Abstract
HIV infection levels are now rising rapidly in South Africa. In an initial stage of the AIDS epidemic in the country where the first cases of AIDS were seen among homosexuals in 1982, the pattern of AIDS resembled that initially seen in the USA and Europe. That phase now appears to have been superseded by a new one. Whilst the rate of increase amongst male homosexuals may even be showing some signs of levelling off, according to some reports,1 this second phase, one in which the disease is primarily heterosexually transmitted and which appears to be predominant among the black heterosexual population, is showing indications of gaining momentum. The first reported black heterosexual cases were seen in December 1987; 1988 saw paediatric cases being reported, and relatively recently around 100 cases of vertical transmission had been reported in the black population.2
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Grania Christie, ‘AIDS in South Africa’, undated paper, AIDS Centre, South African Institute for Medical Research, Johannesburg.
Ibid.
The apparently rapid spread of HIV is reflected in the reported doubling times of male and female STD attenders. Figures of 10.7 and 9.8 months respectively, and 6.6 months for female family planning attenders have been given. Among these three groups the HIV infection rate was 1.56 per cent, 1.37 per cent and 1.91 per cent, respectively. These samples were, however, small and, as with much of the data on doubling times, relate to specific geographical areas (in this case, predominantly the Witwatersrand area). Nevertheless, these and other figures from around the country indicate a continuing silent spread of the disease. See ‘Considerations on the further expansion of the AIDS epidemic in SA, 1990’, SA Medical Journal, by five Wits Watersrand University Virology Department professors and two Johannesburg City Health Department doctors, and reported in Business Day, 19 June 1990. See also Alan Whiteside, ‘AIDS in Southern Africa: a position paper for the Development Bank of Southern Africa’, Economic Research Unit, University of Natal and Development Bank of Southern Africa, 1990.
G.N. Padayachee and R. Schall, ‘Short-term predictions of the prevalence of human immunodeficiency virus infection among the black population of South Africa’, South African Medical Journal 77 (1990), pp. 329–33. They consider various forecasting models according to five categories: extrapolation, the direct method, back projection, macro-level, and micro-level models.
R.M. Anderson, R.M. May and R.R. McLean, ‘Possible demographic consequences of AIDS in developing countries’, Nature, 332, pp. 22832. See also R.M. Anderson, `The impact of the spread of HIV on population growth and age structure in developing countries’, in Alan F. Fleming, Manuel Carballo, David W. FitzSimons, Michael R. Bailey and Jonathan Mann. The Global Impact of AIDS (New York: Alan R. Liss, 1988), pp. 95 – 106.
John Bongaarts, `Modelling the spread of HIV and the demographic impact of AIDS in Africa’, The Population Council, Center for Policy Studies Working Papers, No. 140, October 1988.
Peter O. Way and Karen Stanecki, The demographic impact of an AIDS epidemic on an African country: application of the iwgAIDS model’, US Bureau of the Census, Center for International Research, Staff Paper No. 58, 1991.
Developed by Rodolfo Bulatao and Eduard Bos, Population and Human Resources Division, The World Bank. See PRAY: Projecting the Demographic Impact of AIDS (Washington, DC: The World Bank, 1991). Rodolfo A. Bulatao, ‘Projecting the demographic impact of the HIV epidemic using standard parameters’, unpublished paper, The World Bank, Washington, DC, 1988.
Kenneth Hill, ‘PROJ3S — a computer program for population projections’, The Johns Hopkins University, School of Hygiene and Public Health, 1990.
Peter D. Glasner and Richard A. Kaslow, The epidemiology of human immunodeficiency virus infection’, Journal of Consulting and Clinical Psychology, 58 (1990), pp. 13–21.
Roy Anderson and Graham F. Medley, ‘Epidemiology of HIV infection and AIDS: incubation and infectious periods, survival and vertical transmission’, AIDS, 2, suppl. 1 (1988), pp. 57–63.
In transfusion-infected patients estimates of the mean latency period have ranged from 4.5–15 years, the most recent of which showed a mean of 8 years for those in the 5–59 age group; see Glasner and Kaslow, ‘The Epidemiology’.
A summary of estimates of median survival times of AIDS patients reported by Anderson and Medley, ‘Epidemiology’, indicated a range of 9–13 months.
Glasner and Kaslow, ‘The Epidemiology’.
Anderson and Medley, ‘Epidemiology’.
Ibid.
J.L. Sadie, ‘A reconstruction and projection of demographic movement in the RSA and TBVC countries’, Bureau of Market Research, University of South Africa, Research Report no. 148, 1988.
For example, the demographic projection model estimates the level of TFRs that would have been prevailing in the five-year period prior to the base year according to the numbers in the 0–4 age group, in conjunction with assumed infant mortality rates. The calculated TFR was significantly lower than what would be anticipated and also lower than the level
assumed to be prevailing in 1985. This indicated a substantial underreporting of those in the 0–4 age group and, one may speculate, of the 0–1 age group in particular since this group has, in many contexts, a tendency to be underreported.
