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Collections under which this article appears: HIV Infection/AIDS

BMJ 2002;324:1477 ( 22 June )
 

News roundup

South Africa’s HIV/AIDS epidemic may be flattening out

Pat Sidley Johannesburg

South Africa’s HIV/AIDS epidemic seems to be flattening out, according to figures released by the national health department.

The government’s much delayed annual statistical report estimates that some 24.8% of pregnant women attending antenatal clinics were infected with HIV at the end of 2001, compared with 24.5% in the previous year.

Slight decreases in prevalence were shown among teenagers, from 16.1% in 2000 to 15.4% last year.

The survey's authors say that the drop is not statistically significant, however, whereas they say that the substantial rise among women aged 30-39 is significant. Experts have questioned the reliability of figures showing a drop in prevalence in that age group in KwaZulu-Natal (the province with the highest prevalence rate in the country) from 36.2% in 2000 to 33.5% last year.

The sentinel population for the study includes pregnant women attending a public sector antenatal clinic for the first time during the current pregnancy.

The women were also tested for syphilis, and 2.8% had syphilis infections. The figure had declined from 4.9% in 2000. One province, the Northern Cape, however, showed a marked increase between the two years.

Some anomalies have been pointed out by researchers and AIDS activists, who have become used to having to debunk official government pronouncements on HIV and AIDS. This follows two difficult years for researchers and health professionals in the field, whose efforts to control the serious epidemic were thwarted by doubts in the government, led by President Thabo Mbeki, that HIV leads to AIDS.

Dr Debbie Bradshaw of the Medical Research Council (MRC) who was part of the MRC team that produced a study contested by the government on the effects of the epidemic on South Africa’s mortality patterns, said much of the antenatal survey was in keeping with the MRC’s research.

She believed it was too early to state that the epidemic had "flattened" but saw indications of this. The MRC’s research was based on a model which predicted that the epidemic would flatten in 2004. "It is slowing, but it has not turned the corner yet," she said.

There were, however, questions around the apparent drop in prevalence in KwaZulu-Natal. The MRC research had indicated the prevalence should have been closer to 40% last year—but it seemed to have slowed to 33.5% from 36.2%. There do not seem to be any explanations for this.

Shortly before the government released its report, the death at the age of 44 from pneumonia was announced of one of the most recent vocal exponents of the theory that HIV may not lead to AIDS and that antiretroviral drugs cause more deaths than the disease they assist.

Peter Mokaba, a noted outspoken activist with the African National Congress, and former deputy cabinet minister with a colourful past, had spent the latter part of last year and the early part of this year as the loudest exponent of some of the more eccentric views expressed in the country on AIDS.

It was widely rumoured, however, that he had the disease, particularly after he looked wasted and ill and then disappeared from view for over two years. He reappeared, however, looking well, denied he had the disease or had taken antiretrovirals and then died suddenly.

It brought back earlier memories of the death of President Mbeki’s spokesman, Park Mankahlana, an equally vocal exponent of dissident views who died at a similar age, with similar rumours.

Newspapers and broadcasters in the country, which reported the death of Mr Mokaba, were criticised by the African National Congress for hinting at a link with AIDS. No newspapers were prepared to state categorically what many thought was obvious, however. Typical was part of the report in Business Day which read: "Officials would not say what caused Mr Mokaba’s death, but he had for a long time been denying media reports and rumours that he was HIV-positive."

Despite the funeral notices in the Sowetan daily newspaper, made up of photographs of people who have died disturbingly young, the newspaper (which is the country's largest circulating newspaper that is run and read by black people) failed to draw attention to the rumour of the cause of Mokaba’s death.

National HIV and Syphilis Sero-prevalence Survey of Women attending Public Antenatal Clinics in South Africa can be accessed at: www.gov.za
 
 
 

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No surprise

David Rasnick

bmj.com, 21 Jun 2002 [Full text]

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