Global Policy Forum

By Andrew Quinn

South Africa is entering the "death" phase of its Aids epidemic as mortality outstrips new infections, presenting new challenges for a health care system struggling to cope with the disease, scientists said on Monday. "South Africa is experiencing a devastating epidemic, the world's worst, and this is just the beginning," Quarraisha Abdool Karim, a researcher at the University of Natal, told the country's first national Aids conference in Durban.

South Africa's government is under fresh attack by activists who accuse it of failing to respond adequately to a disease which already infects 4,7 million South Africans, the highest single caseload in the world. Health Minister Manto Tshabalala-Msimang, blamed by activists for delaying the widespread introduction of life-prolonging anti-retroviral drugs in public hospitals, was publicly heckled at the opening of the conference on Sunday. She repeated her government's position that the drugs could not be rolled out without adequate preparation.

Activists say this policy effectively signs a death warrant for hundreds of thousands of South Africans who might otherwise cope with HIV as a manageable illness. Several hundred members of the Treatment Action Campaign, the country's largest Aids activist group, marched on the conference centre on Monday, many wearing T-shirts saying they were HIV-positive.

"The government's action is profoundly unhelpful... it has dragged its feet, it has delayed, it has deceived," TAC leader Zackie Achmat told reporters.

While adult HIV and Aids prevalence in the country is starting to plateau at around 33 percent, sickness and death are on the increase as the disease kills off workers in Africa's most vibrant economy. "What we are starting to see is the real face of the epidemic," Abdool Karim said. Scientists say South Africa's real Aids death toll is hard to quantify because government statistics list many probable Aids fatalities as deaths due to tuberculosis and other common HIV-related opportunistic infections.

But activists say Aids kills about 600 South Africans each day, a number that seems sure to grow as more people enter late stages of the disease without drug treatment. "Mortality is really just starting and won't peak for another three to four years," said Rod Hoff, a senior epidemiologist in the Aids division at the United States National Institutes of Health.

"The social and economic impact will be considerable. Industry is really going to take a hit as people get sick."

Abdool Karim said that in one major South African hospital, King Edward in Durban, an estimated 90 percent of hospital patients were HIV positive. In another sign of the toll Aids is taking on the country, national mortality rates for both men and women are rising sharply. It is up by 150 percent for men aged between 20 and 40, and even more for women aged between 20-35, the group most at risk for contracting the disease, researchers say.

Abdool Karim said the rising numbers of deaths would likely stabilise the overall national Aids prevalence rate but it would be "premature and foolish" to assume that Aids was coming under control in the country.

The data showed that South Africa would have to redouble its efforts at both prevention and treatment of HIV and Aids, as only a two-pronged approach would be effective, she said. "This is an incredibly critical period," she concluded, adding that it was "non-negotiable" the government should quickly roll out drug treatments.

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