From Africa Recovery, Vol.14#4 (January 2001), page 19 (Country in Focus: South Africa)

South Africa's mounting AIDS toll

Limited access to health services, low educational levels speed the disease's advance

By Ernest Harsch

Along one of the main roads in Soweto, South Africa's largest black township, sits the Othandweni Children's Home. It has about 300 residents, ranging in age from just a few days up to 18 years. They all ended up at Othandweni because they were orphaned or abandoned, many by parents who are seriously ill from AIDS or have already died. A few of the more curious children come out to stare at the visitors, but passively, with no sign of excitement. "No one wants to adopt them," says a guide, since a big majority are themselves HIV-positive.

Othandweni is but one face of South Africa's enormous -- and growing -- AIDS crisis. About 500,000 South Africans already have died from AIDS-related causes, and projections based on the current growth rate of HIV prevalence suggest that as many as 10 million may succumb over the next 15 years. Young black women are at greatest risk. In 1998, 22.8 per cent of women attending post-natal clinics in public health facilities were found to be HIV-positive. About 5 per cent of the child population already is infected. By 2010, a quarter of the general population may be infected, lowering average life expectancy from a pre-epidemic high of 65 to 48 years or less.

Because of the impact of the HIV/AIDS epidemic on production and the costs of fighting the disease, South Africa's economy may be 17-20 per cent smaller in the year 2010 than it might be without the syndrome, according to a study by two US economists, Mr. Jeffrey Lewis of the World Bank and Ms. Channing Arndt of Purdue University, presented at a conference in Johannesburg in September. A May 2000 government report on social conditions in South Africa emphasized the linkages between poverty and HIV/AIDS. It estimated that HIV/AIDS will worsen poverty, while at the same time noting that limited access to health services, low educational levels and patterns of labour mobility within South Africa and the region tend to speed the disease's advance. In this way, it commented, "South Africa's legacy of apartheid and inequalities are contributory factors to the rapid rate at which HIV is spreading."

Some comments by President Thabo Mbeki stressing the role of poverty and questioning whether HIV actually causes AIDS stirred considerable dispute in the media and scientific community. Despite the controversy, the government has an extensive programme to combat HIV/AIDS. In addition to its "Partnership Against AIDS" campaign to mobilize various sectors of society against the disease, the government has budgeted R450 mn over the past three years through the departments of health, welfare and education to directly treat those with the virus and to raise public awareness of how to avoid it. In addition, the 2000/01 budget allocates an extra R75 mn to fight HIV/AIDS, a figure that is set to rise to R125 mn next year and R300 mn in 2002/03.

South Africa also has been in the forefront of international negotiations to ensure that developing countries gain access to more affordable anti-AIDS and other medicines. Legislation adopted in 1997 provides both for imports of commercial medicines through third countries at lower cost and for the licencing of domestic producers of generic versions of the drugs. Although World Trade Organization regulations allow both practices under certain conditions, US pharmaceutical companies threatened to take South Africa to court. Under public pressure, the companies have since backed down. In December 2000, the US drug giant Pfizer donated $50 mn worth of a medicine used against several AIDS-related maladies, enough for free distribution through public clinics for two years. The government, which previously had been reluctant to approve distribution of anti-HIV medicines, is now talking with another company for a similar donation of a drug that impedes mother-to-child transmission of HIV.


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