HIV in South Africa

Abstract

More than 1 in 40 young adults in South Africa were estimated to be infected with HIV through the end of 1992. The rate of infection has slowed so that the current doubling time is 16 months; 400 people are nonetheless newly infected daily. HIV and AIDS were first noted among gay White Men in the Cape of South Africa. Education and support from within the gay community, however, prompted the rapid and substantial decrease in the incidence of infection. The 1st evidence of infection among Black heterosexuals was then noted in 1987. It is mainly young adults who are infected, with women affected earlier than and at least as often as men. The arrival of HIV to South Africa and its expected pattern of transmission should have been no surprise to country health policymakers and administrators. Sexually transmitted diseases (STD) facilitate the spread of HIV infection and tuberculosis (TB) fosters the development of AIDS once people are infected with HIV. An estimated 3 million cases of STD present annually in South Africa and almost half of the adult population is infected with quiescent TB. The failure to learn from experiences with HIV in some central and eastern Africa countries simply highlights the extent of poor public health in South Africa. South Africa has the infrastructure and health funding needed to check AIDS, but failed to take action. The central health ministry did not respond to the epidemic until 1990 with the establishment of an AIDS unit, secondary school AIDS prevention programs and packages in 8 languages, a neutral national information campaign, workshops to increase awareness, and funding to organizations targeting hard-to-reach groups. The AIDS unit was soon merged into a health promotion section and the unit's head fired, with all the prevention initiatives terminated except the continued availability of pamphlets in only English and Afrikaans. An official complaint has been made to no avail against the health department official who closed the AIDS campaign. Meanwhile, the government contends that it holds no responsibility for educating its population in the prevention of AIDS. These recent actions suggest that the government is committing genocide by allowing excess mortality from AIDS to decimate Black heterosexuals during the impending period of interim rule and political transition. These observations and conclusions are based in part on the author's experience as medical advisor to South Africa's AIDS unit in 1991/92.