A Brief History of HIV in South Africa

Efforts Marred by Deteriorating Health Infrastructure and Past AIDS Denial

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Nicholas Raymond

Nowhere in the world is the AIDS epidemic been more devastating than the continent of Africa. For South Africa, political turmoil and a long history of government denial fueled an epidemic that had reached disastrous proportions by the late 1990s and early 2000s. 

Even today, despite plunging death rates and greater leadership on the AIDS war front, the rate of new HIV infections continue to rise year on year.

As a result, South Africa remains the country with the largest single population of HIV-infected people in the world.

South African Demographics

Located at the southern-most tip of the African continent, South Africa has a population of roughly 48 million people (about one sixth as many as the U.S.) spread over 1.2 million square miles (about one fourth the size of Texas.

The country has eleven official languages, including English, with a 79% black and 10% white population.

HIV Statistics in South Africa

The most current estimate suggests that 5.7 million South Africans are living with HIV, representing about 12% of the population (or nearly one in eight citizens). Moreover

  • the HIV rate among adults is today over 18% (or roughly one in five people).
  • one in four people aged 15 to 49 years are believed to be infected with HIV.
  • 45% of all deaths in the country can be attributed to HIV.
  • 13% of South African blacks are infected with HIV versus 0.3% of South African whites.
  • currently it is estimated that there are 600,000 orphaned children as a result of AIDS.

A Short History of HIV in South Africa

The HIV epidemic emerged in South African around 1982. However, as the country was in the midst of the dismantling of apartheid, the HIV problem was for the most largely ignored.

Silently, while political unrest dominated the media, HIV began to take hold, both in the gay community and the vulnerable black population.

By the mid-1990s, even as HIV rates had increased by 60%, the government remained slow in its response to what was becoming a public health disaster. It was only the 1990s that President Nelson Mandela acknowledged his government's grievance response to the crisis, by which time South Africa had already become the largest population of people with HIV in the world.

By 2000, the South African Department of Health outlined a five-year HIV/AIDS plan but received little support from South African President Thabo Mbeki. After consulting a group of AIDS denialists headed by Dr. Peter Duesberg, Mbeki rejected conventional HIV science and instead blamed the growing AIDS epidemic on poverty, colonialism, and corporate greed.

Without government support, the five-year plan did not get off the ground as quickly as planned, with few showing up to receive from free antiretroviral medication.

In the meantime, HIV among pregnant South African women soared from eight-tenths of 1% in 1990 to over 30% by 2000.

It was only with the removal of Mbeki from office in 2008 that the government took steps to rein in the catastrophe, ramping up efforts to become what is today the largest HIV drugs program in the world.

However, increasing pressure to expand outreach has been undermined by a deteriorating public health infrastructure and the weakening of the South African currency (rand) under President Jacob Zuma. To date, less than 30% of people with HIV are on therapy, while infection rates among young adults continue to rise, unheeded.

The Faces of HIV in South Africa

For decades, the prevailing thought among South Africans was that HIV/AIDS was a disease of the poor. And that remains largely true, with little to stop the spread of infection in poverty stricken communities.

Among those most affected;

  • Young people ages 15 to 24 years make up the largest proportion of HIV infected people in South Africa, roughly 50%.
  • Women account for 55% of all new infections. Social and economic disparity, female disempowerment, and high rates of rape in South Africa are among the causes for these numbers.
  • Men who have sex with men (MSM) are at high risk of HIV in South Africa, with an estimated prevalence of 33%. A dearth of HIV-specific services for gay and bisexual men, as well as cultural disapproval in some communities are driving the high rates.
  • Migrant workers are as exceptionally high risk of HIV, with some mining communities showing infection rates of over 60%. Male-only populations compounded by high rates of commercial sex trade work in tandem to create a perfect storm for infection.

Successes in the South African HIV Battle

It would be unfair to say that the picture has been all doom and gloom for South Africa. One of its major successes has been the reduction of mother-to-child transmission (MTCT) of HIV. With better surveillance at antenatal clinics and widespread use of prophylactic HIV medications, the rate of MTCT dropped from 8% in 2008 to 2.7% by 2012.

As a result, the HIV death rate has also dropped among children has also dropped by 20%. Despite this, the implementation of antiretroviral therapy in children has fallen well behind that of adults, and over 70% of all maternal deaths in South Africa attributed to HIV.

Learn more about HIV in South Africa today at "Is South African Winning the AIDS Battle?"


Human Sciences Resource Council (HSRC). "South African National HIV Prevalence, Incidence and Behaviour Survey, 2012." Pretoria, South Africa; December 2014; accessed February 17, 2016.

Natrass, N. "AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa." Oxford Journals: African Affairs. February 2008; 107(427):157-176.

U.S. Centers for Disease Control and Prevention (CDC). "CDC's HIV/AIDS Care and Treatment Programs in South Africa: TB and HIV." Atlanta, Georgia; December 5, 2011.

Heywood, M. "The Price of Denial." Interfund Development Update. December 2004; 5(3).

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