Epidemiology of HIV/AIDS in South Africa
AIDS is now the leading cause of death in sub-Saharan Africa, and South Africa is facing one of most serious HIV epidemics not only in the region but in the world. 2001 estimates indicate about one-in-nine South Africans (or 4.7 million people) living with HIV/AIDS. At the end of 1999, the estimated number of adults (aged 15-49) living with HIV infection in the country was 4.1 million, of which women made up 56 percent (2.3 million). These figures indicate that South Africa has the highest number of people living with AIDS of any country in the world.
During 1999 adult HIV prevalence was 19.94 percent and there were 250,000 adult deaths from AIDS. It is estimated that average life expectancy is only 47 years in South Africa, instead of 66, if AIDS were not a factor. Infant mortality rates among those with AIDS rose to 59 per 1000 in 2000, compared to 41 for those without AIDS. There were nearly 400,000 AIDS orphans alive at the end of 1999 - children aged under 15 who had lost one or both parents to AIDS - and almost one million children were living with HIV.
South Africa is also experiencing one of the fastest growing HIV/AIDS epidemics, with considerable heterosexual transmission. HIV prevalence among pregnant women attending antenatal clinics in South Africa was less than 1 percent in 1990 (almost a decade after the first HIV diagnosis there in 1982). According to the South African Ministry of Health a decade later, prevalence among pregnant women had risen to just under 25 percent by the end of 2000. Condom use is low. In national surveys during 1998, 28.4 percent of women aged 15-19 had ever used a condom, while a slightly higher number of older women (32.4 percent aged 20-24) had ever done so. Rural areas appear to be infected to the same extent as urban areas, particularly in KwaZulu/Natal Province, the hardest hit area. In that province, antenatal clinic data from 2000 reveal HIV prevalence of 36 percent.
Large-scale information campaigns and condom distribution programs appear to be bearing fruit. In the country free male condom distribution rose from 6 million in 1994 to 198 million five years later. In recent surveys, more than half the sexually active teenage girls surveyed reported that they always use a condom during sex. But these developments are accompanied by a troubling rise in prevalence among South Africans aged 20-34, highlighting the need for greater prevention efforts targeted at older age groups, and tailored to their realities and concerns.
HIV/AIDS in Pretoria, South Africa:
In Natal, Western, Eastern and Gauteng states where the major urban areas of Johannesburg, Pretoria, Durban and Port Elizabeth are located, HIV prevalence among ante-natal clinic (ANC) attendees increased from less than 1 percent in 1990 to a median of 19 percent in 1998. Divided by age, HIV prevalence among ANC attendees under 20 years of age in these areas increased tenfold from 1991 to 20 percent in 1996. In 1997, 10 percent of women under 15 years of age attending clinics tested HIV positive. Peak HIV infection occurred among ANC attendees aged 20-24 years of age.
According to behavioral surveys in Gauteng province, where the University of Pretoria is located, around a third of adult men reported having ever used a condom. In major urban areas such as Pretoria, almost one in five pregnant women tested HIV positive in 1998. Among sex workers the figure was 61 percent, rising to 69 percent for high risk groups as a whole. There are few sentinel sites located in Pretoria itself.
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