South Africa has been ground zero in the HIV/AIDS tragedy. In 2011, about 5.6 million people were HIV positive, about 12 percent of South Africa’s population. According to the Economist, the HIV/AID disease burden was born disproportionately by blacks, 13 percent of whom were HIV positive. For Coloureds it was 3 percent; for whites, 1 percent. South African women also carry a disproportionate burden; they account for more than half of all new cases of infection.
Health Minister Dr. Aaron Motsoaledi commented in February 2014 that the mortality rate doubled in the country between 2006 and 2007, a statistic characteristic of a war zone. In 2014, he went on, 49 percent of maternal deaths are attributable to HIV/AIDs, and the child mortality rate (children who die before the age of five) is 35 percent because of HIV/AIDS. The disease also makes people vulnerable to other diseases. “A lot of cancers…diseases like leprosy and TB, which we thought had been defeated, came back because of HIV/AIDS.” He also commented that 43 percent of people who are HIV positive “developed mental health problems.”
The slow and unscientific response to HIV/AIDS by the administrations of Nelson Mandela and Thabo Mbeki is one of the greatest failures of the early years of post-apartheid “non-racial” democracy. But, beginning in the later years of the Mbeki administration, there was a turn-around. According to a South African Institute of Race Relations (IRR) spokesperson, the Department of Health distributed almost 400 million condoms (male and female) in 2011/2012. Condom use at first sex increased from 18 percent to 66 percent between 1996 and 2012. According to the IRR, those who use condoms at first sex are likely to continue to do so.
The Department of Health has also launched a campaign to circumcise as many men as possible. According to Dr. Motsoaledi, “we have circumcised one million men–we are going to quadruple it and circumcise four million men by 2016.” (Male circumcision significantly reduces the risk of contracting HIV.) He said that the campaign to reduce mother-to-child transmission of HIV is working: “it is now markedly low at 2.7 percent. At one stage, it was 8 percent. We want it to go below 1 percent or if possible 0 percent.” According to the IRR , the new infection rate has decreased by more than 50 percent since 1999.
There has also been a dramatic increase in the number of South African HIV/AIDS victims receiving antiretroviral treatment. Here, the United States has been an important partner. According to the American embassy in Pretoria, the President’s Emergency Plan for Aids Relief (PEPFAR) has invested more than $4.2 billion in South Africa’s HIV and TB programs. Unusual for PEPFAR partners, the South African government has assumed greater managerial and financial responsibilities for these programs, now investing about $1.5 billion annually of its own in countering HIV and AIDS.
The payoff can be seen in South Africa’s significant increase in life expectancy, from fifty-four years in 2005 to sixty years in 2011. South Africa still carries a heavy HIV/AIDS burden, and will do so for a long time. But, the South African government’s campaigns against HIV/AIDS are a major achievement.