HIV Infection In South Africa Research Articles

Screening for acute HIV infection in South Africa: finding acute and chronic disease*

The yield of screening for acute HIV infection among general medical patients in resource-scarce settings remains unclear. Our objective was to evaluate the strategy of using pooled HIV plasma RNA to diagnose acute HIV infection in patients with negative or discordant rapid HIV antibody tests in Durban, South Africa. We prospectively enrolled patients with negative or discordant rapid HIV antibody tests from a routine HIV screening programme in an out-patient department in Durban with an HIV prevalence of 48%. Study participants underwent venipuncture for pooled qualitative HIV RNA, and, if this was positive, quantitative RNA, enzyme immunoassay and Western blot (WB). Patients with negative or indeterminate WB and positive quantitative HIV RNA were considered acutely infected. Those with chronic infection (positive RNA and WB) despite negative or discordant rapid HIV tests were considered to have had false negative rapid antibody tests. Nine hundred and ninety-four participants were enrolled with either negative (n=976) or discordant (n=18) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6-2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3-3.1%) had chronic HIV infection (false negative rapid test). One per cent of out-patients with negative or discordant rapid HIV tests in Durban, South Africa had acute HIV infection readily detectable through pooled serum HIV RNA screening. Pooled RNA testing also identified an additional 2% of patients with chronic HIV infection. HIV RNA screening has the potential to identify both acute and chronic HIV infections that are otherwise missed by standard HIV testing algorithms.

Continued High Risk Sexual Behavior Following Diagnosis with Acute HIV Infection in South Africa and Malawi: Implications for Prevention

Understanding sexual behavior following diagnosis of acute HIV infection (AHI) is key to developing prevention programs targeting individuals diagnosed with AHI. We conducted separate qualitative and quantitative interviews with individuals newly diagnosed (n=19) with AHI at 1-, 4- and 12-weeks post-diagnosis and one qualitative interview with individuals who had previously been diagnosed with AHI (n=18) in Lilongwe, Malawi and Johannesburg, South Africa between October 2007 and June 2008. The majority of participants reported engaging in sexual activity following diagnosis with AHI with a significant minority reporting unprotected sex during this time. Most participants perceived to have changed their behavior following diagnosis. However, participants reported barriers to condom use and abstinence, in particular, long term relationships and the need for disclosure of sero-status. Understanding of increased infectiousness during AHI was limited. Participants reported a desire for a behavioral intervention at the time of AHI diagnosis, however, there were differences by country in the types of interventions participants found acceptable. Studies are underway to determine the feasibility, acceptability and potential effectiveness of interventions designed for individuals with AHI.

Effect of CD4+ lymphocyte count, viral load, and duration of taking antiretroviral treatment on presence of oral lesions in a sample of South African children with HIV+/AIDS

This was to determine the presence and types of oral mucosal lesions in a sample of HIV(+)/AIDS South African children taking antiretroviral therapy and to investigate the relationship between CD4(+) lymphocyte counts, viral load, duration of taking antiretroviral therapy (DART), and age on presence of oral lesions. The samples consisted of 56 South African children aged 0-4 years (mean age =7.09 years) with HIV(+)/AID, infected at birth. Subjects were divided into two groups according to the presence of oral lesions with test group (patients with oral lesions) and control group (patients with no oral lesions). Children were also divided into two groups, those <6 years and those >6 years old to study the effect of age on presence of lesions. Oral Candidiasis was the most common lesion reported in 19/56 children, followed by Recurrent Herpetic Infection in 9 children. Other lesions such as Kaposi's sarcoma, Multifocal Epithelial Hyperplasia, Oral Hairy Leukoplakia, Linear Gingival Erythema, and oral ulceration were also present. A statistical significant difference in CD4(+) lymphocyte count (p value 0.005), and viral load (p value 0.002) was found between the oral lesion and no oral lesion groups, those with oral lesions having a significantly higher viral load and lower CD4+ count. No statisticaly significant difference between the two groups in terms of the DART effect (p value 0.811) was found. Furthermore, there was no effect of age groups on the presence of lesions in children with HIV(+)/AIDS. This study contributes to the relatively scant literature on the prevalence of oral lesions in children with HIV infection in South Africa and also the relationship of these lesions to the viral load and CD4(+) lymphocyte counts.

