Burden of Disease Research Unit

What is the impact of HIV/AIDS in South Africa?
The Human Immunodeficiency Virus (HIV) and the accompanying health sequel, Acquired Immunodeficiency Syndrome (AIDS), has emerged as a global pandemic, with a potentially catastrophic impact on human societies. Sub-Saharan Africa, with 75% of the world’s HIV/AIDS population is faced with a critical public health challenge in addressing this epidemic and preventing the decimation of large sections of the population. The epidemic is also threatening the South East Asian region.

In South Africa the prevalence of HIV was less than 1% among antenatal clinic attendees in 1990 and has now reached levels of 30%. HIV/AIDS is the largest single cause of death, accounting for 25% of deaths in 2000 and 47% in 2006. As can be seen from Table 1, besides infants and children under 5 years of age, the economically critical age groups have the most HIV/AIDS deaths. The high number of young adult deaths as well as child deaths can be seen from this table. The South African Burden of Disease study has shown that HIV/AIDS is the cause of almost 40% of premature mortality, measured as years of life lost, in the year 2000 and, with no intervention strategies, will account for 75% of premature mortality by 2010. Table 2 shows the number of HIV/AIDS deaths estimated for the year 2006. Prevention has been prioritized and in 2004, the South African Government introduced a treatment programme. Approximately 230 000 HIV-infected individuals were receiving antiretroviral treatment by the end of 2006.

Table 1. Estimated number of deaths by age group and sex, South Africa 2000

Source: Norman et al, 2003.
http://www.mrc.ac.za/bod/bod.htm

Table 2. Projected number of deaths by age group and sex, South Africa 2006

Source: Dorrington et al, 2006.
http://www.assa.org/aidsmodel.asp

The ASSA2003 model estimated the total population of South Africa to be about 48 million in 2006 (http://www.assa.org/aidsmodel.asp). Assuming a realistic change in behaviours and roll-out of treatiment, the model estimates that 5.4 million people are HIV positive, accountring for 11% of the whole population. The model projects that the prevalence will stabilise at a level of about 5.4 million as the number of AIDS-related deaths then will start matching the number of people newly infected with HIV.

The prevalence rate varies across age groups and by gender. Figure 1 shows that the prevalence rate is higher for women than men in the 15 to 34 year age group, while it is higher for men in the older ages. Among women, the rate is highest (over 30%) for the age group 25-29 years. Among men, the rate peaks at slightly older ages, with 26% of those aged 30-34 years being estimated to be infected.

Figure 1. Estimated prevalence of HIV by sex and age in 2006, ASSA2003

Source: Dorrington,  Johnson, Bradshaw and Daniel, 2006.
http://www.mrc.ac.za/bod/DemographicImpactHIVIndicators.pdf

The incidence of infections, the number of people who are newly infected in a specified time period, is one of the most important indicators of the progression of the epidemic that needs to be monitored, particularly in the more mature stage of the epidemic. Incidence peaked at nearly 700 000 in 1998 and has started to decrease. (The number of newly infected persons are the number of uninfected persons at the beginning of a 12-month period, who become infected over that 12 months). Figure 2 shows the projected number of people who were and will be expected to be newly infected with HIV each year from 1990 to 2010.

It is important to note that, although the annual incidence has started to decline, the number of people newly infected each year is still are very high. In 2006, it is estimated that over half a million persons (530000) were estimated newly infected, which means that an estimated 1400 persons were newly infected with HIV per day.

Figure 2. Projected number of newly infected people by sex and age group, ASSA2003

Source: Dorrington, Bradshaw, Johnson and Daniel, 2006.
http://www.mrc.ac.za/bod/DemographicImpactHIVIndicators.pdf

Deaths from AIDS have been increasing from the late 1990s. It is estimated that in 2006 around 740 000 deaths occurred, of which 350 000 were due to AIDS (approximately 950 AIDS-related deaths per day). This mortality has resulted in an increasing number of children who are orphaned. The number of maternal orphans who are under 18 years of age is estimated to be over 1.5 million 2006 and two thirds are as a result of AIDS.

The demographic impact of HIV/AIDS on the South African population is apparent in statistics such as life expectancy, which has dropped from 63 in 1990 to 51 in 2006, and in the under-5 mortality rate, which has increased from 65 deaths per 1000 births in 1990 to 75 deaths per 1000 births in 2006. Mortality rates in 1990 suggested that a 15-year old had a 29% chance of dying before the age of 60, but mortality rates in 2006 suggest that 15-year olds have a 56% chance of dying before they reach 60.

Model estimates of the impact of HIV and AIDS are used to extend available empirical data to assess scenarios. As the epidemic has progressed and more empirical data have become available and the possible scenarios have changed, for example, the introduction of treatment, the models have  been adjusted. Recent years have seen most of the models of the impact of HIV and AIDS being revised downwards. However, they all point to a devastatingly large impact of the disease.  

• The Demographic Impact of HIV/AIDS in South Africa: National and Provincial Indicators for 2006, November 2006 (pdf format, 542 kb)
• The Demographic Impact of HIV/AIDS in South Africa: National Indicators for 2004, November 2004 (pdf format, 215 kb)
• HIV/AIDS profile in the provinces of South Africa - indicators for 2002 and trends for each province. (pdf format, 2.14 Mb)

Updated 10 February 2007