Well guys its been some time now since I have done an update and will update you shortly about the past year. I have access now to update this blog and am in the process in creating a new blog which I will link with this one.
We are celebrating XMAS a special time of the year. I just wanted to wish you all a Merry Xmas and happy 2007!
love Mark
The first week of work was great. I was doing a presentation on living
with HIV for a company and the results where great! I am currently on
a planning committee with the Tygerberg Department Of Health in
regards to HIV support groups and VCT.
I will also be doing courses to increase my knowledge base to offer a
better service. I am an independent consultant and liaise with the
dept of health to assist them and the day hospitals.
I am outsourced to other companies and that is how I am paid. Not
every week but at least this is a start.
I will soon be on Tygerberg Radio and will let you guys know when. My
cell phone is damaged due to old age and does not work to well. So
guys if you have an old cell phone let me know.
I am still a servant to the nation and will always be that's just me.
Still need a laptop to do presentations as taking my whole pc is a bit
too much sometimes, so if you do have a second hand one pls let me
know.
I have been asked to speak at various church groups over the next few
Sundays and that will be great. Furthermore, I will be at a function
coming up in September and will be a guest speaker.
So guys things are looking up\
May God bless you all
Love
Humbly your servant and servant to the nation
--
Mark Farrell "The Rose Of Life"
Mobile 27 76 280 2833
Living just not for myself but for all those affected and infected by
the HIV/AIDS pandemic
Building a better future of communication
Guys I dont want you ever to surrender to anything in life, but if you
know of any work out there or someone who will sponsor me if I do go
to college to study HIV management and other courses and serve my
community, please mail me at 81 Fitzroy Street, Goodwoood, 7460, South
Africa , Cape Town
If you know of any work available also pls advise me. I have to have
an income and work brings income.
Till we meet again, may you be blessed in all that you do
Humbly yours
Mark Farrell
Not living for myself but for all those affected and infected by HIV/AIDS
Hi guys its been some time since I could do an update. Currently, I
have been to many many interiews and they either dont bother to come
back to you or just quote the equity quota. Its very frustrating since
I have still not resolved the first two issues my previous employer
who paid a lumpsum but the labour consultant turned out to be a fraud
and the legal company he was freelanceing for wont take responsibility
for his actions. After providing the original documents from the
Reciever Of Revenue (Tax) receipts I still have no resolve. I have to
rely on the goodness of my dad.
However I am doing volunteer work for HIV+ support groups and the
local day hosp and Tygerberg region. I am still going for interviews
on a daily basis but am so tired of walking km.s per day to no avail.
but you guys know me by now that I am a fighter and will not give up
at any cost.
Life is wonderful and I know that this is a trying period for me. I
have the flu but that has not stopped me from looking for work. My
cell phone is bust for those who have been trying to get hold of me.
No money to replace or have it repaired at the moment.
I am just very tired but I will never give up!
My home number is 0215917666 or 27215917666 if you would like to talk to me.
--
Mark Farrell "The Rose Of Life"
Mobile 27 76 280 2833
Living just not for myself but for all those affected and infected by
the HIV/AIDS pandemic
Building a better future of communication
As you know its been an uphill battle against the Department Of
Labour, the passing of my life partner and this year, my labour
consultant who ran off with my settlement.
Well that was the bad year past, now I have the opportunity to start
work on Monday after many months of suffering and pain.
I can only give thanks to the creator for His counsel and wisdom and
that he has given me the strength to carry on until now.
Also, without your support I would not have made it and that is very
important to me. Of course I cant go to France and be with Lal and
assist him due to all the past happenings.
I trust and pray that all will go well as from Monday and that my
dignity is restored.
My pledge still remains until death, that I do not live for myself but
for all those affected and infected by the pandemic.
I will be hard at work writing "The Rose Of Life" which some of the
poems you have already read on my personal blog. But, my aim is to
complete the book by next year so that it can enhance and inspire all
those who are suffering from the pandemic
I will always remain the servant of mankind
Humbly yours
Mark Farrell
--
Mark Farrell "The Rose Of Life"
Mobile 27 76 280 2833
Living just not for myself but for all those affected and infected by
the HIV/AIDS pandemic
Building a better future of communication
Dear Friends, I would like to take the oppertunity to thank all of
you for all that you are doing for me. There is so much to tell you
and I will be updating you soon. My personal journal I will publish
soon and may it encourage and empower all. My thanks to all my friends
in Germany, Sweden, South Africa,United Kingdom, Ireland, Denmark and
France. Without your help and constructive and practicle assistance I
could not have made it. Once again thank you and thanks to all who
are making all of this possible. Regards, Mark --
Mark Farrell "The Rose Of Life"
Mobile 27 76 280 2833
Living just not for myself but for all those affected and infected by
the HIV/AIDS pandemic
Building a better future of communication
French
De chers amis, je voudrais prendre l'oppertunity pour remercier tout
le vous de tous ce que vous faites pour moi. Il y doit tellement dire
de vous qu'et je vous mettrai à jour bientôt. Mon journal personnel
que j'éditerai bientôt et puis il encourager et autoriser tous. Mes
mercis à tous mes amis en l'Allemagne, la Suède, l'Afrique du Sud, le
royaume uni, l'Irlande, le Danemark et France. Sans votre aide et
aide constructive et de practicle je ne pourrais pas l'avoir faite.
