Article - S007

An atomic bomb every six months – that’s AIDS in South Africa

Published on News24: 14 September 2017


Consider a scenario where South Africa is engaged in a terrible war with an invading country:


“Since the war started, over 3,8 million South Africans have lost their lives, and although the annual death toll has declined from an estimated 325 000 in 2006 to 150 000 in 2016, the war is still raging. Yet, despite this, the South African government and its people appear to have grown complacent about the war.


“Leaders seldom refer to it, and when they do, they focus predominantly on the nation’s hard-fought victories. This short-sighted approach serves only to distract their constituencies from the horrors of potential defeat.


Much of the population also chooses to live in ignorance and/or denial of the war, which in itself, undermines efforts on the frontline.” In reality though, our enemy is not an invading country, it’s a treatable virus known as HIV.


AIDS epidemic in context


The table below puts into perspective the sheer scale of South Africa’s HIV/AIDS epidemic by comparing it to other widely-reported human tragedies:


Human Tragedy (Year/s)                                            Official/Estimated Death Toll


Mining fatalities in RSA (in 2016)                                 73

9/11 Terrorist attack – United States (2001)             3 800

Ebola virus outbreak – West Africa (2014)                12 000

AIDS-related deaths in RSA (1 month in 2016)        12 500

Road deaths in RSA (in 2016)                                       14 000

Murders in RSA (in 2016)                                              18 500

Japanese earthquake/tsunami (2011)                        20 000

AIDS-related deaths in RSA (6 months in 2016)      75 000

Hiroshima atomic bomb (August 1945)                     80 000

Bangladesh cyclone (1991)                                          130 000

AIDS-related deaths in RSA (in 2016)                        150 000

Haiti earthquake (2011)                                                160 000

Indonesian earthquake/tsunami (2004)                     280 000

AIDS-related deaths in RSA (in 2006)                        325 000

Syrian War – civilian casualties (2011 – 2017)         450 000

Rwandan Genocide (1994)                                            800 000

AIDS-related deaths in RSA (1987 to 2017)              3 800 000

WW2 Holocaust (1939 – 1945)                                    6 000 000


If the figures above haven’t quite sunk in yet, consider that between 2011 and 2017, over 450 000 Syrians have been killed in the terrifying Syrian War. During that same time, South Africa registered over a million AIDS-related deaths, more than double the number of Syrian civilian casualties.


The scary truth is … HIV is preying on our nation’s fundamental weaknesses and without a concerted counteroffensive strategy, this costly war will never be won. 


Acknowledging our vulnerabilities


Without listing our nation’s historical shortcomings in dealing with the HIV crisis, we find ourselves here in 2017 with numerous unresolved government and societal vulnerabilities that facilitate HIV’s unrelenting proliferation.


The acronym ‘AIDS’ is useful in highlighting our societal vulnerabilities: abuse, ignorance, denial and stigma, and it is these that have enabled HIV to infect 20% of South Africa’s adult population.


Ironically, it’s the mass-rollout of ARVs that is largely responsible for the steady decline in the number of AIDS-related deaths since 2006 (refer to Chart #1 – red line), rather than the underwhelming efforts of national government and society to address our vulnerabilities.


This assertion is validated by the steady rise in our HIV population which rose by 180 000 in 2016, despite ARVs (refer to Chart #1 – green line). And, taking the 2016 AIDS-related deaths into account, there were effectively 330 000 new HIV-infections in 2016 alone.


(Note: Chart #1 can be found at the end of this article)


Today, over 7 million South Africans are HIV-positive, and the sad truth is that ARVs have lulled our society into a dangerous false sense of security.


Denialist society perpetuated by inept leadership


Considering the holocaust-scale of this HIV/AIDS epidemic, one would expect it to attract war-like attention from our national leadership, the media and the general public. But, inexplicably, this is not the case.


The ANC leadership appears to be so preoccupied with power retention, factional infighting, personal gain and scandal, that there is no time left for them to champion a nationwide AIDS-awareness initiative that is serious about eradicating HIV-transmission from our society.


Emanating from this, almost every form of media has been swamped with news and opinion in the wake of unprecedented national discord … and let’s face it, AIDS is old news.


All the while, our society remains stranded in either ignorance or the headlights of political and economic distraction. 


Nationwide counteroffensive is needed


With South Africa’s AIDS-related death toll already equivalent to 48 Hiroshima atomic bombs; annual HIV-infections exceeding the capacity of six Ellis Park stadiums; and ARV expenditure that could have funded a nuclear power station … the time is nigh for South Africa to declare war on HIV-transmission.


This counteroffensive strategy should complement the UNAIDS 90-90-90 initiative, whose goal is as follows: “By 2020: 90% of all people living with HIV will know their HIV-status; 90% of all people with diagnosed HIV-infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.”


As a priority, the counteroffensive should ‘motivate’ HIV-testing by making it a pre-requisite not only for free ARV treatment (if HIV-positive), but also for voting, grant and tax rebate eligibility. This HIV-test would need to be undertaken every 24 months to confirm a citizen’s eligibility for these basic privileges.


Importantly, the test result itself – either positive or negative – would have no bearing on a citizen’s eligibility, just so long as each citizen has had a test and knows his/her status.


If the test result is positive, then the citizen would be added to the National ARV Program and given counselling – including being informed of the legal consequences of not taking ARV treatment as prescribed and/or transmitting the disease to others. If the test result is negative, then the citizen would receive lifestyle guidance on how to remain HIV-negative.


With respect to foreigners or asylum seekers: temporary residence permits should be issued, then renewed every two years, with an HIV-test being a mandatory requirement each time. 


Light at the end of the tunnel


A significant positive of this counteroffensive strategy, is that the prevailing stigma of being seen at HIV-testing clinics will be immediately removed from society.


Another positive spinoff is the anxiety associated with an HIV-test where there is status-uncertainty, which should serve as motivation to embrace responsible sexual behaviour in the future. Ultimately, the long-term goal of the strategy would be for HIV-testing to become second nature, like taking an eye-test as part of renewing your driver’s licence.


This strategy could effectively see 90% of South Africa’s residents being tested, knowing their HIV-status, and being placed on ARVs by 2020. This success would translate into a greatly reduced transmission rate and death rate.


The war is at a tipping point


If a counteroffensive strategy of this magnitude is not adopted for fear of public disapproval, then we risk the inevitable evolution of drug-resistant HIV-strains which could lead to future soaring infection/death rates – that could well put the rest of the world at risk.


The United States knows this and has consequently contributed over R65 billion to South Africa’s ongoing HIV and ARV campaigns. This life-saving funding, which could be cut at any time, should be seen as a golden opportunity for us to contain the spread of HIV and protect our precious future generations from it.


In times of war, there’s no time for complacency… 


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Chart #1

Annual AIDS-related deaths & HIV Population in SA (2002 - 2016)

Source: Stats SA; Statistical release P0302-2016; Mid-year population estimates; Pages 6 & 7