Time to deal with the reality of AIDS
As more South Africans develop AIDS symptoms, employers will have to start dealing with the implications of the disease. LEE-ANNE SMITH reports
He says the HIV/AIDS epidemic could be more severe here than in other comparable African countries because of a combination of factors such as rapid urbanisation, labour mobility, and a highly developed transport infrastructure: "Prevalence (the proportion of infections in the population) is in line with the Doyle Model's worst-case scenario. The epidemic is no different from what was witnessed in countries like Uganda and Malawi. Almost all communities in South Africa's nine provinces are in the epidemic stage (prevalence greater than 1% in the adult population)."
Data shows that prevalence in rural areas of KwaZulu-Natal is often greater than in urban areas. Doyle says this is particularly worrying and can be attributed to excellent mobility together with the existance of a migrant labour system. In contrast, in Uganda there is a massive differential between rural and urban prevalence.
In addition, many African countries are only 30% urbanised whereas South Africa is already about 50% urbanised and this figure could well increase. On top of this, HIV/AIDS is not only a disease of the poor and unemployed; data shows prevalence among people working in all sectors of the economy to be as high as among the unemployed.
When the Doyle Model was developed in 1990 it made a significant assumption - that the biggest co-factor in the spread of HIV/AIDS was the presence of other sexually transmitted diseases.
Doyle says one of the key advances in HIV/AIDS research recently has been confirmation by the Mwanza Tanzania Trial that the treatment of STDs reduces the rate of new HIV infections. A random sample of 12 000 adults was monitored over a two-year period to record HIV incidence and prevalence. The incidence of HIV infections over two years was 1,2% in the intervention group compared with 1,9% in comparison communities.
Hope that the number of new infections occurring may have decreased comes from studies of the epidemic in Uganda, which has one of the older epidemics in Africa. A study of recent trends in HIV infection in women attending several antenatal clinics in Uganda shows significant declines in HIV prevalence. "This shows, for the first time in Africa, an absolute drop in prevalence, and that we can look forward to when the epidemic will peak at a more manageable level."
There has been a fundamental shift in the way the epidemic is being viewed by all stakeholders because they are beginning to feel its impact, and also because data in support of what was forecast six years ago is beginning to emerge, says Doyle. "Companies will have to become more proactive in their approach to dealing with AIDS in the workplace, especially in the light of the implications of the recently promulgated Labour Relations Act, and the fact that the expected higher mortality and disability arising from AIDS will have a significant impact on employee benefits."
He warns that South Africa will not be able to change the fundamental course of the AIDS epidemic. "But it is possible to reduce the incidence and improve the situation for future generations."