A catastrophe in the 21st century: the public health situation in South Africa following HIV/AIDS

Abstract

During the early 1900s, African populations in South Africa were subject to very widespread infections which especially affected the young. This resulted in high mortality rates and a low life expectancy of 20-25 years. By the mid-century, mortality rates from infections had decreased considerably. Moreover, the occurrences of non-communicable diseases, even in urban areas, remained very low. In the 1970s, the proportion of Africans aged 50 or over that reached 70 years was 38.5%, higher than that in the juxtaposed white population, which was 35.5%. And by 1985, the life expectancy of Africans reached 61 years for males and 63 years for females, probably the highest in sub-Saharan African populations. Since then, however, the African continent has been devastated by the AIDS epidemic. In 2001, HIV was responsible for the death of a third of the African population in South Africa, but even higher proportions prevailed in Botswana and in Tanzania. The calamitous advent of the HIV infection has caused major falls in life expectancy, in the case of Africans in South Africa reducing this to just 43 years. With little hope of meaningful changes occurring in sexual habits or of an early vaccine becoming available, the infection's high morbidity/mortality burden is likely to continue.