Remerciez de nouveau vous et les mercis à tous ce qui rendent tous de
ceci possibles. Respect, marque -- marquez Farrell "Rose le mobile 27
de vie" 76 280 2833 vivant juste pas pour me mais pour le tout ceux
affectés et infectés par le bâtiment pandemic de HIV/aids par meilleur
futur de communication
German
Liebe Freunde, möchte ich das oppertunity nehmen, um den ganzen Ihnen
für alle zu danken, die Sie für mich tun. Es soll soviel Ihnen
erklären daß und ich Sie bald aktualisieren werde. Mein persönliches
Journal, das ich bald veröffentliche und es alle anregen und
bevollmächtigen kann. Mein Dank aller meiner Freunde in Deutschland,
in Schweden, in Südafrika, in vereinigtem Königreich, in Irland, in
Dänemark und in Frankreich. Ohne Ihre Hilfe und konstruktive und
practicleunterstützung könnte ich nicht sie gebildet haben. Danken
Sie noch einmal Ihnen und Dank aller, die alle von diesem ermöglichen.
Respekt, Markierung -- kennzeichnen Sie Farrell "die Rose des Lebens"
Mobile 27 76 280 2833 lebend gerade nicht für mich aber für alles die,
die durch das pandemic Gebäude HIV/AIDS ein bessere Zukunft der
Kommunikation beeinflußt werden und angesteckt sind
Italian
Cari amici, vorrei prendere il oppertunity per ringraziarlo per tutti
che stiate facendo per me. Ci deve così tanto dirvi che e li aggiorni
presto. Il mio giornale che personale pubblicherò presto e che posso
esso consigliare ed autorizzare a tutti. I miei ringraziamenti a
tutti gli miei amici in Germania, in Svezia, in Africa del sud, il
regno unito, in Irlanda, in Danimarca ed in Francia. Senza vostri
aiuto ed assistenza del practicle e costruttiva non potrei farlo.
Ancora una volta ringrazi voi ed i ringraziamenti a tutti che stiano
permettendo tutti di questo. Riguardi, contrassegno -- contrassegni
Farrell "la Rosa mobile 27 di vita" 76 280 2833 che vive appena non
per me ma per il tutto quelli influenzati ed infettati dalla
costruzione pandemic di HIV/aids un il futuro migliore della
comunicazione
The statistics discussed here come from two prevalence studies that estimate how many South Africans have HIV, and two reports on AIDS deaths. Viewed together these sources give an idea of the scale of South Africa's HIV epidemic. If you are looking for statistics from elsewhere, try our statistics index.
The first section is based on the report of the Department of Health "National HIV and Syphilis Sero-prevalence Survey in South Africa 2004", published in 2005. This is the 15th in a series of annual studies which look at data from antenatal clinics and use it to estimate HIV prevalence amongst pregnant women. The report also contains an estimate of the total number of people living with HIV in South Africa, derived from the antenatal data using a simple mathematical model.
The second section is based on the report of the "South African National HIV Prevalence, HIV Incidence, Behaviour and Communiaction Survey, 2005". In this survey, a sample of people were chosen to represent the general population, 55% of whom agreed to give a blood sample to be anonymously tested for HIV. The report contains estimates of HIV prevalence in various groups of people, derived from this general population sample.
Seen together, the two prevalence studies provide a clearer picture of the South African epidemic than either of them viewed alone.
The third section looks at AIDS-related deaths using data from death certificates. The report "Mortality and causes of death in South Africa, 1997-2003" contains the raw data, while the article "Identifying deaths from AIDS in South Africa" analyses a large sample of death certificates and attempts to estimate how many deaths caused by HIV have been misclassified.
The page goes on to compare the two prevalence studies and to draw conclusions.
Based on its sample of more than 16,000 women attending antenatal clinics across all nine provinces, the South African Department of Health Study estimates that 29.5% of pregnant women were living with HIV in 2004. The provinces which recorded the highest HIV rates were KwaZulu-Natal, Gauteng and Mpumalanga.
Until 1998 South Africa had one of the fastest expanding epidemics in the world, but HIV prevalence is now growing more slowly. Among teenage girls, the rate declined from 1998 to 2002, and has since risen only slightly. The full set of annual national prevalence figures can be found in our South Africa page.
| Province | 2000 prevalence % | 2001 prevalence % | 2002 prevalence % | 2003 prevalence % | 2004 prevalence % |
| KwaZulu-Natal | 36.2 | 33.5 | 36.5 | 37.5 | 40.7 |
| Gauteng | 29.4 | 29.8 | 31.6 | 29.6 | 33.1 |
| Mpumalanga | 29.7 | 29.2 | 28.6 | 32.6 | 30.8 |
| Free State | 27.9 | 30.1 | 28.8 | 30.1 | 29.5 |
| Eastern Cape | 20.2 | 21.7 | 23.6 | 27.1 | 28.0 |
| North West | 22.9 | 25.2 | 26.2 | 29.9 | 26.7 |
| Limpopo | 13.2 | 14.5 | 15.6 | 17.5 | 19.3 |
| Northern Cape | 11.2 | 15.9 | 15.1 | 16.7 | 17.6 |
| Western Cape | 8.7 | 8.6 | 12.4 | 13.1 | 15.4 |
| National | 24.5 | 24.8 | 26.5 | 27.9 | 29.5 |
| Age group (years) | 2000 prevalence % | 2001 prevalence % | 2002 prevalence % | 2003 prevalence % | 2004 prevalence % |
| <20 | 16.1 | 15.4 | 14.8 | 15.8 | 16.1 |
| 20-24 | 29.1 | 28.4 | 29.1 | 30.3 | 30.8 |
| 25-29 | 30.6 | 31.4 | 34.5 | 35.4 | 38.5 |
| 30-34 | 23.3 | 25.6 | 29.5 | 30.9 | 34.4 |
| 35-39 | 15.8 | 19.3 | 19.8 | 23.4 | 24.5 |
| 40+ | 11.0 | 9.8 | 17.2 | 15.8 | 17.5 |
Because infection rates vary between different groups of people, the findings from antenatal clinics cannot be applied directly to men, newborn babies and children. However, some simple calculations can yield an approximate estimate of the total number of people living with HIV in South Africa.
