Updated March 16, 2005
The Sunday Times, in Johannesburg reported that according to actuarial reports, the death rate in South Africa soared by 43% between 1996 and 2001. In 1996, 387,784 adults died of all causes, 168,801 fewer than in 2001. This was mainly a result of deaths related to HIV. dAmong children under five, 74 of the deaths could be empirically classified as HIV/AIDS related, although death certificates only 25% were certified.
Bisiness Day in Johannesburg, noted the lack of health infrastructure in sub-Saharan Africa as a whole was impeding the delivery of ARV's to the general population. South Africa's health infrastructure is relatively good, but it is estimated that other sub-Saharan countries needed 72 billion a year, whereas they were receiving only 8.5 billion, including foreign aid.
The Sunday Times of Johannesburg noted there is still a terrible stigma attached to AIDS in the country that most AIDS victims only seek help when they are desperately ill, and then under cover of darkness. HIV+ patiente make up a staggering 60% of hospital admissions. The are labelled "the midnight people." According to research, some six million South Africans are HIV+, but 80% are not aware of their status, the stigma is still so great people refuse to be tested and receive help. South Africans were broadly aware of a link between sex and HIV, only 30% of men reported they always used condoms.
It has abundant resources, with well-developed financial, legal, transport, communications, and energy sectors. However, daunting problems remain from the apartheid era, the there is a high unemployment rate, widespread poverty, a high crime rate, and the HIV/AIDS crisis. The Union of South Africa has been very slow in addressing the problem of AIDS. The country was still under apartheid when the first cases of HIV were diagnosed in 1982. Tests for HIV were done at ante-natal clinics, and at that time, the prevalence rate was 0.8%. A newly formed AIDS Advisory Group has carried out annual ante-natal tests since that time. The AIDS Advisory Group's latest tests of ante-natal women shows that in 2002, the prevalence rate among women in that group had climbed to 26.5%.
When apartheid ended, there were so many problems facing the country that AIDS was pushed to the back burner. When Mbeki became president, he denied the presence of HIV in Africa, blaming the mounting number of deaths on lack of food and poor sanitation. He resisted all attempts to bring ARV's to South Africa. As a result, AIDS there has spiraled almost out of control. There are presently over 420,000 known AIDS orphans in the country; 5 million South Africans are infected with full-blown AIDS, and 4 million more are HIV+. Each day, 1500 more are infected. Half of all patients, and one third of all children admitted to hospitals are HIV+. Hospitals and doctors are overwhelmed. In some hospitals, patients must sleep two and three to a bed.
The UN has estimated the AIDS virus could kill up to half of young adults and teenagers in sub-Saharan Africa. This will wreak social and economic havoc among the worst affected nations, including South Africa. Sylvia Kunene, an AIDS counsellor, says, "AIDS is an economic issue in South Africa, and no longer just seen as a healh issue. ..Manufacturing companies are worried about factory floor workers and bank and service industries are concerned about white collar and management employees." A major gold producer estimates up to a third of its local workforce may be infected with HIV/AIDS. However, the company said it would provide quality health care to all its employees.
Inequalities in government health clinics between districts differ widely, the richer districts receive 389 Rand per person, but poorer districts receive only 42 Rand per person. There is also a great disparity in income; the average per capita income is $2900 a year, but 11% of the population live on less than $1. a day
Deaths among 25-40 year olds now exceeds deaths among those over 55. People are now experiencing full-blown AIDS, and there is a higher mortality among the working population, which has a potentially catastrophisc effect on South Africa's ability to work. Like most other sub-Saharan countries, South Africa is experiencing a shortage of cemetary space.
President Mbeki had announced that 53,000 South Africans would be on anti-retroviral drugs (ARV's) by March 31, 2005, but in August, it was announced that only 10,000 were receiving ARV's.
A female diaphragm is being tested in South Africa; a real breakthrough, because if it works as hoped, women will be able to exert influence over their own sexuality. At present, it is almost always the men who control sexual decision-making, and most of them refuse to wear a condom. If women suggest their use, they can be accused of infidelity, beaten, or raped.
Fueled by the AIDS crisis, TB is on resurgence in South Africa. It is one of the serious opportunistic diseases which attack when AIDS has crippled the immune system. It is often the actual cause of death in an AIDS patient. TB had been declining, but when AIDS began to run out of control, TB cases again began to increase. Up to 80% of TB patients also have HIV.
In September, threatened by legal action, the South African health department published ;the findings of the 2003 HIV/AIDS prevalence. It is the 14th survey of its kind since 1990. The epidemic still has not levelled off. About 27.9% of pregnant women attending government clinics are infected with HIV, up slightly from 26.5% in 2002. The government now estimates the total number of South Africans infected with the disease at 5.6 million. An estimated 3.2 million women and 2.4 million men between the ages of 15 and 49 are infected. About 4,000 schoolchildren from 40 schools in four provinces are infected with HIV, according to a community survey. Educators and community members are working to see that affected children and AIDS orphans receive whatever government grants are available to them, and also helping with training those children in parenting skills, as some of them are household heads. One helpful note; HIV and AIDS prevalence among South African teenagers has been declining constantly. A camppaign to help the growing number of AIDS orphans in sub-Saharan Africa has been launched in Capetown. The Democratic Alliance is concerned that the army's batle-readiness is severely compromised by soldiers with HIV/AIDS. South African researchers have developed a novel application in mobile phone technology ;that helps health workes to monitor HIV patients cheaply and efficiently. The Cell-Life project has developed software that lets clinic workers use their cell phones to monitor patients' treatments and spot health problems before they become serious. The phones have a special menu which lets HIV counsellors record data on a patient's symptome, whether they are sticking to their medications, even a shortage of food. Information is sent to a central data base. Cell Phone now plans to expand the program to other provinces.
