
Condom use has increased twofold in all provinces between 2002 and 2008. The two provinces where condoms were least used in 2002 were also the provinces where condoms are least used in 2008, namely the Northern Cape and the Western Cape.[6]
HIV/AIDS prevalence among sexually active South Africans by province are:
A comparison done in 2003 of the results from four forecasting methods predicted the difference between an HIV/AIDS scenario versus a no-HIV/AIDS scenario for annual growth rates between 2002 and 2015.[10] According to the study, real growth in GDP would be 0.6 percentage points lower than if there were no HIV/AIDS, but per-capita growth in GDP would be 0.9 percentage points higher. Growth in population would have been 1.5 percentage points lower, and growth of the labour force would be 1.2 percentage points lower, but the unemployment rate would be 0.9 percentage points lower as well.
The South African branch of the company Daimler-Chrysler estimated that in 2002 expenses related to HIV/AIDS were equivalent to 4% of all its salaries in South Africa.[11] A study done in 2000 by South Africa's second largest company, Sasol, indicated that 15% of its local workforce was HIV positive, of which 11% had AIDS.[12] According to the CEO of South Africa's largest company, SAB Miller, the cost of HIV/AIDS include costs associated with increased absenteeism, reduced productivity, increased turnover, and healthcare costs.[13]
The four main HIV/AIDS awareness campaigns in South Africa are Khomanani (funded by the government), LoveLife (primarily privately funded), Soul City (a television drama for adults) and Soul Buddyz (a television series for teenagers).[14] Soul City and Soul Buddyz are the most successful campaigns although both campaigns experienced a slight loss of effectiveness between 2005 and 2008. Khomanani is the least successful campaign, although its effectiveness has increased by more than 50% between 2005 and 2008.
In South Africa, an orphan is defined as child of whom one or both of its biological parents have died. In 2005, there were 3.5 million such orphans in South Africa, of which 500 000 had lost both biological parents.[15] In 2007 it was estimated that 1,400,000 orphans in South Africa were orphaned as a direct consequence of HIV/AIDS.[16]
Data from 2007 indicates that there were 150 000 children in a total of 79 000 child-headed households. A child-headed household is defined in South Africa as a household in which no person older than 17 years was present for at least 4 nights a week.[17] In 2008 it was found that there is little evidence that HIV/AIDS has had any impact on the number of households headed by children. Child-headed households accounted for 0.7 percent of all children and 0.5 percent of all households in 2007, which is roughly the same as in 2002.[18]
In 2007, it was estimated that one third of HIV infected people will develop TB (tuberculosis) in their lifetime. Although not all patients with TB are tested for HIV, in 2006, some 40% of TB patients were tested for HIV. It has been the government policy since 2002 to cross-check all new cases of TB for HIV infection.[19]
Although STI prevention is part of the government's HIV/AIDS programmes, as it is in that of most countries, in South Africa HIV/AIDS prevention is done in conjunction with TB prevention. Most patients who die from HIV-related causes die from TB or similar illnesses. In fact the Health Department's programme of prevention is called the "National HIV and AIDS and TB Programme".[20] In line with United Nations requirements, South Africa has also drawn up an "HIV & AIDS and STI Strategic Plan".[21]
In 1983, AIDS was diagnosed for the first time in two patients in South Africa.[22] The first recorded death owing to AIDS occurred in 1983.[22] By 1986, there were 46 recorded AIDS diagnoses. Estimates from 2000 indicated that 5% of actual infections and only 1% of actual deaths due to AIDS were reported prior to 1990. Prior to 1990, AIDS was more common among homosexual people. By 1990, less than 1% of South Africans had AIDS. By 1996, the figure stood at around 3% and by 1999 the figure had reached 10%.[23] AIDS infection started reaching pandemic proportions around 1995.[24]
In 1985, the South African government set up the country’s first AIDS Advisory Group.
In 1990 the first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive. It was estimated that there were between 74,000 and 120,000 people in South Africa living with HIV. Antenatal surveys have subsequently been carried out annually.
In 1993 the HIV prevalence rate among pregnant women was 4.3%. By 1993 the National Health Department reported that the number of recorded HIV infections had increased by 60% in the previous two years and the number was expected to double in 1993.
In August 1995, the Department of Health awarded a R14.27 million contract to produce a sequel to the musical, Sarafina, about AIDS that would reach young people.[25] The project was dogged by controversy, and was finally shelved in 1996.[26]
From 6–10 March 1995, the 7th International Conference for People Living with HIV and AIDS was held in Cape Town, South Africa.[27] The conference was opened by then-Deputy President Thabo Mbeki.[28]
In January 1996 it was decided that South Africa's national soccer team, Bafana-Bafana, would contribute to the AIDS Awareness Campaign by wearing red ribbons to all their public appearances during the African Nations Cup.[29]
On 5 July 1996,[30] South Africa's health minister Nkosazana Zuma spoke at the 11th International Conference on AIDS in Vancouver. She said:
In February 1997, South African government's Health Department defended its support for the controversial AIDS drug Virodene by stating that "the `cocktails' that are available [for the treatment of HIV/AIDS] are way beyond the means of most patients [even from developed countries]".[32] Parliament had previously launched an investigation into the procedural soundness of the clinical trials for the drug.[33]
In 1999 the South African HIV prevention campaign loveLife is founded.
In 2000 the Department of Health outlined a five-year plan to combat AIDS, HIV and STIs. A National AIDS Council (SANAC) was set up to oversee these developments.