Based on the antenatal data, the study estimates that 6.29 million South Africans were living with HIV at the end of 2004, including 3.3 million women and 104,863 babies. In producing these figures, it is assumed that pregnant women accurately represented all women aged 15-49 years, that men are 85% as likely to be infected as women, and that 30% of babies born to infected mothers will themselves have HIV (ignoring any reductions due to preventive action).
The National HIV Survey is a "household" survey. This involves sampling a proportional cross-section of society, including a large number of people from each geographical, racial and other social group. The researchers take great pains to try to make the sample as generalised as possible, and the findings are later adjusted to correct for likely over- or under-representation of individual groups (according to census data).
The survey's fieldworkers visited 12,581 households across South Africa, of which 10,584 (84%) took part in the survey. Of the 24,236 people within these households who were eligible to take part, 23,275 (96%) agreed to be interviewed and 15,851 (65%) agreed to take an HIV test. This means that only 55% of eligible people were tested.
The main reasons given for refusing HIV testing were fear of having a blood sample taken (58%); religious objections to having a blood sample taken (16%) and not wanting to learn HIV status (7%). A further 13% of people who refused were, for various reasons, afraid or mistrustful of the survey. The report of the survey claims that people at high risk for HIV infection were more likely to take part in the survey. The results were adjusted to compensate for this perceived bias.
The response rate is considered "good" by the standards of this type of survey, but is considerably lower than that found in other parts of sub-Saharan Africa.1 White people and those of Indian origin were the least cooperative.
Based on this survey, the researchers estimate that 10.8% of all South Africans over the age of 2 years were living with HIV in 2005. Among those between 15 and 49 years old, the estimated HIV prevalence was 16.2% in 2005.
|  |
|
The results of this study suggest that KwaZulu-Natal, Mpumulanga and Free State have the highest HIV prevalence. However, the relatively small sample sizes limit precision, and in several cases the ranges of uncertainty overlap.
| Age (years) | Male prevalence % | Female prevalence % |
| 2-4 | 4.9 | 5.3 |
| 5-9 | 4.2 | 4.8 |
| 10-14 | 1.6 | 1.8 |
| 15-19 | 3.2 | 9.4 |
| 20-24 | 6.0 | 23.9 |
| 25-29 | 12.1 | 33.3 |
| 30-34 | 23.3 | 26.0 |
| 35-39 | 23.3 | 19.3 |
| 40-44 | 17.5 | 12.4 |
| 45-49 | 10.3 | 8.7 |
| 50-54 | 14.2 | 7.5 |
| 55-59 | 6.4 | 3.0 |
| 60+ | 4.0 | 3.7 |
| Total | 8.2 | 13.3 |
Among females, HIV prevalence is highest in those between 25 and 29 years old; among males, the peak is in the group aged 30-39 years. According to these results, males aged 15-49 years old are 58% as likely to be infected as are females in the same age group ( 11.7% in men versus 20.2% in women).
In February 2005, the South African government and Statistics South Africa published the report "Mortality and causes of death in South Africa, 1997-2003". This large document contains lists of how many people died from each cause over a six year period, according to death notification forms.
The government's report reveals that the annual number of registered deaths rose by a massive 57% between 1997 and 2002. Among those aged 25-49 years, the rise was 116% in the same six year period. Part of the overall increase is due to population growth and more complete reporting of deaths. However, this does not explain the substantial rise in the proportion of deaths occurring among persons aged 25 to 49 years. In 1997, people in this age group accounted for 23% of all deaths, but in 2003 they made up 34%.
| Year of death | Age (years) | Total | ||||
| 0-14 | 15-24 | 25-49 | 50+ | Unspecified | ||
| 1997 | 40,495 | 19,831 | 92,479 | 159,731 | 5,571 | 318,287 |
| 1998 | 47,407 | 22,723 | 113,848 | 178,616 | 5,095 | 367,689 |
| 1999 | 46,534 | 24,629 | 129,383 | 178,637 | 2,719 | 381,902 |
| 2000 | 47,419 | 26,252 | 149,391 | 188,714 | 2,193 | 413,969 |
| 2001 | 48,954 | 28,026 | 171,942 | 201,127 | 1,887 | 451,936 |
| 2002 | 56,250 | 30,815 | 199,485 | 210,729 | 1,989 | 499,268 |
| Increase 1997-2002 | 38.9% | 55.4% | 115.7% | 31.9% | -35.7% | 56.9% |
Each year from 1997 to 2002, HIV was recorded as a cause of death in fewer than 11,000 cases. In 2001, Statistics South Africa estimated that 8.7% of deaths explicitly reflected HIV/AIDS on the death certificate. However, shortly before the government report was released, the Medical Research Council of South Africa (MRC) published an article which claims that the majority of deaths due to HIV are misclassified.