Transmission rates from a mother to her infant are assumed to be 0.64, 0.52, 0.28, 0.40, 0.60, 0.90 and 0.90 over successive infectivity periods. These rates are also those adopted in some World Bank runs of the PRAY model for other sub-Saharan African countries.
The degree to which condom use can assist in reducing the probability of transmission depends, of course, on a range of factors including, inter alia the quality of the condom and the extent to which it is used in the correct manner through all the aspects of its utilisation (the latter aspect is obviously difficult to measure).
Padayachee and Schall, ‘Short-term predictions’.
R. Schall, G.N. Padayachee and D. Yach, ‘The case for HIV surveillance in South Africa’, South African Medical Journal, 77 (1990), pp. 324–5.
The reported cumulative number of cases of AIDS in South Africa are as follows: 84 reported cases in 1987, 170 in 1988, 305 in 1989 and 554 to 1 November 1990. The WHO’s estimates for the equivalent years are 1800, 31 000, 4900, and 7150.
Peter O. Way and Karen Stanecki, ‘How bad will it be? Modelling the AIDS epidemic in Eastern Africa’, paper prepared for the Annual Meeting of the American Association for Advancement of Science, Washington, DC, February 1991.
Population Data Sheet, 1990 (Population Reference Bureau, Washington, DC).
A figure of 27 per cent of the black population, mainly in the 25–40 age group, infected by 2005 has been suggested by a Metropolitan Life study, reported in the Financial Mail 24 May 1991. Other estimates — for example, by Padayachee - suggest 20–25 per cent of the population aged between 15 and 62 years could be HIV positive by 1999. See also Dr Jack van Niftrik, ‘South African Consensus on Modelling’, AID Analysis Africa 2, 2 (August/September 1991).
It is of note that the WHO has initiated a new research initiative on sexual behaviour and reproductive health worldwide: see ‘New research initiative on sexual behaviour and reproductive health’, WHO Special Programme of Research, Development and Research Training in Human Reproduction, Task Force for Social Science Research on Reproductive Health.
Although these studies will be small-scale or exploratory studies rather than large-scale or national ones, they do focus on areas pertinent in the spread of AIDS.
A collection of studies on sexual networking is also presented in T. Dyson (ed.), Sexual Behaviour and Networking: Anthropological and Socio-Cultural Studies on the Transmission of HIV, forthcoming early 1992, International Union for Scientific Study of Population, Liege, Belgium.
In the South African context the author knows of one study of sexual
networking in the environs of a mine, but of no others at present.
See Wolf Bleek, ‘Lying informants: a fieldwork experience in Ghana’, Population and Development Review 13, 2 (1987), pp. 314–22, for a pessimistic view on surveys relating to delicate issues.
In his fieldwork in southern Ghana, Bleek noted the falsification of answers to survey questions asked by nurses, with the presentation of behaviour reported by respondents apparently conditioned by the desire to gain the nurse interviewer’s respect, rather than by a willingness accurately to report actual behaviour patterns.
An example of a carefully executed study on this area is ‘Sexual relationships, use and condoms, and perceptions of AIDS in an urban area of Guinea-Bissau with a high prevalence of HIV 2’, in Dyson, Sexual Behaviour.
Karen Jochelson, Monyaola Mothibeli and Jean Leger, ‘Restoring miners’ family lives will help control AIDS’, Business Day, 29 May 1991.
D.I. Foure, Medical Adviser, Chamber of Mines, has argued that the vast majority of mine workers do not have sexual behavioural patterns that place them at a greater risk for HIV than similar groups of males (Response to Jochelson, Mothibeli and Leger in Business Day, June 1991).
Roy Anderson, S. Gupta and W. Ng, The significance of sexual partner contact networks for the transmission dynamics of HIV’, Journal of Acquired Immuno-Deficiency Syndromes, 3 (1990), pp. 417–29; and R.M. Anderson, R.M. May, M.C. Boily, G.P. Garnett and J.T. Rowley, ‘The spread of HIV-1 in Africa: sexual contact patterns and the predicted demographic impact of AIDS’, Nature, 352 (15 August 1991).
Rodolfo A. Bulatao and Eduard Bos, ‘Implications of control measures for the spread of HIV infection’, unpublished paper, The World Bank, Washington, DC, 1988.
Sharon Kingman, ‘Sisters of the Revolution’, The Independent on Sunday, 2 June 1991, reports on an AIDS counselling project in Soweto where the problems involved in attempting to increase condom use are pronounced; see also Anna Strebel, of the University of the Western Cape, Seminar on ‘Women and AIDS in South Africa’, London School of Hygiene, July 1991.
Editor information
Editors and Affiliations
Copyright information
© 1996 Palgrave Macmillan, a division of Macmillan Publishers Limited
About this chapter
Cite this chapter
Brophy, G. (1996). Modelling the Demographic Impact of AIDS: Potential Effects on the Black Population in South Africa. In: Cross, S., Whiteside, A. (eds) Facing up to AIDS. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-24930-5_6
Download citation
DOI: https://doi.org/10.1007/978-1-349-24930-5_6
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-0-333-66990-7
Online ISBN: 978-1-349-24930-5
eBook Packages: Palgrave Social & Cultural Studies CollectionSocial Sciences (R0)