AIDS Watch

South Africa and HIV/AIDS – what is the truth?

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With the conflicting statistics surrounding HIV/AIDS in South Africa being bandied around, spare a thought for those tasked with planning for the future.

World AIDS Day observed on 1 December saw a deluge of reports on what is purportedly the latest statistics reflecting the state of affairs in the fight against the disease, internationally and in South Africa. The picture that emerged is extremely confusing, confronting future planners with a nightmare where it comes to mid- to long-term production investments and the creation of service delivery capacities.

For example, one report by the SABC, picked up by news outlets across the world, claims “Half of adolescents have HIV in SA: Study.” Another report, put out by the charitable Thomson Reuters Foundation (TRF), stated that in South Africa “… just 4% of boys and young men 15 to 24 years old carry the virus that causes AIDS. Among girls the same age, the rate is 13%, according to Southern African Development Community (SADC) figures.”

The SABC report might have made a wrong projection from a “recent United Nations Children’s Fund (UNCF) study” that reportedly found that “South Africa is among six countries where over half the world’s adolescents living with HIV can be found”.

No official title of nor a link to the UNCF report is provided and it was not possible to check the 50% claim about South Africa and its adolescent population. The discrepancy between the TRF report’s 4% and 13% is also suspiciously large.

These are, however, not the only statistics punted by various groups active in the field of HIV/AIDS. They generally tend to be on the alarmist side and look shaky under close scrutiny.

According to a report on the UN News Centre website “UNAIDS estimates that 17.1 million of the 36.9 million people living with HIV worldwide do not know they have the virus.” The SABC report quotes UNAIDS office head, Simon Bland, putting the “they do not know” figure at 19 million.

Apart from the discrepancy between the two figures coming out of the same institution, the big question that arises is: If people don’t know their HIV status because they have not been tested, how does anybody or institution manage to count them to arrive at a reliable figure?

A problem going back decades

The problem, especially for planners, with reliable statistics and future projections based on it, goes back more than thirty years.

In the early 1980s a consultancy firm I was involved with was approached by one of South Africa’s largest manufacturing and consumer goods production conglomerates for assistance on this issue.

Projections based on the statistical claims about the AIDS pandemic at the time indicated that by late in the previous century there would not only have been a labour shortage in the country, but that by early in this century a population decline would set in.

Worried about the implications of such eventualities for their businesses and long-term production investment, they committed substantial resources to a research project at a South African university – the subject being the demographic impact of the AIDS pandemic.

What happened in reality is that the caution in investment in production capacity was not only counterproductive – contributing to current high levels of unemployment – but that the population growth rate hardly showed any signs of coming down.

For the sake of balance it should be said that the projections of the 1980s usually carried the rider: “If no cure is found”.

South Africa’s progress

A cure has not yet been found. But since that time antiretroviral therapy has made its appearance and South Africa can pride itself on the successes on that front.

The University of the Witwatersrand’s Reproductive Health and HIV Institute (WRHHI) reported last week that “South Africa has made incredible strides providing antiretroviral treatment to millions of people since 2004. HIV has been transformed from a grim and inexorable death sentence to a chronic disease controlled with a cheap, safe tablet-a-day, rendering a person with HIV healthy and non-infectious.”

But the report also warns that the antiretroviral treatment is not perfect, the number of infected people are still staggering and new infection rates remain high. The fight against the disease is far from over – not in South Africa and also not internationally.

Keep stats truthful and balanced

It is true that adolescents as a demographic sector are an especially vulnerable group for a number of reasons, not only in South Africa, but internationally too. In countries like India, Indonesia, Brazil and even the United States there is a worrying rate of infection among teenagers.

It is, however, also worrying that there seems to be a tendency to manipulate and overemphasise the statistics around this group. It can only undermine a truly balanced approach to the much wider problem, including dealing with the social fallout of an estimated 2.3 million orphans in South Africa, from before the anti-retroviral treatment campaign turned things around.

Campaigners around this issue run the risk of endangering the credibility of the larger fight against HIV/Aids. They must, in particular, pardon scepticism and some cynicism when emotionally loaded claims around some statistics are packaged with calls for billions of dollars to be spent annually.

If the claims around the adolescents of today are indeed correct, implications regarding markets and workforces a generation down the line are similar to those faced in the 1980s.

Society’s planning fraternity should take a sober look at the stats to ensure a balanced approach.

Heed should be paid to the concluding paragraph of the WRHHI report: “South Africa can be justly proud of its progress in HIV treatment. But the ongoing crisis of HIV prevention needs more focus, creativity and resources for research and programs. The country needs the kind of urgency and drive around HIV prevention that has given it a successful treatment program.”

by Piet Coetzer

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