A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008

BackgroundThree national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use.Methods and Principal FindingsWe used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated “excess” HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2–3.0/100pyar). The highest incidence rate was among 15–24 year-old women, at 5.5/100pyar (4.5–6.5). In the period 2005–2008, incidence among men and women aged 15–49 was estimated to be 1.3/100 (0.6–2.5/100pyar), although the change from 2002–2005 was not statistically significant. However, the incidence rate among young women aged 15–24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth.ConclusionsOur analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.

Gender and Poverty in South Africa in the Era of HIV/AIDS: A Quantitative Study

Recent research identifies gender inequality as a driver of the HIV/AIDS epidemic. The feminization of poverty is also increasingly apparent, as is the disproportionate vulnerability of members of female-headed households. We sought to examine the relationships among sex, gender, age, HIV status, and socioeconomic characteristics, focusing on heads and nonheads of households. We interviewed 6,338 men and 10,057 women. Significantly more males (51.4%) than females (34.8%) indicated that they were heads of households (p < 0.001). Female heads of households were significantly more likely to be infected with HIV than their male counterparts (17.9% vs. 13.1%). Among 15-24-year-old males, those who are often without cash are more likely to be infected with HIV than those who are never without cash (OR = 3.33, 95% CI 1.17-9.49). Similar results were observed among females, who sometimes had no cash (OR = 1.86, 95% CI 1.22-2.82), and among adults aged >or=25 years. Results confirmed that age and gender are related to HIV infection in South Africa and that poverty is a social determinant for HIV infection across all age groups. However, sex is a determinant only among the younger age groups. Young female heads of household are more likely to be poor and are more likely to be HIV positive. The results indicate that the HIV/AIDS epidemic in South Africa is characterized by gender inequalities. Young women are more likely to be HIV infected, especially heads of households. Young women are also more likely to live in poverty, although this study cannot establish the directionality of a causative relationship between poverty and risk of HIV. Greater attention must be paid to young women, especially those who head households, in terms of treatment, prevention, and poverty alleviation.

High Incidence of Transfusion-Related HIV Infection in Nigeria

There is a high incidence of transfusion related HIV infection in Nigeria. This was evident in our pilot study that indicated that the incidence was 1.2% in a teaching hospital in Enugu. In this article, we discuss several possible reasons for the high incidence of transfusion related HIV infections in the Enugu hospital. Firstly, most donors were paid. There was no structured questionnaire to identify populations at risk and to increase self-awareness of the risk of HIV infection. Even if a donor were concerned about having a HIV infection, there was no mechanism for self-deferral. Donated blood was screened only by an ELISA, a test that usually does not detect HIV if contracted within 90 days prior to testing. To control transfusion related HIV infection, the National Blood Transfusion Service (NBTS) was established in 2005, and a National Blood Policy was developed in 2006. Seventeen blood transfusion centers have been set up with support from the private sector, the United States Presidential Emergency Plan for AIDS Relief (PEPFAR), the Safe Blood for Africa (SFA) and the Center for Disease Control (CDC). The goals were: 1) to actively change attitudes to encourage voluntary non-paid donations; 2) to develop and use questionnaires to identify individuals and populations at risk for HIV and to increase self-awareness of the risk for HIV; 3) to introduce mechanisms for self-deferral; 4) to screen blood with antigen testing in addition to the ELISA to detect new HIV infections contracted within16 days prior to testing. An ELISA alone only detects HIV contracted 90 days prior to donation. Despite the regulations introduced by the NTBS, the incidence of HIV infected blood in blood banks is still high There are multiple reasons for the continued high incidence of transfusion related HIV infections in Nigeria, which includes high endemic incidence of HIV. Another reason is that most donors are still being paid. In teaching hospitals in Nigeria in 2009, about 75% of donors are still paid for donations. The guidelines outlined by NTBS have not been widely implemented. There are an insufficient number of established safe transfusion centers to meet the country’s need for safe blood. Although the government administers public health, the private sector accounts for about 70% of all the health facilities in the country. According to the Nigeria National Blood Transfusion Service, more than 80% of blood collected and transfused in Nigerian hospitals is not properly screened The donor deferral option has not been widely implemented. The ELISA is still the only test used to screen donated blood for HIV. Unfortunately, there is a lack of political will to regulate adequately the screening of donors for infections. An examples of successful reduction of transfusion-related HIV infection in South Africa is discussed that could serve as a role model for addressing this problem in Nigeria.

