Aids, the great unknown
By, Belinda Beresford, Mail & Guardian online, January 12, 2007
Prediction is very difficult, especially of the future, said Nobel Prize-winning physicist Niels Bohr. His quote is particularly appropriate looking at the future impact of HIV/Aids in South Africa because the country faces a situation as yet unknown in human history.
Historical, social and biological factors have conspired to create an epidemic that has two unique features: it kills adults, and it is disproportionately affecting women. The result is a change in the size, growth and structure of South Africa's population, falling life expectancy, increased mortality, especially among adults between 20 and 49 years, and a growth in the number of orphans.
The social repercussions of those changes are unknown, and to a large degree unresearched. Another unknown factor is the impact of migration, especially the thousands of illegal immigrants who live below the radar.
The long latent period of HIV means that the number of current infections is still building, and will accumulate until prevention campaigns start working effectively. For example, the estimated 500 000 people believed to have become infected in 2006 will only start falling ill from 2012 on. Estimates vary, but it is generally accepted that about 11% (5,3-million to 5,5-million) of South Africa's adult population is HIV-positive.
Professor Alan Whiteside, co-author of Aids in the 21st Century, points out that South Africa is becoming a country with a large number of orphans. This has wider psychological and social repercussions and represents a loss of social capital.
"We are in what is, in effect, a massive social experiment. The biggest problem with Aids is we have too narrow a focus. We don't look [at it] how we should -- as the product of anthropological, social, psychological, economic and political dynamics," he said.
Life expectancy in the region is now lower than it was 30 years ago -- a child born in South Africa today will live for just 47 years, although this does not take into account the potentially life-saving effects of mass antiretroviral therapy (ART). But significant numbers of people need to be on ART before the gains are felt at a population level.
Demographic effect
The direct demographic impact of Aids can only be estimated by models. One of the most oft-cited of these is that created by the Actuarial Association of South Africa (ASSA), which estimates that without ART there would have been half a million Aids-related deaths in 2010. According to the same model, if 90% of the people who need ART received it, by 2015 more than two million people would be recipients.
The model predicts that from 2011 South Africa's population will grow by 0,5% per year. This means that by 2015 South Africa will have a population of more than 50-million people. Just more than six million people will be HIV-positive, and 800 000 sick with Aids. The number of Aids deaths is estimated to reach 5,4-million by 2015, and there will be about 2,5-million orphans under the age of one.
For the next few years rising HIV prevalence is not necessarily bad news -- if it results from fewer deaths among HIV-positive people because of proper treatment. It will be bad news if rising prevalence continues to be driven by high rates of new infection.
How long the current ARV drugs will remain effective on a mass scale is still unknown because clinicians don't know how long it will take before drug resistance becomes a serious problem. New drugs are in the pipeline, but they are likely to be costly. The golden hope -- a vaccine against HIV infection -- is likely to be two decades off. The development of microbicides and chemical condoms is likely to be a little bit faster.
Economy
It's difficult to isolate the effect of HIV/Aids on the economy. Certainly the impact on macroeconomic indicators is thought to be small. This is in part because South Africa has such high levels of unemployment and many HIV-positive people are not formally employed, or else are in jobs where replacements can be found fairly easily. Research by the Stellenbosch University-based Bureau for Economic Research in 2006 found that on average the impact of HIV/Aids on GDP would be a decline of 0,4% to 0,6%.
Now social scientists are looking to the developmental and intergenerational effects of HIV/Aids and are finding corrosive and long-term impacts that are difficult to measure quantitatively. But one recurring finding is the need to develop the human resources of the country. It is the impact on women, who tend to have an overwhelming role in child rearing, as well as being workers in the formal and informal sectors, that is likely to have profound repercussions on South African society.
In 2005 30% of women attending public antenatal clinics were HIV-positive. It is estimated that young women are four times more likely to be HIV-positive than their male peers. Ten years ago the highest mortality rate for women was in the 70 to 79 demographic. Five years ago it had shifted to women in their late twenties and early thirties. The result has been the rise of "skipped generation" households, with grandmothers caring for grandchildren.
