NEWS
South Africa and AIDS No more denial
Dec 5th 2002 | JOHANNESBURG
From The Economist print edition
A new report shows exactly who is infected with HIV

GOOD data make good policy, as South Africa's politicians like to say. But deciding how best to fight AIDS requires knowledge of exactly whom it afflicts. Activists, academics and the United Nations have long insisted that there is plenty of evidence about AIDS in South Africa. But the government has always demanded more detail. President Thabo Mbeki is personally affronted by the idea that Africans might be seen as “sub-human” carriers of disease, and so is especially demanding.

Agreeing on that information is tricky. Last year, the politicians duly rubbished a study by the Medical Research Council, which showed fast-rising deaths among the young, especially women. The council blamed AIDS illnesses. The government said that an independent rise of tuberculosis or pneumonia might be responsible. Since doctors and family members rarely admit that a patient has died of AIDS, nobody trusts death certificates. And making calculations from high levels of infection among women who are pregnant is difficult. These tell you only about young women who have had unprotected sex and become pregnant.

Now years of fruitless wrangling should be over. On December 4th Nelson Mandela launched the most authoritative report so far. In 2002, researchers from the Human Sciences Research Council interviewed 10,000 people of all races, ages, incomes and locations, and conducted confidential oral-swab HIV tests on 8,428 of them. Their results are relatively good news. HIV infection for 15-49-year-olds was previously put at about 20%; the new study says it is 15.6%. Overall, that suggests 4.5m infected people (some 11.4%).

Another surprise is that some provinces have lower levels of infection than expected. Recent antenatal surveys in KwaZulu-Natal showed that 33.5% of 15-49-year-old women had the virus. The new study puts it at just 19.5%. This is more persuasive than antenatal surveys, because it included women who are not pregnant, and also went beyond clinics in densely populated areas, in which infections tend to be higher.

Most encouraging, though, is the fact that South Africans are well informed about AIDS. Some 80% are sure, unlike Mr Mbeki, that HIV causes AIDS. And young people aged between 15 and 24 are changing their sexual behaviour. Young people have long been thought to be particularly vulnerable to the disease. But fewer young people than expected are having sex, and 23% say they have given it up altogether. And 29% said they had not had sex in the 30 days before being questioned. Of those who had, most report only one partner in the past year. Crucially, around half use condoms, a high level that matches countries such as Uganda, where HIV infection levels are dropping.

Can you trust all these answers? Yes, say the researchers. Interviews were strictly confidential, and levels of infection by age corroborate what these young people are suggesting: they are less likely to be infected than their elders.

This week, the researchers briefed ministers on the findings. They are not likely to be delighted by all of them. Over 95% of respondants want AIDS sufferers and infected pregnant women to get anti-retroviral drugs, which the government resists. Only just under half think the government spends enough fighting AIDS.

The survey also shows that income and education have no bearing on the chance of infection, so Mr Mbeki's emphasis on fighting poverty to tackle AIDS seems misplaced. Most disturbing, though, is that children are worse affected than previously thought. Around 6% of those aged between two and 14 have HIV—a level four times higher than suspected. And children now head 3% of South African households.

Will the government attack this report? It seems unlikely. The researchers have been astute to team up with Mr Mandela, whose political clout should prevent much official meddling. And the scale and thoroughness of the research is without parallel. The government now has some good data. Roll on the good policy.






JONATHAN FAULL

The EDGE Institute: Economic Development, Growth & Equity

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E-mail: jfaull@the-edge.org.za

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