Can Oral Fluid Testing Be Used to Replace Blood-Based HIV Rapid Testing to Improve Access to Diagnosis in South Africa?

Can Oral Fluid Testing Be Used to Replace Blood-Based HIV Rapid Testing to Improve Access to Diagnosis in South Africa?

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients ( N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 ( SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 ( SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated ( r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60–8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers ( p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers ( p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Meeting the challenges of the Ottawa Charter: comparing South African responses to AIDS and tobacco control

The paper compares the response of the South African Government to HIV and AIDS with the government's policy development concerning the use of tobacco. The high burden of disease from HIV and AIDS in South Africa and the morbidity and mortality from the use of tobacco are outlined. Using the framework of the Ottawa Charter for Health Promotion, the paper reviews and critiques the Government's different stance to building public policy, creating supportive environments, engaging community participation, developing personal skills and re-orienting the health services, for HIV/AIDS and tobacco. The result of these policy choices is described. The lack of adequate implementation of the key elements of the Ottawa Charter has resulted in high morbidity and mortality due to the spread of HIV infection in South Africa. This has also influenced the resurgence of tuberculosis, and the accompanying MDR and XDR TB epidemics. The high prevalence of HIV infection has also meant that the health system is unable to cope with the large numbers of patients requiring anti-retroviral treatment, and the early morbidity and mortality of young economically active people has had devastating social consequences, resulting in the large numbers of orphans. In contrast, South Africa is a signatory to the World Health Organizations' Framework Convention on Tobacco Control, and has successfully implemented many of the policies.

Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002.

To investigate the nature of male circumcision and its relationship to HIV infection. Analysis of a sub-sample of 3 025 men aged 15 years and older who participated in the first national population-based survey on HIV/AIDS in 2002. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model. One-third of the men (35.3%) were circumcised. The factors strongly associated with circumcision were age > 50, black living in rural areas and speaking SePedi (71.2%) or IsiXhosa (64.3%). The median age was significantly older for blacks (18 years) compared with other racial groups (3.5 years), p < 0.001. Among blacks, circumcisions were mainly conducted outside hospital settings. In 40.5% of subjects, circumcision took place after sexual debut; two-thirds of the men circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% HIV positive in the circumcised group v. 12% HIV positive in the uncircumcised group). HIV was, however, significantly lower in men circumcised before 12 years of age (6.8%) than in those circumcised after 12 years of age (13.5%, p = 0.02). When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% v. 13.6%, p = 0.08.). There was no effect when adjusted for possible confounding. Circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy.

Disclosure of Maternal HIV-Infection in South Africa: Description and Relationship to Child Functioning

South Africa has one of the highest HIV-infection rates in the world, yet few studies have examined disclosure of maternal HIV status and its influence on children. This study provides descriptive information about HIV disclosure among South African mothers and explores whether family context variables interact with maternal HIV disclosure to affect children's functioning. A total of 103 mothers, who self-identified as living with HIV and who were the primary caregivers of a child between the ages of 11 and 16, were interviewed. A total of 44% of mothers had disclosed, and those who had most typically perceived children's reactions to disclosure to be sadness and worry. Widows and married mothers were more likely than single mothers to disclose their HIV status. Disclosure to children significantly predicted externalizing, but not internalizing, behaviors. Family variables had direct but not interactive effects on child functioning. This study highlights the complexity of disclosure-related decisions and the importance of addressing the family context.

The role of pregnancy intention in HIV prevention in South Africa: a proposed model for policy and practice

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural, behavioural, environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore, understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy, prevention of transmission of HIV, protection of the infant, and protection of the mother.