South Africa is the richest country in sub-Saharan Africa, but even here, there are additional hurdles. Nearly 40% of the population is unemployed, and the tablets must be taken with food twice a day. If they are taken without food, the patient may die. And the pills must be taken regularly or they are ineffective. South Africa is working to strengthen the health care infrastructure, but infrastructure alone will not conquer AIDS. The disease remains so feared that those affected are afraid to go public. Newspaper obituaries are packed with death notices of people in their 30's and 40's, but AIDS is almost never listed as the cause of death. South Africa desperately needs political leaders who will deliver frank talk about sex and sexual practices. ***** Zackie Achmet, a South African with HIV who has led the way in the struggle to get ARV's for the infected public, notes that there had been many people and organizations, including UN agencies, who were skeptical of the ability of poor people to understand how to take ARV's. A simplified treatment process, involving nurses, clinical officers, and even people living with HIV offering psychological support to patients has proved a breakthrough in expanding treatment to HIV patients. ***** The majority of AIDS orphans, who number about a million in South Africa are looked after by grandparents or guardians. The South African courts have been asked to tackle what is perceived as widespread discrimination against old grandparents caring for orphaned grandchildren. The law in South Africa entitles people who take on the care of children not their own to a grant of about 100 dollars a month, and government will support up to 6 children per household. But there is so much paperwork required that older people, many of whom are illiterate, find it impossible. If you are old and black, there is a 90% chance you are illiterate ***** South Africa's pension funds have been slashed, in part because of AIDS. Pension benefits of a working lifetime were effectively reduced by 12% to 13%, as the funds were needed elsewhere. South Africa's HIV/AIDS was causing people to die earlier, and drained pension funds. A survey found that 76% of employers do not have any HIV/AIDS management plan, and called the pandemic was an "economic time bomb." ***** Student deaths and illness due to HIV/AIDS has resulted in debts to the National Student Financial Aid Scheme of 8 million Rand. The audit was conducted by the Higher Education HIV and AIDS Program, and the director, Barbara Michel, said the scheme could not discriminate against students with HIV. Universities must find some way to provide treatment, care and support for students, so they could maintain good health long enough to pay back their loans, she said. The audit's authors said that all institutions were now involved in HIV/AIDS programs. This was a marked improvement since 2000, when many institutions did nothing. ***** In rural KwaZulu-Natal, the Province with the highest number of people infected with HIV/AIDS, (about 1.5 to 1.8 million people), free ARV's are being distributed. So far, about 2,500 patients have been enrolled at eight hospitals, and 300 patients are on retrovirals. Many of the estimated 150,000 to 180,000 people needing retrovirals live in remote, impoverished areas. The nurse distributing the drugs is carefully pointing out the correct way to take the drugs, and being aware of possible side effects. The circle of adults in front of her is listening intently. Many nurses, doctors, pharmacists and councillors are taking training courses to learn the latest information about giving retrovirals, and the province hopes to have 40 sites accredited to provide treatment and about 20,000 patients by March of 2005. Recent elections were held in South Africa, but it's estimated that about 800,000 people will have missed out on voting because of HIV. Some were too sick to come out and vote, many were caring for he sick. The figure also includes those who died just before the election. ***** South African college students are organized into a vast volunteer network, the South African Students Volunteer Organization (SASVO). A recent project, helped by the US Association for Volunteer Organization, has devoted $600,000 to organize workshops for volunteer students, training them for volunteer work in agriculture, HIV/AIDS, web design and social infrastructure. This project aims to bring the aid to places where it is most needed, namely, the rural areas of the country, often largely undeveloped. ***** Hospitals in KwaZulu-Natal are under pressure, despite the fact that several new and modern hospitals and over 130 clinics have recently been opened in the province. The demand for health care has been exacerbated by recent epidemics of malaria, cholera, and HIV/AIDS, and the poverty of the province means that 88% of the population is dependent on public health sector. The malaria epidemic peaked in 1999, and was brought under control by spraying households at risk with DDT and treating patients with a new combination drug. The cholera epidemic peaked in 1999-2000 and infected 120,000 people, and the WHO has praised the way the South African government dealt with it. But the only way to prevent a new cholera epidemic is to ensure all households have safe drinking water and proper sanitation. Only a little over a third of households in the province have piped water. But HIV/AIDS remain the greatest challenge. In 2002, about 36.5% of pregnant women tested positive for HIV, the highest rate in the country. Up to 1.8 million people in the province are living with HIV. The province has developed a plan to ensure that every patient who receives ARV's will take their pills responsibly. When an HIV patient first visits the clinic, they consult with trained counselors and undergo a medical examination, including a viral load count. It the count is below 200, the patient is a candidate for ARV's. The first appointment is followed by a three week training course, when the patient learns about the HIV virus. Only in the fifth week, does he receive. ARV's. The patient also must go public about his HIV status. It is found that the emotional stress level becomes much lower after such disclosure is made.