BEE Partner, South Africa Economy Watch

In a highly significant paper, Nicoli Nattrass uses regression analyses to show that today ’simply being a southern African country increases HIV prevalence massively and significantly’. HIV prevalence, she says, ‘is eighteen times higher for southern African countries’ than anywhere else with similar levels of poverty and inequality (n.d.; emphasis in original). This is all the more striking because throughout the 1980s, as South Africans were engaged in the final struggle against apartheid, the country seemed sheltered from the onslaught of a disease that was taking its toll in both developed and developing countries, perhaps because of its relative isolation from the rest of sub-Saharan Africa, especially East Africa, where by the mid-1980s, it was clear that both the rate of increase and the progress of the disease from HIV infection to fully symptomatic AIDS was far more rapid and affected a far broader swathe of society than in the developed world.

The reasons for this are neither entirely clear, nor agreed upon among scientists, and have continued to puzzle President Mbeki. Nevertheless, the existing social science and medical literature does suggest some potential answers. One possibility is that the specific Glade, or subtype, of HIV-1 that occurs in southern and eastern Africa, is of greater virulence and infectivity than clades elsewhere.’ The C Glade predominates in southern Africa and Malawi, where HIV/AIDS has proven most devastating. In the Western Cape, with its diverse and historically segregated ethnic groups, both the C Glade and the B Glade, which is generally found in gay communities in Europe and the Americas, occur, suggesting two separate epidemics.’ This may contribute to the consistently lower prevalence of HIV/AIDS in the Western Cape.

Whether or not this suggestion is proven correct, the differences in the capacity to control the disease in southern and eastern Africa, both within the C-clade zone, are striking. There is some indication that the epidemic in South Africa has peaked and there has been some behavioural change (for geographical differences, see Actuarial Society of South Africa 2006). Nevertheless, prevalence and incidence levels remain substantially higher in southern than in eastern Africa, despite the considerable private and government resources that have been devoted to preventative programmes on the subcontinent and the ingenuity of non-governmental organisations (NGOs) and civic organisations, especially in South Africa, in tackling such problems as the cost of drugs, denialism and treatment literacy. There is no definitive answer to these challenges, although they suggest the continued need for and force of historical and sociocultural explanations.

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