Establishing a Cohort at High Risk of HIV Infection in South Africa: Challenges and Experiences of the CAPRISA 002 Acute Infection Study

ObjectivesTo describe the baseline demographic data, clinical characteristics and HIV-incidence rates of a cohort at high risk for HIV infection in South Africa as well as the challenges experienced in establishing and maintaining the cohort.Methodology/Principle FindingsBetween August 2004 and May 2005 a cohort of HIV-uninfected women was established for the CAPRISA 002 Acute Infection Study, a natural history study of HIV-1 subtype C infection. Volunteers were identified through peer-outreach. The cohort was followed monthly to determine HIV infection rates and clinical presentation of early HIV infection. Risk reduction counselling and male and female condoms were provided. After screening 775 individuals, a cohort of 245 uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9% to 62.8%) posing a challenge in accruing HIV-uninfected women. The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. Most women (95%) reported more than one casual sexual partner in the previous 3 months (excluding clients) and 58.8% reported condom use in their last sexual encounter. Based on laboratory testing, 62.0% had a sexually transmitted infection at baseline. During 390 person-years of follow-up, 28 infections occurred yielding seroincidence rate of 7.2 (95% CI: 4.5 to 9.8) per 100 person-years. Despite the high mobility of this sex worker cohort retention rate after 2 years was 86.1%. High co-morbidity created challenges for ancillary care provision, both in terms of human and financial resources.Conclusions/SignificanceChallenges experienced were high baseline HIV-prevalence, lower than anticipated HIV-incidence and difficulties retaining participants. Despite challenges, we have successfully accrued this cohort of HIV-uninfected women with favourable retention, enabling us to study the natural history of HIV-1 during acute HIV-infection. Our experiences provide lessons for others establishing similar cohorts, which will be key for advancing the vaccine and prevention research agenda in resource-constrained settings.

Patients with severe mental illness: a new approach to testing for HIV.

The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients.

In Their Own Voices

This study qualitatively examines the intersections of risk for intimate partner violence (IPV) and HIV infection in South Africa. Eighteen women seeking services for relationship violence were asked semistructured questions regarding their abusive experiences and HIV risk. Participants had experienced myriad forms of abuse, which reinforced each other to create a climate that sustained abuse and multiplied HIV risk. Male partners having multiple concurrent sexual relationships, and poor relationship communication compounded female vulnerability to HIV and abuse. A social environment of silence, male power, and economic constraints enabled abuse to continue. "Breaking the silence" and women's empowerment were suggested solutions.

Variability of Airborne Transmission of Mycobacterium tuberculosis: Implications for Control of Tuberculosis in the HIV Era

The recent collision of extensively drugresistant (XDR) tuberculosis with HIV infection in South Africa created an outbreak of tuberculosis with a 98% mortality rate and raised the specter of untreatable tuberculosis. Most of these cases of XDR tuberculosis were probably a result of nosocomial transmission because two-thirds of the patients had been recently hospitalized prior to the onset of tuberculosis and at least 2 health care workers died. A World Health Organization Global Task Force on XDR tuberculosis recommended several interventions including accelerated implementation of infection-control measures to reduce transmission and strategies that promote prevention and control of XDR tuberculosis. In this context the article by Escombe et al. in this issue of Clinical Infectious Diseases could not be more relevant. At first glance it might seem that studies of guinea pigs regarding airborne transmission of pulmonary tuberculosis could offer nothing new. Less than 2 decades after Kochs elegant demonstration of Mycobacterium tuberculosis as the etiologic agent of tuberculosis in 1882 Flugge infected guinea pigs by having patients with tuberculosis cough on them. His logical but erroneous interpretation was that tuberculosis was transmitted by large respiratory droplets. Less than 50 years ago Wells his protege´ Richard Riley and their coinvestigators convinced the world that M. tuberculosis is transmitted by the airborne route. To do so they developed a model of guinea pigs in a penthouse exposed to the air exhausted from an experimental tuberculosis ward which was reproduced by Escombe et al.. When I had the pleasure of meeting Richard Riley several years before his death he thought that his work would probably never be reproduced because of its complexity and expense. Escombe and his team are to be congratulated for proving Riley wrong about this. (excerpt)