The South African government successfully defended against a legal action brought by transnational pharmaceutical companies in April 2001 of a law that would allow cheaper locally-produced medicines, including anti-retrovirals, although the government's roll-out of anti-retrovirals remained generally slow.
In 2001, Right to Care, an NGO dedicated to the prevention and treatment of HIV and associated diseases, was founded. Using USAID's PEPFAR funding, the organisation expanded rapidly and after ten years (2011) had over 125 000 HIV-positive patients in clinical care.
In 2002 South Africa's High Court ordered the government to make the drug nevirapine available to pregnant women to help prevent mother to child transmission of HIV, following campaigns by Treatment Action Campaign and others.
According to the National HIV and Syphilis Antenatal Sero-prevalence Survey of 2005[34] and 2007,[35] the percentage of pregnant women with HIV per year was as follows:
| Year: | 1990 | 1991 | 1992 | 1993 | 1994 | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 |
| Percentage: | 0.7 | 1.7 | 2.2 | 4.0 | 7.6 | 10.4 | 14.2 | 17.0 | 22.8 | 22.4 | 24.5 | 24.8 | 26.5 | 27.9 | 29.5 | 30.2 | 29.1 | 28.0 |
According to a 2006 study by The South African Department of Health, 13.3% of 9,950 Africans that were included in the poll had HIV. Out of 1,173 whites, 0.6% had HIV.[36] These numbers are confirmed in a 2008 study by the Human Sciences Research Council that found a 13.6% infection rate among Africans, 1.7% among Coloreds, 0.3% among Indians and 0.3% among Whites.[37]
In 2007, it was estimated that between 4.9 and 6.6 million of South Africa's 48 million people of all ages were infected with HIV (human immunodeficiency virus), which is the virus that causes AIDS (acquired immunodeficiency syndrome).[38]
On 9 July 2000, Mr Mbeki opened the International AIDS Conference in Durban with a speech not about HIV or AIDS but about extreme poverty in Africa. In the speech, he confirmed his belief that immune deficiency is a big problem in Africa but that one can't possibly attribute all immune deficiency related diseases to a single virus.[39][40]
On 4 September 2000, Thabo Mbeki acknowledged during an interview with Time Magazine (South African edition) that HIV can cause AIDS but confirmed his opinion that HIV should not be regarded as the sole cause of immune deficiency. He said:
On 20 September 2000, Mr Mbeki responded to a question in Parliament about his views. He said:
In 2001 the government appointed a panel of scientists, including a number of AIDS denialists, to report back on the issue. The report suggested alternative treatments for HIV/AIDS, but the South African government responded that unless alternative scientific proof is obtained, it will continue to base its policy on the idea that the cause of AIDS is HIV.[44]
Despite international drug companies offering free or cheap anti-retroviral drugs, the Health Ministry remained hesitant about providing treatment for people living with HIV. Only in November 2003 did the government approve a plan to make anti-retroviral treatment publicly available. Prior to 2003, South Africans with HIV who used the public sector health system could get treatment for opportunistic infections but could not get anti-retrovirals.[36]
The effort to improve treatment of HIV/AIDS was damaged by the attitude of many figures in the government, including President Mbeki. The then health minister, Manto Tshabalala-Msimang, advocated a diet of garlic, olive oil and lemon to cure the disease.[45] Although many scientists and political figures called for her removal, she was not removed from office until Mbeki himself was removed from office.[46]
In August 2007, President Mbeki and Health Minister Tshabalala-Msimang dismissed Deputy Health Minister Nozizwe Madlala-Routledge. Madlala-Routledge has been widely credited by medical professionals and AIDS activists.[47] Although she was officially dismissed for corruption, it was widely held that she was dismissed for her more mainstream beliefs about AIDS and its relation with HIV.[48]
The South African press took a strong advocacy position during the denialism era under Thabo Mbeki.[49][50] There are numerous examples of journalists taking the government to task for policy positions and public statements that were seen as irresponsible.[49] Some of these examples include: attacks on Health Minister Manto Tshabalala-Msimang’s “garlic and potato” approach to treatment,[51] outrage at Mbeki’s statement that he never knew anyone who had died of AIDS,[52] and coverage of the humiliating 2006 Global AIDS Conference.[53]
It could be claimed that the news media have taken a less aggressive stance since the end of Mbeki’s presidency and the death of Tshabalala Msimang. The emergence of Jacob Zuma as party and state leader heralded what the press saw as a new era of AIDS treatment.[54] However, this also means that HIV is afforded less news coverage. A recent study by the HIV/AIDS and the Media Project has shown that the quantity of HIV-related news coverage has declined dramatically from 2002/3 (what could be considered the pinnacle of government denialism) to the more recent “conflict resolution” phase under Zuma. Perhaps HIV has fallen into the traditional categories of being impersonal, undramatic, "old" news.[50] The number of health journalists has also declined considerably.[55]
Nonetheless, quality media coverage of the HIV epidemic remains an essential component to increasing the public’s awareness of the issue, and forms an integral part of any behaviour change drive. It is therefore necessary that media practitioners are well informed of the technicalities, science and ethics of covering HIV, that they have a good network of medical professionals and people living with HIV whom they can access, and that they are committed to ensuring that HIV remains on the public agenda. It is also important that organisations, such as the HIV/AIDS and the Media project,[56] provide a platform for journalists and non-journalists alike to remain informed about the HIV epidemic in these ways.
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