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Kaiser Family Foundation

The HIV/AIDS Epidemic in South Africa

HIV/AIDS Policy Fact Sheet

Kaiser Family Foundation

June 2007

SARPN acknowledges the Kaiser Family Foundation as the source of this document: www.kff.org
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South Africa has more than 5 million people living with HIV/AIDS and is one of the countries hardest hit by the epidemic.1,2,3,4 South Africa’s HIV/AIDS prevalence rate (the percent of people living with the disease) is much higher than that of the Sub-Saharan African region overall and is among the highest in the world,1,3,4 although prevalence rates have begun to stabilize.2,3,5 The epidemic has already had a profound impact on many aspects of South African society and is projected to affect the country’s demographic structure and its economic, education, and health sectors if more is not done to stem its tide.1,3,6 As a middle-income country7 of significant political and economic importance in the African continent, the future course of the HIV/AIDS epidemic in South Africa will have broader implications for Africa overall. The Government of South Africa first established the National AIDS Coordinating Committee of South Africa (NACOSA) in 1992 and created the South African National AIDS Council (SANAC) in 2000.8,9 In March 2007, the government released its HIV and AIDS and STI Strategic Plan for South Africa 2007–2011, designed to guide the country’s multisectoral response to HIV/AIDS.3 Comprehensive policies and interventions are in place and significant resources, both domestic and in the form of external aid, have been committed to address the epidemic in South Africa, yet many challenges remain.9,10 In addition, new threats such as the emergence of extensively drug resistant tuberculosis (XDR-TB) in the country may further complicate the response given the high rates of HIV/TB coinfection in South Africa and the high mortality associated with XDR-TB.2,11,12


Overview

  • The first case of HIV/AIDS in South Africa was reported in 1982.13
  • South Africa had an estimated 5.5 million people living with HIV/AIDS in 2005; the South African government’s estimate for 2006 is similar at 5.4 million.1,3,4 This is the second highest number of any country in the world and highest on the African continent.1,3,4 Approximately 2 million South Africans infected with HIV do not know they are infected.2
  • The HIV/AIDS prevalence rate14 in South Africa is between 18–19% (18.8% in 2005 and 18.3% in 2006), significantly higher than the rate in sub-Saharan Africa (5.9%) and globally (1.0%).1,2,3,4
  • In 2006, an estimated 350,000 South Africans died of HIV/AIDS.3 AIDS has been cited as the major cause of premature deaths in the country—AIDS-related deaths are estimated to have accounted for nearly half of all deaths in 2006 and overall death rates, from all causes, have increased by about 80% between 1997 and 2004 largely due to HIV/AIDS.3,4
  • HIV is spread primarily through heterosexual sex in South Africa.3
Populations and Regions Affected

  • Women account for over half (55%) of adults15 estimated to be living with HIV/AIDS in South Africa.3,4
  • Young South Africans have been particularly affected by HIV/AIDS in South Africa, especially young women.1,2,3,4,5,16 Among young South Africans aged 15–24, young women are significantly more likely to be HIV-infected than young men.1,2,3,4 Young women aged 25–29 have the highest rates of infection in the country.3
  • In 2006, 290,000 children17 in South Africa were estimated to be living with HIV/AIDS3,4 and there are more than one million AIDS orphans.1,4,18
  • There is significant variation in the epidemic’s impact by region, with the highest rates occurring in KwaZulu-Natal, Mpumalanga and Gauteng and the lowest in the Western Cape, Northern Cape and Limpopo.3,4
Other Key Data