People whose deaths are caused by HIV are not killed by the virus alone, but HIV should be recorded as an underlying cause if it "initiated the chain of morbid events leading directly to death". In other words, if someone contracts tuberculosis and dies from it because their immune system has been weakened by HIV then HIV should be included among the underlying causes. The MRC article claims that in many cases, this does not happen; instead, the doctor records only the immediate cause of death such as tuberculosis or respiratory infection. This could be because the doctor does not know the deceased person's HIV status. Alternatively, they may seek to conceal HIV infection to spare stigmatisation of relatives, or to avoid invalidating life insurance claims. As The Lancet notes, authorities are largely to blame:
"Social stigma associated with HIV/AIDS, tacitly perpetuated by the Government's reluctance to bring the crisis into the open and face it head on, prevents many from speaking out about the causes of illness and deaths of loved ones and leads doctors to record uncontroversial diagnoses on death certificates.... The South African Government needs to stop being defensive and show backbone and courage to acknowledge and seriously tackle the HIV/AIDS crisis of its people." 2
The MRC analysed a 12% sample of death certificate data from the year 2000-2001, and compared it to all the data from 1996. When they looked at deaths for which HIV was a reported cause, they saw that rates (deaths per thousand) had increased according to a distinctive age-specific pattern. The greatest increases were in the age groups 0-4 and 25-49 years, while death rates among teenagers and older people remained more or less unchanged.
The researchers observed that nine other causes of death had increased substantially according to the same distinct age pattern as HIV. They then estimated how much of the increases were likely to be caused by HIV, and concluded that 61% of deaths related to HIV had been wrongly attributed to other causes in 2000-2001. In adults, tuberculosis accounted for 43% of misclassified deaths, and lower respiratory infections for another 32%. Among infants, most of the excess deaths had been misclassified as lower respiratory diseases or diarrhoeal diseases. According to the MRC results, HIV caused the deaths of 53,185 men aged 15-59 years, 59,445 women aged 15-59 years, and 40,727 children under 5 years old in the year 2000-2001.
The MRC estimates come very close to those made by a computer model of the Actuarial Society of South Africa, called ASSA2000. According to ASSA2000 calculations, HIV caused 165,859 deaths in 2000 - 30% of their estimated total of 556,585 deaths. In the age ranges they looked at, the MRC's estimates fell just 7% short of those from ASSA2000.
The MRC did not have sufficient data on which to base estimates for the year 2004. However, the ASSA2002 model calculates that 311,000 people died because of AIDS in 2004 - comprising 44% of all deaths. Among adults aged 15-49 years, it estimates that 70% of all deaths were due to AIDS.
The highest numbers of all come from UNAIDS/WHO. They estimate that AIDS claimed 370,000 lives in 2003 - more than 1,000 every day.
Bearing in mind that they were conducted in different years, it is possible to compare the results of the National HIV Survey 2005 with those of the Department of Health Study 2004.
HIV prevalence according to the Department of Health Study 2004:
HIV prevalence according to the National HIV Survey 2005:
The two studies clearly produce quite different results - so why could this be?
Antenatal surveillance is internationally recognised as the most useful way of assessing HIV prevalence in countries with generalised epidemics. Pregnant women are sexually active and constitute an easily identifiable, accessible and stable population. They are more likely than any other single group to be representative of the general adult population. Nevertheless, there are a number of limitations to the Department of Health's technique.
The greatest difference between the two studies concerns prevalence among women aged 15-19 years old, for which the antenatal survey produces an estimate 70% higher than the household survey (16.1% compared to 9.4%). This is, at least in part, probably because not all young women are sexually active, and those represented in the antenatal data are by definition practicing unprotected sex, which puts them at higher risk of HIV infection. Overestimation of HIV prevalence in this age group is a known bias in antenatal studies.
It is possible that overestimation occurs in older age groups as well, particularly as those who use condoms stand less chance of both infection and pregnancy. On the other hand, underestimation might also occur: for example, studies have shown that HIV lowers fertility.
The advantage of the National HIV Survey is that it can give a better idea of HIV prevalence levels among men, children and non-sexually active women. The survey also recorded a vast amount of other data besides the age and location of respondents (most of which is beyond the scope of this page), including information on race, wealth and education. Participants were also interviewed about factors that might influence their risk of HIV infection, such as behaviour, knowledge and risk awareness.
Although the study did attempt to survey as representative a population sample as possible, it recognises that some groups were excluded. Only people living in homes or hostels were contacted, so there was no representation of homeless people and those living in police and army barracks, prisons, hospitals and educational institutions. This probably resulted in underestimation of some prevalence figures. Additionally, by excluding all children below 2 years of age (because they cannot be reliably tested for HIV using antibody tests) the survey missed a significant proportion of children who acquired HIV from their mothers.
The study is also limited by the accuracy of its many assumptions about South Africa's demographics - based on census data, aerial photographs and field surveys - and by the representativeness of its selected sample. To improve the precision of racial data, the surveyors deliberately chose disproportionately large samples from the smaller racial groups, and then weighted the results accordingly. However, some groups that may be of particular interest for the understanding of the epidemic could not be captured in sufficient numbers, including men who have sex with men, injecting drug users and sex workers.
