With antiretroviral drug treatment, HIV-positive people can maintain their health and often lead relatively normal lives. Sadly, few people in South Africa have access to this treatment. This means that AIDS deaths are alarmingly common throughout the country. It is thought that almost half of all deaths in South Africa, and a staggering 71% of deaths among those aged between 15 and 49, are caused by AIDS.

As well as the death and suffering that HIV has caused on an individual and community level, South Africa's AIDS epidemic has also had a substantial impact on the country's overall social and economic progress:

Average life expectancy in South Africa is now 54 years - without AIDS, it is estimated that it would be 64. Over half of 15 year olds are not expected to reach the age of 60.5

Between 1990 and 2003 - a period during which HIV prevalence in South Africa increased dramatically - the country fell by 35 places in the Human Development Index, a global directory that ranks countries by how developed they are.

It is clear that AIDS is having a devastating impact on South Africa. There are many possible reasons why South Africa has been so badly affected by AIDS, including poverty, social instability and a lack of government action. One way to gain a better insight into the situation is to look back on the history of AIDS in South Africa.

The history of AIDS in South Africa

South Africa has had a turbulent past, and this history is relevant to the explosive spread of HIV in the country.

1980s - In 1985, a State of Emergency was declared in South Africa that would last for five years. This was a result of riots and unrest that had arisen in response to Apartheid, the system of racial segregation that had been in place since the 1950s. Apartheid prohibited mixed-race marriages and sex between different ethnic groups, and categorised separate areas in which different races lived. In the same year, the government set up the country's first AIDS Advisory Group in response to the increasingly apparent presence of HIV amongst South Africans. The first recorded case of AIDS in South Africa was diagnosed in 1982, and although initially HIV infections seemed mainly to be occurring amongst gay men, by 1985 it was clear that other sectors of society were also affected. Towards the end of the decade, as the abolition of Apartheid began, an increasing amount of attention was paid to the AIDS crisis.

1990 - The first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive.9 It was estimated that there were between 74,000 and 120,000 people in South Africa living with HIV. Antenatal surveys have subsequently been carried out annually.

1991 - The number of diagnosed heterosexually transmitted HIV infections equalled the number transmitted through sex between men. Since this point, heterosexually acquired infections have dominated the epidemic. Several AIDS information, training and counselling centres were established during the year.

1992 - The government's first significant response to AIDS came when Nelson Mandela addressed the newly formed National AIDS Convention of South Africa (NACOSA). The purpose of NACOSA was to begin developing a national strategy to cope with AIDS. The free National AIDS Helpline was founded.

1993 - The National Health Department reported that the number of recorded HIV infections had increased by 60% in the previous two years and the number was expected to double in 1993. The HIV prevalence rate among pregnant women was 4.3%.

1994 - The Minister for Health accepted the basis of the NACOSA strategy as the foundation of the government's AIDS plan. There was criticism that the plan, however well intended, was poorly thought-out and disorganised. The South African organisation Soul City was formed, with the aim of developing media productions to educate people about health issues, including HIV/AIDS.

1995 - The International Conference for People Living with HIV and AIDS was held in South Africa, the first time that the annual conference had been held in Africa. The then Deputy President Thabo Mbeki, acknowledged the seriousness of the epidemic, and the South African Ministry of Health announced that some 850,000 people - 2.1% of the total population - were believed to be HIV-positive.10

1996 - The HIV prevalence rate among pregnant women was 12.2%.

1997 - The HIV prevalence rate among pregnant women was 17.0%. A national review of South Africa's AIDS response to the epidemic found that there was a lack of political leadership.

1998 - The pressure group Treatment Action Campaign (TAC) was founded, to campaign for the rights of people living with HIV, and to demand access to HIV treatment in South Africa for all those who were in need of it. Deputy President Thabo Mbeki launched the Partnership Against AIDS, admitting that 1,500 HIV infections were occurring every day.

1999 - The HIV prevalence rate among pregnant women was 22.4%.

2000 - The Department of Health outlined a five-year plan to combat AIDS, HIV and STIs.11 A National AIDS Council was set up to oversee these developments. At the International AIDS Conference in Durban, the new South African President Thabo Mbeki made a speech that avoided reference to HIV and instead focused on the problem of poverty, fuelling suspicions that he saw poverty, rather than HIV, as the main cause of AIDS. President Mbeki consulted a number of ‘dissident' scientists who rejected the link between HIV and AIDS.

2001 - The HIV prevalence rate among pregnant women was 24.8%.

2002 - South Africa's High Court ordered the government to make the drug nevirapine available to pregnant women to help prevent mother to child transmission of HIV. Despite international drug companies offering free or cheap antiretroviral drugs,12 the Health Ministry remained hesitant about providing treatment for people living with HIV.

2003 - In November, the government finally approved a plan to make antiretroviral treatment publicly available. The HIV prevalence rate among pregnant women was 27.9%.

2004 - The South African government's treatment program began to take effect in Gauteng in March, followed shortly afterwards by other provinces.

2005 - At least one service point for AIDS related care and treatment had been established in all of the 53 districts in the country by March, meeting the government's 2003 target. However, it was clear that the number of people receiving antiretroviral drugs was well behind initial targets. The HIV prevalence rate among pregnant women was 30.2%.

2006 - Jacob Zuma, the Former South African Deputy-President, went on trial for allegedly raping an HIV-positive woman. He argued that she had consented to sex and was eventually found not guilty, but attracted controversy when he stated that he had showered after sex in the belief that this would reduce his chances of becoming infected with HIV. Criticism of the government's response to AIDS heightened, with UN special envoy Stephen Lewis attacking the government as ‘obtuse and negligent' at the International AIDS Conference in Toronto. At the end of the year, the government announced a draft framework to tackle AIDS and pledged to improve antiretroviral drug access. Civil society groups claimed that this marked a turning point in the government's response.

Why did South Africa's AIDS epidemic go unchecked for so long?

The most rapid increase in South Africa's HIV prevalence took place between 1993 and 2000, during which time the country was distracted by major political changes. While the attention of the South African people and the world's media was focused on the political and social changes occurring in the country, HIV was rapidly becoming more widespread. Although the results of these political changes were positive, the spread of the virus was not given the attention that it deserved, and the impact of the epidemic was not acknowledged. It is likely that the severity of the epidemic could have been lessened by prompt action at this time.

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