  • Concern about HIV/AIDS and other epidemics: South Africans are concerned about HIV/AIDS. More than nine in ten (96%) say that HIV/AIDS and other epidemics are a “very big” problem in their country. Over four-fifths (90%) of South Africans feel that HIV/AIDS and other infectious diseases are the greatest threat to the world.19 South African youth are also concerned about HIV/AIDS.16,20 Six in ten named HIV/AIDS as the most important issue facing young people in the country in a recent survey; six in ten also were very concerned about becoming infected with HIV in the next 10 years.20
  • Knowledge of HIV/AIDS: Studies have found that general awareness of HIV/AIDS in South Africa is high.9,16,20 Most young South Africans (aged 15–24) are knowledgeable about key aspects of HIV prevention and treatment, but small shares of youth still hold misconceptions about some key aspects of the epidemic.20 Many South African youth say they would like more information about HIV/AIDS.20
  • Access to Antiretroviral Therapy (ART): The Government of South Africa is scaling up access to ART and will continue to do so over the next few years as the country implements its 2007–2011 Strategic Plan.3 The country already has the largest number of people on ART in the world, but with an estimated one million people in need of ART, South Africa also has one of the highest unmet needs for ART in the world. However, progress has been made. As of the end of 2006, an estimated 287,000–363,000 people in the country were receiving ART (about 33% of those in need) and South Africa accounted for one-quarter of all people receiving ART in Sub-Saharan Africa.21
  • Prevention of Mother-to-Child Transmission (PMTCT) of HIV: In September 2001, the South African government initiated a national program to prevent mother-to-child transmission of HIV. In 2005, PMTCT services were available at over 3,000 health sites nationwide,9 making the program among the largest PMTCT programs in the world.22 The percentage of HIV positive pregnant women who received antiretrovirals to reduce the possibility of transmitting HIV to their infants increased from 22% to 30% between 2004 and 2005.21
Financing HIV/AIDS: Domestic and International Support

  • Domestically, the HIV/AIDS response is primarily financed through the national health budget. In 2007, the budget for national HIV/AIDS programs is estimated to be R2.4 billion (approximately $334 million USD).23
  • A number of donor governments also provide funding and other support to address South Africa’s HIV/AIDS epidemic including: the United States, the United Kingdom, Belgium, Australia, Germany and the European Union.8 South Africa is one of the 15 focus countries of the United States Government’s President’s Emergency Plan for AIDS Relief (PEPFAR). U.S. bilateral aid for South Africa was $221.5 million in FY2006.24 The U.S. also provides support for HIV/AIDS efforts around the world through its contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund).
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved five HIV/AIDS grants (including HIV/TB grants) in South Africa.25
  • UNAIDS and the UN Family support a variety of HIV/AIDS activities in South Africa.8


Key Sources/Websites


References:
  1. UNAIDS, 2006 Report on the Global AIDS Epidemic; May 2006.
  2. UNAIDS, 2006 AIDS Epidemic Update; December 2006.
  3. Republic of South Africa, Department of Health, HIV and AIDS and STI Strategic Plan for South Africa, 2007–2011; March 2007.
  4. Dorrington R, et al., The Demographic Impact of HIV/AIDS in South Africa: National and Provincial Indicators for 2006, Cape Town: Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa; 2006.
  5. Republic of South Africa, Department of Health, National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa 2005; 2006.
  6. Abt Associates, The Impending Catastrophe, A Resource Book On The Emerging HIV/AIDS Epidemic in South Africa; 2000.
  7. World Bank, “Country Classification: Country Groups”: http://www.worldbank.org/data/countryclass/classgroups.htm#Upper_middle_income.
  8. UNAIDS, UNAIDS at Country Level: Progress Report, 2004.
  9. Republic of South Africa, Department of Health, Progress Report on Declaration of Commitment on HIV and AIDS, Prepared for United Nations General Assembly Special Session on HIV and AIDS; February 2006.
  10. UNAIDS, Country Page for South Africa: http://www.unaids.org/en/Regions_Countries/Countries/south_africa.asp.
  11. WHO, Emergence of XDR-TB: http://www.who.int/mediacentre/news/notes/2006/np23/en/index.html.
  12. Kaiser Family Foundation: www.globalhealthfacts.org.
  13. UNAIDS/WHO, “South Africa: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections—2004 Update.”
  14. Among adults aged 15–49.
  15. South African government estimates define adults as those aged 20–64; UNAIDS uses age 15 and over.
  16. Pettifor AE, et al., HIV and Sexual Behaviour among Young South Africans: A National Survey of 15–24 Year-Olds; April 2004.
  17. Under age 14.
  18. Under age 18.
  19. Pew Research Center for The People and The Press, “What the World Thinks in 2002;” December 2002.
  20. Kaiser Family Foundation and South African Broadcasting Corporation, Young South Africans, Broadcast Media, and HIV/AIDS Awareness: Results of a National Survey; March 2007.
  21. WHO/UNAIDS/UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report; April 2007
  22. Thom A, “Many Challenges for Pregnant HIV Mothers Programme;” August 10, 2005. http://www.health-e.org.za/news/article.php?uid=20031289
  23. Republic of South Africa, National Treasury, Estimates of National Expenditure 2007; 2007.
  24. United States Government, State Department, Office of the Global AIDS Coordinator, “2007 Country Profile: South Africa;” 2007
  25. The Global Fund: www.theglobalfund.org.




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