AIDS in South Africa^*

Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV.

Some 320,000 South Africans died of AIDS in 2006. That figure is expected to rise to 500,000 per year in the next few years. Life expectancy at birth has fallen from about 60 years to 49 years for women and 47 years for men as of the end of 2006. Some 5,300,000 adults aged 15 and over are living with HIV in South Africa, and more than 58% of these are women. In South Africa, more women than men are infected, and women bear the brunt, both of the infections and the care of the infected. Girls are much more likely to be taken out of school to care for the sick and manage the home.

South Africa currently has a high proportion of children who are not continuously cared for by either parent, and very high rates of care by aunts and grandmothers. This is due to the history of displacement of people during the racially segregated apartheid era, combined with the migrant labor system. In that system, the men of the communities tend to work in distant mines, factories, farms, and other industries, often seeing their families only once or twice a year. High poverty, low education levels and an inadequate welfare system result in more risk-taking behavior and commercial sex work. Shifting social norms permit high numbers of sexual partners. A highly volatile work force and a good transport system (compared with other African countries) allow spread of the virus.

The AIDS epidemic inserts itself into this already fragile family environment, at least partially through lonely men using infected sex workers and bringing the disease home to their wives. Cultural norms often make use of condoms unwelcome for the men. The low status of women in society makes it difficult for them to protect themselves in sexual relationships, and married women have a higher rate of infection than sexually active unmarried women. Myths such as “have sex with a virgin to be cured” exacerbate the problems. One of the worst consequences is the creation of AIDS orphans and other children whose family members are HIV positive. In 2006, 240,000 children in South Africa were living with HIV, and there were 1,200,000 children orphaned by AIDS.

KwaZulu-Natal (KZN), home to the village of Ndawana where Edzimkulu is working, is pinpointed as the nucleus of the disease in South Africa, but statistics for the province are sketchy and often in conflict.

For a summary of the history of HIV/AIDS in South Africa, please see the AVERT web site.

* All statistics from UNAIDS and AVERT.

Supporting the Children

Children affected by HIV/AIDS can best and most inexpensively be supported by keeping them in their communities rather than institutionalizing them in orphanages. That goal, in turn, is accomplished by providing food, education/training, housing, family support and other basic supplies to, or in support of, the children, their caregivers, and their communities in general. This is the major focus of Edzimkulu.

Progress in Ndawana

Ndawana statistics are readily available because Edzimkulu is regarded as the leader in providing rural counseling and testing for HIV, and to the end of 2006 we have tested more than 900 people in Ndawana (from a village with a population of about 3,800). By contrast, the regional hospital, St. Apollinaris, has tested less than 900 people. The St. Apollinaris catchment area is about 100,000 people. Of those tested in Ndawana, about 30% are HIV positive. The overall statistic however does not reveal the differences by age. Based on those we have tested, there is a prevalence rate of about 20% in the 15-24 age range, about 50% in the 25-45 age range, and 20% in the 46-60 age range. These statistics are slightly biased because women are over-represented in the test group.

Other Ndawana information as of year-end 2006:

• Ndawana has approximately 60 people on ARVs, (known as anti-retroviral treatment - ART) which is 50% more than the Underberg clinic.

• VCT is provided one day a week on a scheduled basis; there typically are about 20 people tested each week. In addition, the community health workers do VCT in people’s homes, and most days at least one person drops in to the centre requesting VCT.

• All blood for CD4 counts and baseline bloods is now drawn in Ndawana and sent to provincial labs for analysis. All adherence training for living with HIV and for preparation for initiation of ARVs is also provided by community health workers in Ndawana.

• As of January 2007 ARVs are delivered in Ndawana through a joint venture with the Department of Health and Valley Trust. This makes Ndawana the most remote ARV access site in KZN (and perhaps SA). Roger Pierie, head of HAST for the province, is visiting the site in February to assess the potential for full accreditation by the province as well as looking at Ndawana as a model for other rural under-serviced areas.

• As an outreach program VCT has been provided in five communities surrounding Underberg at the request of the Family Literacy Program (FLP) and people in Underberg. More than 80 people were counseled and tested by Ndawana community health workers. This gave additional experience in VCT to these people and created much interest in our work in these communities.

• The district health manager, Mrs. Radebe, has asked Ndawana to offer workshops to teach other communities how to achieve what we have achieved. She publicly proclaims that Ndawana is the leader in the district and the hospitals, clinics and communities have to learn how to catch up to us.

• Dr. Pitt from Valley Trust, on contract to the Department of Health and responsible for ARV rollout in the Sisonke District Municipality, is now sending professional VCT counselors to Ndawana to learn from the community there. Virtually 100% of people counseled in Ndawana go for testing, a much higher rate than any other testing site in the District.

• We still will take more than 30 people to the hospital at St. Apollinaris every week until the ARV rollout in Ndawana is complete. People come publicly to the taxis, and everyone in the village knows the taxis are for people who are HIV positive. Ndawana has virtually eliminated stigma in the village.

• In nine months from June 2005 until March 2006 we recorded 22 deaths from AIDS with people we were transporting for treatment. During the following nine months we recorded only ten deaths, a decrease of 55%. We attribute this to getting people into the system much earlier, thus increasing the chances of successful treatment. Three of the ten deaths were due to a delay at provincial labs in completing blood work for people waiting to begin ART, which meant that people died while waiting for treatment.

As a result of all these factors, despite the gains we have made, there are a high number of AIDS orphans and other children affected by AIDS in Ndawana. At the end of 2006, there are some 270 orphans living in Ndawana, mostly due to AIDS, and many of these children are themselves HIV positive. We currently are feeding about 170 orphans every month. Many other children are affected and/or infected by HIV, and the number of orphans grows every month with the death of their parents from AIDS.