The effect of non-response on accuracy is uncertain. It is difficult to conclude whether those who refuse to be tested are more or less likely to have HIV. The only certain effect of the low response rate is that it increases uncertainty. 3
The National HIV Survey is the the second of its kind to be conducted across the whole of South Africa.
The National HIV Survey claims that women of African ethnicity are over-represented in the Department of Health Study. It argues that the antenatal data should be compared with its own estimates relating to African women only. The two sets of estimates do indeed look similar, especially in the age groups 25-29, 30-34 and 35-39 years.
According to the National HIV Survey, males are 58% as likely to be infected as are females. However, the Department of Health calculates male prevalence using a factor of 85%. If they chose 58% instead then their estimate of HIV prevalence in all people aged 15-49 years would be around 21% (rather than 24.6%).
The location of clinics may also be an issue. For example, a lot of clinics in KwaZulu-Natal are sited near major transport routes, where prevalence is known to be unusually high. This could explain why the studies disagree over which provinces have the highest prevalence.
The National HIV Survey reports that of those African women who were surveyed and had been pregnant in the last 24 months - 630 in total - somewhere between 21.9% and 32.3% were HIV-positive (26.8% is the best guess, but the small sample size limits precision). This range includes the Department of Health result of 29.5%.
Neither prevalence study sets out to mislead or to contradict the other. Each uses a standard surveillance technique to obtain its estimates and clearly explains all of its methods and calculations. Most of the observed differences are the result of choosing different groups of people to be tested, since these groups differ in how well they are able to represent the general population.
In such a large and diverse country as South Africa, no-one can know exactly what the true figures are. What is essential is that the limitations of each study are acknowledged whenever their estimates are interpreted. To illustrate why this is so important, this page has suggested a few reasons why estimates might vary, though this is by no means an exhaustive list.
UNAIDS and WHO recommend that antenatal and population-based studies should both be conducted at regular intervals. In countries with generalised epidemics, antenatal clinic attendees are thought to represent the adult population with good accuracy. Moreover, when conducted regularly such surveys can reveal long-term trends in prevalence. On the other hand, household surveys tell us more about the nature of the epidemic by providing prevalence data according to gender, race, wealth and other characteristics. Such information informs better interpretation of antenatal data.
With access to the results of the previous household survey of 2002, the Department of Health Study of 2003, and the results of many smaller surveys, UNAIDS/WHO made their own estimate of 21.5% prevalence in those aged 15-49 years old, at the end of 2003. Their high and low estimates are 18.5% and 24.9% respectively. According to their own estimate of total population size (which is another contentious issue), this implies that around 5.3 million South Africans were living with HIV at the end of 2003, including 230,000 children under 15 years old.
What is clear from every study is that there is an exceptionally severe epidemic of HIV/AIDS in South Africa. This epidemic affects all parts of the population, though women are more likely to be infected than men. Many tens of thousands of people are dying.
For South Africa there are tremendous challenges remaining in the fields of HIV education, prevention and care. To read more about what has already happened and what is being done now, take a look at the page HIV & AIDS in South Africa.
AVERT.org has more HIV and AIDS statistics pages and a general guide to understanding HIV & AIDS statistics.
Written by Rob Noble.
Last updated February 1, 2006
The Republic of South Africa is a comparatively large country, covering 1.2 million square kilometres and with an estimated population of about 40 million. Some 13% of all the people in the world living with HIV can be found in South Africa. UNAIDS estimates that at the end of 2003 there were 5.3 million people in South Africa living with HIV, equivalent to 21.5% of the adult population.
The country is comprised of large, crowded cities and sparsely populated rural areas. The average density of the population works out at 29 people per square kilometre, with 60% of these in urban areas and 40% in rural areas. Some parts of the country, especially in the rural areas, are very isolated and underdeveloped. This lack of infrastructure is one of several factors that make it difficult to get a clear picture of the size of the population and the HIV prevalence.
A common method of measuring HIV prevalence in South Africa is by looking at HIV test results taken from pregnant women who attend antenatal clinics. Some areas of South Africa, however, lack antenatal facilities and many women will not have the opportunity to see a midwife during their pregnancy or to take a HIV test. There has also been criticism that this method of measuring prevalence only gives a picture of HIV rates amongst sexually active women, some of whom, due to the stigmatisation experienced by people with HIV, are naturally reluctant to have a test.
A survey published in March 2004 found that South Africans spend more time at funerals than they do having their hair cut, shopping or having Bar-B-Qs. It found that over twice as many people had been to a funeral in the past month as had been to a wedding. 1 It is estimated that about 600 people in South Africa die of HIV-related illnesses each day.11
Whatever the precise levels of infection are, what is certainly clear is that the problem is a huge one. For more information about the demographics and statistics of the epidemic in South Africa, see our statistics page.
Historically, South Africa has had a turbulent past, and this history is relevant to the explosive spread of HIV in the region.
Apartheid was legislated into force in the 1950s, with the prohibition of mixed-race marriages, and the categorisation of separate areas in which different races might live. Sex between different ethnic groups was prohibited. In 1955 the African National Congress (ANC) demanded equal political rights, and 1956 Nelson Mandela and other political activists were arrested for high treason. A period of increasing unrest followed, arising from the increasingly militarised discrimination growing in South Africa. In 1985 and 1986, a State of Emergency was declared in response to serious riots, and the violence increased. In 1990 Nelson Mandela was released from prison, and the pace of political unrest and change accelerated.
