The AIDS Epidemic in South Africa

In South Africa, which has the largest number of HIV infections in the world (5.5 million), an estimated 1.8 million people have died of AIDS-related disease since the epidemic began.

With an estimated 5.5 million [4.9 million–6.1 million] people living with HIV (UNAIDS, 2006), South Africa is the country with the largest number of infections in the world. The country’s Department of Health estimates that 18.3% of adults (15–49 years) were living with HIV in 2006 (Department of Health South Africa, 2007). More than half (55%) of all South Africans infected with HIV reside in the KwaZulu-Natal and Gauteng provinces (Dorrington et al., 2006).

The latest HIV data collected at antenatal clinics suggest that HIV infection levels might be leveling off, with HIV prevalence in pregnant women at 30% in 2005 and 29% in 2006 (Department of Health South Africa, 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. The consistently high and rising prevalence among older antenatal clinic attendees is a concern that needs further investigation.

The epidemic varies considerably between provinces. HIV prevalence among pregnant women is highest in the populous KwaZulu-Natal province (39%), and lowest in the Northern Cape (15%), Western Cape (16%) and Limpopo (19%) provinces. In the five other provinces (Eastern Cape, Free State, Gauteng, Mpumalanga and North West) at least 25% of women attending antenatal clinics in 2006 tested HIV-positive (Department of Health South Africa, 2007). There is also variation within provinces and populations. For example, in the Northern Cape, average prevalence among pregnant women ranged from 5% at clinics in one district to almost 23% in another, while in the province of Limpopo it varied from 14% to 28%, depending on the district. Similarly, although only 9% of South Africa’s population aged 2 years and over live in urban informal settlements, 29% of people living with HIV are found in these areas (Rehle et al., 2007).

Grandmother left to care for grand- child <-------- Patient receiving Hospice care               ---------->

Very high prevalence has been found in parts of KwaZulu-Natal. For example, in Amajuba district, 47% of women attending antenatal clinics tested positive in 2006 (Department of Health South Africa, 2007), as did 51% of women aged 25–29 years who participated in an earlier household-based HIV survey in the rural district of Umkhanyakude (Welz et al., 2007). In another study, in a rural district in the north of the same province, HIV incidence of 8% was found in men and women aged 25–29 years. On current trends, and in the absence of effective programs, it is estimated that two thirds of the 15-year-olds in that district could be infected with HIV by the time they reach their 35th birthday (Barnighausen et al., 2007).

Young women in South Africa face greater risks of becoming infected than men. Indeed, among 15–24-year-olds, women account for about 90% of new HIV infections (Rehle et al., 2007). HIV incidence among 20–29-year-old women in 2005 was approximately 5.6%, more than six times higher than for men of the same ages (0.9%) (Rehle et al., 2007).  However, high HIV incidence is being found also in men towards the upper end of this age group: in a northern KwaZulu-Natal study, an estimated 8.8% of men aged 24–29 years had been infected in the previous year (Barnighausen et al., 2007).

An estimated 1.8 million South Africans have died from AIDS-related disease since the epidemic began (Dorrington et al., 2006). Total annual deaths (from all causes) increased by 87% from 1997 to 2005 (from 316 505 to 591 213) (Statistics South Africa, 2005 & 2006), with at least 40% of those deaths estimated to have been AIDS-related (Bradshaw et al., 2004; Actuarial Society of South Africa, 2005; Medical Research Council, 2005; Anderson & Phillips, 2006). Rising death rates lowered life expectancy at birth to 49 years for males and 52.5 years for females in 2006, and have probably contributed to the decline in the country’s population growth rate from 1.25% in 2001–2002 to slightly more than 1% in 2005–2006 (Statistics South Africa, 2007).