Prospective study of hormonal contraception and women's risk of HIV infection in South Africa

Many women using hormonal contraceptives are also at risk of sexually transmitted HIV infection, but data are mixed on whether hormonal contraception increases women's risk of HIV. We investigated associations between HIV incidence and use of combined oral contraceptives (COC), norethindrone enanthate (NET-EN) or depot medroxyprogesterone acetate (DMPA) in a cohort of South African women. Participants were 4200 HIV-negative women aged 35-49 years enrolled into a cervical cancer screening trial. At enrollment, women were tested for sexually transmitted infections and reported on their sexual behaviour and contraceptive use. During the 24 months of follow-up, women reported on their sexual behaviours and contraceptive use and underwent repeat HIV testing. During the 5010 person-years of follow-up, 111 incident HIV infections were observed (HIV incidence, 2.2 infections/100 person-years). At enrollment, 21% of women reported using hormonal contraception, primarily DMPA (14% of all women) or NET-EN (5%). After adjusting for sexual risk behaviours and sexually transmitted infections, the incidence of HIV was similar among women using COC, NET-EN or DMPA compared with women not using any hormonal method [incidence rate ratios and 95% confidence intervals, 0.65, 0.16-2.66; 0.79, 0.31-2.02 and 0.96, 0.58-1.59, respectively]. There was also no association between increased duration of DMPA use and HIV incidence (P-value for trend, 0.51). These findings contribute to the evidence from general population cohorts of women that hormonal contraceptive use is not associated with increased risk of HIV acquisition. Nonetheless, family planning services are an important venue for HIV prevention activities.

Marital status and risk of HIV infection in South Africa.

Available evidence on the relationship between marital status and HIV is contradictory. The objective of this study was to determine HIV prevalence among married people and to identify potential risk factors for HIV infection related to marital status in South Africa. A multistage probability sample involving 6 090 male and female respondents, aged 15 years or older was selected. The sample was representative of the South African population by age, race, province and type of living area, e.g. urban formal, urban informal, etc. Oral fluid specimens were collected to determine HIV status. A detailed questionnaire eliciting information on socio-demographic, sex behaviour and biomedical factors was administered through face-to-face interviews from May to September 2002. HIV prevalence among married people was 10.5% compared with 15.7% among unmarried people (p-value < 0.001). The risk of HIV infection did not differ significantly between married and unmarried people (odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.71 - 1.02) when age, sex, socio-economic status, race, type of locality, and diagnosis of a sexually transmitted infection (STI) were included in the logistical regression model. However, the risk of HIV infection remained significantly high among unmarried compared with married people when only sex behaviour factors were controlled for in the model (OR 0.55; 95% CI: 0.47 - 0.66). The relationship between marital status and HIV is complex. The risk depends on various demographic factors and sex behaviour practices. Increased prevention strategies that take socio-cultural context into account are needed for married people.

The evolving HIV epidemic in South Africa.

This paper traces the evolution of the HIV epidemic in South Africa placing it in historical context including an insiders view of the national response to it. It was noted that the first case of HIV infection in South Africa was reported in 1982 which heralded the start of the first wave of HIV epidemic. The epidemic was limited to the gay community blood transfusion recipients and hemophiliacs. However the Apartheid regime in South Africa saw the HIV epidemic as a problem in Blacks or gays that is not seen as a priority deserving of serious attention. Similarly as late as 1989 the progressive anti- Apartheid movement was more concerned with dealing with the immediacy of liberating the country than the possibility of a future AIDS threat. In 1990 Chris Hani chief of the ANC promoted the importance in addressing the AIDS epidemic in the country. Unfortunately before democracy was achieved Hani was tragically assassinated. Since political liberation in 1994 many have commented on what went wrong with the campaign of curbing the epidemic. It was noted that the historic change achieved by liberation forces was not harnessed to confront the epidemic and the prophetic words of Hani went unheeded. Hence it is suggested that the campaign must be continued to bring the epidemic under control.

Denial and defiance: a socio-political analysis of AIDS in South Africa.

Denial and defiance: a socio-political analysis of AIDS in South Africa.