It was during this chaotic time, in 1982, that the first cases of HIV were diagnosed in South Africa. For the first few years of the epidemic, cases were mainly amongst white gay men. Following the same trends seen in other countries, as the number of cases increased, the virus began spreading to all other areas of society.
In 1985 an AIDS Advisory Group was appointed.2
In 1990 the first antenatal surveys to test for HIV were carried out.3 0.8% of women were found to be HIV positive.4 It was estimated that there were between 74,000 and 120,000 people in South Africa then living with HIV. Since this time, antenatal surveys have been carried out annually.
In 1991 the number of heterosexually contracted infections equalled the number homosexually contracted. Since that point, heterosexually acquired infections have dominated the epidemic. The prevalence rate was 1.4% based on antenatal testing. Several AIDS information, training and counselling centres were established.
In 1992 the prevalence rate was 2.4% based on antenatal testing. The first governmental response to AIDS came when Nelson Mandela addressed the newly-formed National AIDS Convention of South Africa (NACOSA), although there was little action from the government in the following few years. The purpose of NACOSA was to begin developing a national strategy to cope with AIDS. 5 The free National AIDS helpline was started.
In 1993 the prevalence rate was 4.3% based on antenatal testing. The National Health Department reported that the number of recorded HIV infections had increased 60% in the previous two years and the number was expected to double in 1993. A survey of women attending health clinics indicated that nationally some 322,000 people were infected.
In 1994 the prevalence rate was 7.6% based on antenatal testing. The Minister for Health accepted the basis of the NACOSA strategy as the foundation of the government's AIDS plan. There was criticism that the plan, however well intended, was poorly thought-out and disorganised. The South African organisation Soul City was formed, developing media productions with the intention of educating people about health issues, including HIV/AIDS.
In 1995 the prevalence rate was 10.4% based on antenatal testing. Much of the collection of AIDS data stopped in South Africa.
In 1996 the prevalence rate was 14.2% based on antenatal testing. The International Conference for People Living with HIV and AIDS was held in South Africa, the first time that the annual conference had been held in Africa. The then Deputy President, Thabo Mbeki, acknowledged the seriousness of the epidemic, and the South African Ministry of Health announced that some 850,000 people - 2.1% of the total population - were believed to be HIV positive, and that in some groups, such as pregnant women, the figure had reached 8% and was rising.6
In 1997 the prevalence rate was 17.0% based on antenatal testing. A national review of South Africa's AIDS response to the epidemic found that there was a need for political leadership.
In 1998 the prevalence rate was 22.8% based on antenatal testing. The pressure group Treatment Action Campaign (TAC) was started to advocate for the rights of people living with HIV / AIDS and to demand a national treatment plan for those who were infected. The then Deputy President Thabo Mbeki launched the Partnership Against AIDS, admitting that 1,500 infections were occurring every day.
In this year alone, 49,280 incidences of rape and sexual assault were reported, indicating that sexual violence is likely to be an important factor involved in the transmission of HIV. Sexual assaults in South Africa are thought to go largely unreported, so the true figure is undoubtedly much higher.
Gugu Dlamini, a health worker and AIDS activist, made her HIV status public on World AIDS Day, and was stoned to death by a mob which included her own neighbours.7
Some 50% of adult medical admissions in hospitals in Gauteng Province were AIDS related.
In 1999 the prevalence rate was 22.4% based on antenatal testing. Over 160 million free condoms were distributed. An educational campaign called 'Lovelife' was launched, a national programme targeting 12- to 17-year-old South Africans.
In 2000 the prevalence rate was 24.5% based on antenatal testing. At the International AIDS Conference in Durban, the South African president Thabo Mbeki said that AIDS was a disease caused by poverty, not by HIV. While poverty can be more harmful to people who are HIV+ and lack adequate nutrition, this comment is untrue. It was also extremely unhelpful in promoting the adequate provision of HIV education in South Africa. 8
President Mbeki set up a group charged with solving the country's AIDS problems which included HIV 'dissidents' such as Peter Duesberg, who believe that anti-AIDS drugs such as AZT actually cause AIDS, and that lifestyle choices such as homosexuality or drug addiction can cause AIDS. 9
In 2001 the prevalence rate was 24.8% based on antenatal testing. South Africa's High Court ordered the government to make the3 drug nevirapine available to pregnant women to help prevent the transmission of the virus to their babies. Despite international drug companies offering free or cheap AIDS drugs, 10 the Health Ministry still refused to provide these drugs on a large scale.
In 2002 the prevalence rate was 26.5% based on antenatal testing.
In 2003, data showed that the HIV prevalence rate amongst pregnant women was 27.9%. TAC campaigners embarked on a strategy of civil disobedience and demonstrations to try to embarrass the government into acting. In March 2003 TAC laid culpable homicide charges against the Health Minister and her trade and industry colleague. TAC claims the pair are responsible for the deaths of 600 HIV-positive people a day in South Africa who have no access to antiretroviral drugs. 11
These figures show that there was clearly an explosion in HIV prevalence between 1993 and 2000. This was a time when the country was distracted by the major political changes through which it was going, it is possible that the severity of the epidemic might have been lessened by prompt action at this time. Whilst the attention of the South African people and the world's media was focused on the political and social changes occurring in South Africa, HIV was silently gaining a foothold. Although the results of these political changes were positive, the spread of the virus was not given the attention that it deserved, and people didn't realise the impact of the epidemic in South Africa until prevalence rates had began to accelerate rapidly.
