History in the new South Africa: an introduction - Det danske ...

16 The impact of the AIDS epidemic in South Africa
By Hein Marais
History has not been kind to South Africa. 30 After centuries of colonialism came one of the
most ferocious systems of institutionalized racism the world has known. For almost 50 years,
apartheid wreaked havoc in the lives of black South Africans while securing for whites
possibly the highest standard of living in the developing world. By the early 1990s, after a
long liberation struggle, the country was beginning to extricate itself from its ignominious
past. The future seemed to be there for the making—except that the country now found itself
in the path of a swiftly-growing AIDS epidemic which, in a few years, would become the
worst such epidemic in the world.
As South Africans voted in their first democratic election in April 1994, few were thinking
about AIDS, and even fewer had an inkling of what the epidemic held in store for them and
their country. A mere four years earlier, it had been estimated that less than 1% of adult South
Africans were infected with HIV, the virus that causes AIDS. An enduring sense of
exceptionalism encouraged the notion that South Africa, somehow, would evade the serious
epidemics underway in other parts of East and Southern Africa. The Communist Party leader
Chris Hani was one of the rare public figures to have recognized the threat. In 1990, he had
told conference-goers in Maputo that:
Those of us in exile are especially in the unfortunate situation of being in the areas where the
incidence of this disease is high. We cannot afford to allow the AIDS epidemic to ruin the
realization of our dreams. Existing statistics indicate that we are still at the beginning of the
AIDS epidemic in our country. Unattended, however, this will result in untold damage and
suffering by the end of the century. 31
HIV data highlight two prime features of South Africa’s epidemic: the astonishing speed with
which it evolved (national adult HIV prevalence of less than 1% in 1990 rocketed to almost
25% within 10 years), and its extraordinary intensity. When voters went to the polls for the
country’s second-ever democratic election in 1999, at least 3 million and possibly as many as
4 million South Africans were living with HIV, the virus that causes AIDS. 32 By 2006, that
number had surpassed 5 million (ASSA, 2005). 33
30 This article is based on Hein Marais’s book Buckling: The impact of AIDS in South Africa, published by the
Centre for the Study of AIDS at Pretoria University. An electronic version is available at
http://www.sarpn.org.za/documents/d0001789/index.php
31 Chris Hani, speaking at an AIDS conference in Maputo, Mozambique, 1990, cited in Marais H (2000). To the
edge: AIDS Review 2000. Pretoria, Centre for the Study of AIDS.
32 The Actuarial Society of South Africa’s (ASSA) AIDS models are among the most sophisticated of their kind.
The 1999 figure is derived from the ASSA 2002 model, which retrospectively estimated that 3.2 million South
Africans were living with HIV in that year. Using less nuanced assumptions and data, UNAIDS/WHO (2000)
estimated there were 4.2 million South Africans with HIV at the end of 1999.
33 ASSA (2005). ASSA 2003 AIDS and demographic model. Cape Town, ASSA. For a summary, see
http://www.assa.org.za/scripts/file_build.asp?id=100000538&pageid=1000000022. The latest estimates of the
Actuarial Society of South Africa are that 5.2 million South Africans were living with HIV in 2005, compared
with the Joint United Nations Programme on AIDS (UNAIDS) estimate of 5.5 million.