What is the prevalence of HIV in South Africa?
Sub-Saharan Africa is the region worst-affected by HIV and AIDS. HIV/AIDS in South Africa is a prominent health concern; South Africa has the highest prevalence of HIV/AIDS compared to any other country in the world with 5,6 million people living with HIV, and 270,000 HIV related deaths recorded in 2011. (UNAIDS)
Why is the South African HIV/AIDS prevalence so high?
Many factors contribute to the spread of HIV. These include: poverty; inequality and social instability; high levels of sexually transmitted infections; the low status of women; sexual violence; high mobility (particularly migrant labour); limited and uneven access to quality medical care; and a history of poor leadership in the response to the epidemic.
Research shows high levels of knowledge about the means of transmission of HIV and understanding of methods of prevention. However, this does not translate into HIV-preventive behaviour. Behaviour change and social change are long-term processes, and the factors that predispose people to infection – such as poverty and inequality, patriarchy and illiteracy – cannot be addressed in the short term. Vulnerability to, and the impact of, the epidemic are proving to be most catastrophic at community and household level.
How has this affected the everyday lives of South Africans?
The hardship for those infected and their families begins long before people die. Stigma and denial related to suspected infection cause many people to delay or refuse testing; fear and despair often follow diagnosis, due to poor-quality counselling and lack of support; poverty prevents many infected people from maintaining adequate nutrition to help prevent the onset of illness; limited access to clinics, waiting lists for ARV treatment programmes and eligibility criteria for access to ARVs mean that many people become seriously ill before accessing treatment; loss of income and support when a breadwinner or caregiver becomes ill, and the diversion of household resources to provide care exacerbate poverty; the burden upon family members, particularly children and older people caring for terminally ill adults, and the trauma of bereavement and orphanhood compromise the physical and mental well-being of entire households, where 2,100,000 children orphaned due to AIDS in South Africa in 2011. This all happens in a society where the majority of children live in poverty and 25% of the economically active population is unemployed.
Women face a greater risk of HIV infection. On average in South Africa there are three women infected with HIV for every two men who are infected. The difference is greatest in the 15-24 age group, where three young women for every one young man are infected.
However, South Africa has made positive strides in managing the HIV and AIDS epidemic since the end of 2008. The numbers of people on antiretroviral treatment has increased dramatically to 1 900 000 and there were 100 000 fewer Aids-related deaths in 2011 than in 2005.
What are the proposed solutions?
For many years, the burden of care and support has fallen heavily on the shoulders of impoverished rural communities, where sick family members return when they can no longer work or care for themselves. Community-based care has been promoted as the best option since it would be impossible to care properly for hundreds of thousands of people dying from AIDS in public hospitals. The resilience and capacity to care for dying people and provide for those they leave behind in impoverished communities is extremely overstretched. There remains an acute need for social protection and interventions to support the most vulnerable communities and households affected by this epidemic. The challenge we still face is that people are not testing timeously therefore only once they are very ill at quite a late stage of disease progression do they only realise that they are HIV positive. The central focus remains that we continue to mobilise an increased uptake in HIV testing and counseling, behaviour change communication and combination prevention and treatment.
The AIDS Foundation of South Africa pays significant focus to achieve these goals by having supported 92 Community based organizations (CBOs) countrywide over the last financial year. CBOs are central to our aim to mitigate the effects of HIV and AIDS in the most vulnerable communities within South Africa. Furthermore, the training of community health care workers who conduct household visits and provide HIV & AIDS education, home and community based care and support services to households in distress helps to alleviate the burden of our overwhelmed public health care facilities.