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November 18, 2010

South Africa: At Least 5 Million New HIV Infections Expected Over next 20 years

by Joe DeCapua

A new report says South Africa can expect to have at least five million new HIV infections over the next 20 years.  That’s nearly the same number of people currently living with the disease in the country.

The report was released by the aids2031 South Africa Project.  It outlines for the first time Africa’s “difficult long-term choices and escalating costs” in battling the epidemic.

Collaborating on the findings were the Cape Town-based Center for the Economic Governance on AIDS in Africa and the Washington-based Results for Development Institute.

Robert Hecht, one of the authors and also managing director of the Results for Development Institute, says, “For South Africa, five million infections over the next 20 years is going to be a heavy toll, a heavy burden.”

It translates, he says, into 250,000 new HIV infections every year.

“You have to remember South Africa is a country that already has nearly six million people that are HIV positive,” he says.

Best-case scenario

Hecht warns, though, things could become much worse.

“The scenario or the future where there are five million new infections is actually an optimistic scenario because we also explored in our work with the South Africans possibilities for the future that are much worse.  If South Africa were to basically maintain its prevention and treatment programs at the levels where they are today, there could be as many as 11 million new infections over the next two decades,” he says.

The report says South Africa currently has about 500,000 new infections every year.

What needs to be done

Hecht says to keep new HIV infections as low as possible the South African government needs to maintain the political will over the pandemic that it’s shown in recent years.

“Secondly,” he says, “there’s going to need to be some leadership and efforts to promote social change in South Africa, so that some of the underlying sexual behaviors that are spreading HIV can change gradually.”

What’s more, the report calls on the government to take a long-term view on the money it spends on HIV/AIDS, rather than taking a “crisis approach.”

Hecht says, “It’s going to have to look carefully at how it can spend its money better.  Target that money on the prevention services that are going to be most effective; and make sure that its treatment program, which is already the largest in the world, is absolutely as efficient as possible.”

There are about one million people in South Africa receiving anti-retroviral drugs.

The cost

Holding the expected number of new infections won’t come cheap.  South Africa currently spends about (US)$2 billion annually on HIV/AIDS.

Hecht says that figure will “need to rise very dramatically over the next eight to 10 years.  We estimate in our report that under this maximum effort scenario, the one that would bring down the epidemic most rapidly, South Africa’s total spending would have to more than double…to somewhere between $4 and $5 billion.”

While South Africa would have to pay for most of the new AIDS funding, support would probably be needed from PEPFAR and the Global Fund to Fight AIDS, TB and Malaria.

Hecht says the discovery of a highly effective vaccine would be a “game changer.”  However, he adds, “We don’t see on the horizon in the next few years…such a vaccine coming along.  So, while we need to keep investing in that area, it’s not something that’s going to have an impact on the epidemic in South Africa in the next five or 10 years.”