The population of South Africa is made up of a mixture of races. Black South Africans account for 75% of the population, whites make up around 13%, Asian people make up about 3% of the population, and other people of mixed racial heritages account for about 9%. There are 11 official languages in South Africa and many dialects, which, obviously, makes the job of informing people about the dangers of AIDS all the more difficult. Some 86% of the population is literate. 12
HIV education in South Africa, as in many countries, only became seen as an important issue when HIV had already gained a foothold.
Coming after the government's basic HIV education campaigns, the 'Beyond Awareness' campaign which ran from 1998-2000, came from the perception that national mass-media campaigns might inform people, but seldom had much effect in changing behaviour. 13 Beyond Awareness was a multi-media campaign targeted mainly at young people, and backed by demographic research evaluating the success of the campaign. They also produced and supplied materials and resources for small organisations to use in different contexts, and promoted the free National AIDS helpline, started in 1992 as part of the initial AIDS awareness initiative.
Started by a number of different funders, the Soul City project was designed to educate and empower people to make better choices about their personal health. It used radio, print and television, aiming to reach a wide audience. The project used drama and soap operas to disseminate its message, with the first series broadcast in 1994. The material has also been broadcast in many other parts of Africa as well as Latin America, the Caribbean and South East Asia. As with many HIV prevention education projects, it is difficult to measure the success of the Soul City project. 14
In 1999, an educational campaign called 'Lovelife' was launched. Its aim was to reduce teenage pregnancy, the spread of HIV and sexually transmitted infections among young South Africans. The campaign aims to turn safe sexual behaviour into a brand, in much the same way as Coca Cola or Nike. Funded mainly by foundations set up by Henry Kaiser and Bill Gates, Lovelife involves a glossy multimedia blitz promoting sexual responsibility and a network of telephone lines, clinics and youth centres providing recreational and sexual health facilities. It also has an outreach service, travelling to remote rural areas, trying to reach young people who are not in the educational system. In terms of funding, Lovelife has become the largest campaign aimed at HIV prevention in the world. 15,16
Lovelife is founded on the idea that previous campaigns of sexual health education have largely failed to change sexual behaviour - 90% of people in South Africa know the dangers of HIV and how it is transmitted, yet infection rates continue to rise. Lovelife aims to delay first sex, reduce the number of partners people have, and encourage people to practise safer sex.
The Lovelife campaign has been criticised in some circles for sexualising the epidemic, and, although it may have been very effective, the actual difference it has made to reductions in new HIV infections is very difficult to measure. Some AIDS activists feel that the campaign is misguided, poorly targeted, and will be ineffective. 17
In 2001 the government formed the AIDS Communication Team (ACT) which involved a group of organisations including Soul City, to develop and implement a two-year media campaign intended to educate people about the dangers of HIV. The campaign is called 'Khomanani' which means 'caring together', and produces material in several languages.
HIV is sometimes seen as being a disease of the poor, and in South Africa there is some correlation between extreme poverty and high levels of HIV prevalence, although the virus is prevalent across all sectors of society. 18
By 1998, although people from more affluent, largely white society were starting to come out as being HIV positive, stigmatisation of the condition still remained deeply rooted in township areas. In 1998 Gugu Dlamini, an AIDS activist in Durban, came out as being HIV positive on World AIDS Day. She was beaten to death by her neighbours.
The then Deputy President Thabo Mbeki made the Declaration of Partnership Against AIDS, in which he called for an end to discrimination against people with HIV.19
An important point came in 2000 when Justice Edwin Cameron of the South African court came out at a speech in Durban as being HIV positive. In spite of this, coming out as being HIV positive can in many cases still negatively effect employment and housing opportunities, and social relationships.
The pressure group Treatment Action Campaign (TAC), led by Zackie Achmat, was started in 1998 in response to the unwillingness or claims of inability of the South African government to provide antiretroviral treatment for people with AIDS. 20 They argued that the cost of providing antiretroviral medication and preventative education would ultimately be less expensive than the economic impact of an unchecked epidemic. They felt that the decision of the South African government not to provide antiretroviral drugs was inhumane, and spearheaded the fight to persuade the government to provide drugs to prevent mother-to-child transmission of HIV. Zachie Achmat, himself HIV positive, drew publicity to the situation by refusing to take antiretroviral medication until it was available to all South Africans.
On an international scale, there was also inaction and a tendency to take polarised views. When discussing the provision of multi-drug medication in 2001, USAID head Andrew Natsios argued that drug treatment is impractical because most Africans "don't know what Western time is ... and if you say one o'clock in the afternoon, they don't know what you are talking about". This was seen as being a legitimisation of inaction.
In 2000, at the conference in Durban, Justice Edwin Cameron said that the prospect of 25 million deaths in Africa is fundamentally unacceptable. He described a growing fatalism in the West's perception of the 'sad realities' of Africa's problems. "We don't accept 'sad realities' in South Africa," he said. "If we accepted sad realities, we would still have a racist oligarchy here."
Justice Cameron described how he nearly died of the disease three years before but was brought back to health by antiretroviral drugs he was able to afford.