Prediction is very difficult, especially of the future, said Nobel Prize-winning physicist Niels Bohr. His quote is particularly appropriate looking at the future impact of HIV/Aids in South Africa because the country faces a situation as yet unknown in human history.
Historical, social and biological factors have conspired to create an epidemic that has two unique features: it kills adults, and it is disproportionately affecting women. The result is a change in the size, growth and structure of South Africa's population, falling life expectancy, increased mortality, especially among adults between 20 and 49 years, and a growth in the number of orphans.
The social repercussions of those changes are unknown, and to a large degree unresearched. Another unknown factor is the impact of migration, especially the thousands of illegal immigrants who live below the radar.
The long latent period of HIV means that the number of current infections is still building, and will accumulate until prevention campaigns start working effectively. For example, the estimated 500 000 people believed to have become infected in 2006 will only start falling ill from 2012 on. Estimates vary, but it is generally accepted that about 11% (5,3-million to 5,5-million) of South Africa's adult population is HIV-positive.
Professor Alan Whiteside, co-author of Aids in the 21st Century, points out that South Africa is becoming a country with a large number of orphans. This has wider psychological and social repercussions and represents a loss of social capital.
"We are in what is, in effect, a massive social experiment. The biggest problem with Aids is we have too narrow a focus. We don't look [at it] how we should -- as the product of anthropological, social, psychological, economic and political dynamics," he said.
Life expectancy in the region is now lower than it was 30 years ago -- a child born in South Africa today will live for just 47 years, although this does not take into account the potentially life-saving effects of mass antiretroviral therapy (ART). But significant numbers of people need to be on ART before the gains are felt at a population level.
Demographic effect
The direct demographic impact of Aids can only be estimated by models. One of the most oft-cited of these is that created by the Actuarial Association of South Africa (ASSA), which estimates that without ART there would have been half a million Aids-related deaths in 2010. According to the same model, if 90% of the people who need ART received it, by 2015 more than two million people would be recipients.
The model predicts that from 2011 South Africa's population will grow by 0,5% per year. This means that by 2015 South Africa will have a population of more than 50-million people. Just more than six million people will be HIV-positive, and 800 000 sick with Aids. The number of Aids deaths is estimated to reach 5,4-million by 2015, and there will be about 2,5-million orphans under the age of one.
For the next few years rising HIV prevalence is not necessarily bad news -- if it results from fewer deaths among HIV-positive people because of proper treatment. It will be bad news if rising prevalence continues to be driven by high rates of new infection.
How long the current ARV drugs will remain effective on a mass scale is still unknown because clinicians don't know how long it will take before drug resistance becomes a serious problem. New drugs are in the pipeline, but they are likely to be costly. The golden hope -- a vaccine against HIV infection -- is likely to be two decades off. The development of microbicides and chemical condoms is likely to be a little bit faster.
Economy
It's difficult to isolate the effect of HIV/Aids on the economy. Certainly the impact on macroeconomic indicators is thought to be small. This is in part because South Africa has such high levels of unemployment and many HIV-positive people are not formally employed, or else are in jobs where replacements can be found fairly easily. Research by the Stellenbosch University-based Bureau for Economic Research in 2006 found that on average the impact of HIV/Aids on GDP would be a decline of 0,4% to 0,6%.
Now social scientists are looking to the developmental and intergenerational effects of HIV/Aids and are finding corrosive and long-term impacts that are difficult to measure quantitatively. But one recurring finding is the need to develop the human resources of the country. It is the impact on women, who tend to have an overwhelming role in child rearing, as well as being workers in the formal and informal sectors, that is likely to have profound repercussions on South African society.
In 2005 30% of women attending public antenatal clinics were HIV-positive. It is estimated that young women are four times more likely to be HIV-positive than their male peers. Ten years ago the highest mortality rate for women was in the 70 to 79 demographic. Five years ago it had shifted to women in their late twenties and early thirties. The result has been the rise of "skipped generation" households, with grandmothers caring for grandchildren.
posted by AIDS-Care-Watch at 9:45 am
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