Aids in South Africa

R.W. Johnson

An Aids epidemic is coming to South Africa. The countries with the highest Aids incidence in the world are grouped in East-Central Africa – Burundi, Tanzania, Uganda and Malawi are probably the greatest sufferers of all – and gradually the virus has been making its way southwards. It has indeed been possible to work out South Africa’s ‘HIV prevalence lag time’: nine years behind Burundi, eight behind Tanzania, Uganda and Malawi, seven behind Zaire, Zambia and Rawanda, five behind Kenya and Angola – and so on. South Africa has been protected not only by its position on the continent’s southern tip, but by its social and economic isolation: trade sanctions and the inhibitions on tourism have been an ill wind blowing some good. However, 60 per cent of the world’s Aids victims are to be found in Africa – and there is no prospect of South Africa avoiding the scourge.

What this means is that we shall soon see an epidemic of African proportions raging in a far more highly developed society than any of those so far affected. South Africa is a relatively sophisticated society with levels of medical care and expertise unparalleled elsewhere in Africa and, because the virus is coming to South Africa relatively late, far more is known about its nature, its treatment and its likely economic effects, than was the case when it hit the less developed societies to the north. It is a bit like sitting in an oceanographic laboratory, waiting for a tidal wave to hit – and the evidence suggests that we now have months, not years to wait.

The predominant incidence of the virus has already moved from a relatively restricted ‘ghetto’ of mainly white male gays into the far broader (and mainly black) heterosexual population. Everything we know about that population’s vulnerable health status, its powerful resistance to counsels of sexual abstinence and contraception, and its lack of access both to condoms and to Aids information – suggests that the epidemic cannot possibly be stopped.

How bad will it be? In a paper to a recent conference in Durban on the economic impact of Aids, Jonathan Broomberg, Malcolm Steinberg and Patrick Masobe constructed a complex actuarial model to take into account the fact that the epidemic’s doubling time is likely to slow down as it progresses. In the very early stages the number of adults aged 15-34 who are HIV+ doubles every six months – a rate seen in South Africa in 1986. But the doubling time should rise to 14 months in 1991, 16 months in 1992, and so on up to a plateau level of 34 months in 1995. By that point nearly 1.6 million people will have the virus, but the incubation period of up to ten years means that the cumulative total of Aids deaths will be only 47,000. Thereafter, say Broomberg et al, the snowball effect will really begin to tell. For 2000 they predict 5.2 million HIV+ cases and 666,000 cumulative Aids deaths; for 2005 7.4m HIV+ cases and 2.9m deaths, and for 2010 8.2m HIV+ cases and 6.6m cumulative deaths. It is worth noting how, in the mature period of the epidemic, the fatality rate catches and even passes the infection rate. That is, between 2005 and 2010 the number of HIV+ cases increases by less than 1.2m, but more than 3.6m extra Aids deaths occur in the same five-year period because by then a really large ‘backlog’ of HIV+ cases has been built up.

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