"I have the privilege of purchasing my health, for about $400 a month. Why should I have the privilege of purchasing my life, when 34 million people around the world are becoming ill and dying? It is a moral inequity of fundamental proportions. No one can look at it and not be spurred to action."
Many health-care professionals within the health department became frustrated by the government's lack of progress in supplying nevirapine, proven to be effective and economical in reducing the transmission of the virus from mothers to their babies. Doctors began applying to NGOs for grants to pay for nevirapine, and in some cases used their own money to buy the drug. Official policy stated that the doctors were forbidden to provide the drug, and those who did so risked being disciplined or sacked.
In March 2003 TAC laid culpable homicide charges against the Health Minister and her trade and industry colleague. TAC claimed the pair were responsible for the deaths of 600 HIV-positive people a day in South Africa who had no access to antiretroviral drugs.
In August 2003 the government ordered the health department to develop a detailed operational plan to provide antiretroviral drugs to people living with HIV / AIDS. The announcement was greeted with optimism, but also with an awareness that rapid action was more important than the production of operational documents.
In October 2003 the Clinton Foundation announced that it had brokered a deal with four generics companies to provide triple-drug antiretroviral therapy to governments in the developing world at a cost of less than US $140 per patient per year, much less than the medication had previously cost.
The United States, which has promised to spend $15 billion fighting AIDS in the developing world in the next few years, has recently annouced that Congress has approved $40 million funding for South Africa.
On the 19th November 2003, the government approved the Operational Plan for Comprehensive Care and Treatment for people living with HIV and AIDS. In the same month, the government reversed its views about the administration of ARVs, partly as a result of Glaxo SmithKline and other Pharmaceutical companies agreeing to allow low-cost generic versions of their drugs to be produced. Since this reversal, they have produced a policy document laying out their plans for addressing the HIV epidemic. 21 Much of this policy is very sound, as they admit the need for the provision of ARVs and preventive education.
The policy also accepts that part of a valid treatment package must be nutrition, which is of great importance amongst poorer sections of the population. The South African health minister has proposed that AIDS sufferers eat garlic, onions, olive oil and African potatoes to boost their immune systems. While this isn't going to 'cure' HIV, it is true that a good diet is an important part of treatment.22
AVERT.org has more information about which people around the world are able to access ARV medication .
The Operational Plan for Comprehensive Care and Treatment for people living with HIV and AIDS needs to be implemented immediately, to the extent that South Africa's existing infrastructure will allow. This means that ARVs need to be provided to people with AIDS, and that nevirapine needs to be provided to pregnant mothers who are HIV+. Testing facilities need to be improved. The medical infrastructure needs to be built up before all aspects of the plan can be put in place, but this should not stop the health department from doing all that they are able to with their current resources.
The educational package incorporated in the treatment plan needs to be implemented, for both people who are HIV negative and positive. As the antiretroviral rollout begins to save the lives of people with HIV, then the pool of people able to transmit the virus will increase. Education will be needed to prevent an increase in new infections.
The World Health Organisation (WHO) has recently published a plan outlining aims to bring antiretroviral (ARV) treatment to 3 million people living with HIV in developing countries by 2005.
Three years after it was first introduced to South Africa, nevirapine is still not reaching many pregnant women. Reasons for this are:
The issues experienced in the rollout of nevirapine illustrate the difficulties involved in providing antiretroviral medication across the country.
However, some progress is being made. Western Cape, KwaZulu-Natal and Gauteng claim to provide almost complete access to the drug, and other states are doing well.
The policy promises that within a year there will be "at least one [antiretroviral] service point in every health district across the country, and within five years, one service point in every local municipality". It also involves "upgrading our national healthcare system ... recruitment of thousands of professionals and a very large training programme to ensure nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines."
In February 2004, the government in South Africa admitted that delays in the procurement process and lack of training for doctors were still delaying the rollout of ARV treatment.23
The policy states that they want to provide comprehensive viral-load testing for HIV positive people, something for which the country's medical infrastructure in not equipped. The government haven't stated yet whether they will allow the lack of viral-load testing facilities hold up the provision of ARV medication. This is going to be very demanding, given that the health-care system is short on trained staff in some places, due to the effects of HIV.
The policy may be attempting to be too ambitious. The experiences of Botswana show that, even if sufficient funding is available, implementing ambitious plans in short timescales can be very difficult. 24
The experiences of other resource-poor countries indicates that the time-period between HIV diagnosis and death, in an impoverished area, can be as little as two years.25 It will be challenging to carry out the rollout of medication, but treatment must be implemented immediately, or an estimated two million of South Africa's population could be dead within the next year.
AVERT.org has more information about organisations, countries, costs and challenges involved in providing ARV medication to resource-poor areas.
This page was written by Steve Berry, September 2004.
Last updated April 10, 2006
| Country | Before AIDS | 2010 |
| Angola | 41.3 | 35.0 |
| Botswana | 74.4 | 26.7 |
| Lesotho | 67.2 | 36.5 |
| Malawi | 69.4 | 36.9 |
| Mozambique | 42.5 | 27.1 |
| Namiba | 68.8 | 33.8 |
| Rwanda | 54.7 | 38.7 |
| South Africa | 68.5 | 36.5 |
| Swaziland | 74.6 | 33.0 |
| Zambia | 68.6 | 34.4 |
| Zimbabwe | 71.4 | 34.6 |