South Africa faces one of the most serious HIV epidemics in the world. More than 5 million South Africans were estimated to be living with HIV in 2008; with a national adult prevalence of roughly 10.9%. The figures vary dramatically between different provinces of the country, with the more rural areas being more heavily affected. The Western Cape (relatively urban and developed) has a prevalence estimated at roughly 3.8%, while more rural areas of the country have much higher estimates. Eg. KwaZulu-Natal at 15.8%, and Mpumalanga at 15.4%. Government response to this crisis has, until recently, been completely inadequate and counter-productive. An article in the Journal of AIDS estimated that the HIV policies by the previous government directly led to roughly 330 000 deaths between 2000 and 2005; and 35 000 babies were born HIV+ in this time. More recently, anti-retroviral treatment (ART) has become freely available at clinics, but many people (especially those in more rural areas) do not have access to the clinics to be able to receive these medications; or they are unable to visit the clinics regularly, and so default on their treatment schedules. Many are also unable to afford to access the clinics, due to high unemployment and poverty in rural areas. (All statistics are from the HSRC Third National HIV Prevalence Survey 2008).
Women face a much higher burden of the HIV epidemic – in almost all age categories, women’s prevalence rates are much higher than for males. In the 20-24 age group, women have a prevalence of 21.1%, compared to only 5.1% for males; and 25-29 group, women’s prevalence is at 32.7%, with men at 15.7%. This is especially worrying as these are the major child-bearing ages for women, meaning that many children are also placed at risk. An estimated 60 000 – 70 000 children are infected each year, and it is estimated that, without any interventions, the chances of mother-to-child transmission are 25-45%. However, with Highly Active ART (HAART), the transmission rate can drop to almost 0%. Once again, although this treatment is freely available at clinics, many women are unable to access these clinics (statistics from Health Systems Trust Prevention of Mother to Child Transmission 2009). Farm workers are also severely affected by HIV, as they often live in remote areas with little access to treatment, and no money to attend available clinics.
HIV also increases the incidence of other communicable and opportunistic diseases, such as tuberculosis (TB), malaria, and sexually transmitted infections (STIs). In the past 15 years, incidences of TB almost tripled in countries with high HIV prevalence (www.stoptb.org). Co-infection rates in South Africa are also very high, with an HIV prevalence of almost 75% amongst those with TB (Statistics South Africa – Mortality and causes of death in South Africa, 2006). Poor nutrition and hygiene also contribute to increased levels of communicable infections; and decrease the effectiveness of any treatments being undertaken by patients. Thus, the burden facing the healthcare system across South Africa is immense, but it even more severe in rural areas.