The HIV-AIDS pandemic in Africa: its implications for human development in the continent and the critical issues in its control: country report for South Africa presented by The Academy of Science of South Africa (ASSAf)

Gevers, W.

Discovery and Innovation 17(Special Edition): S48-S51

2005


ISSN/ISBN: 1015-079X
Document Number: 198749
South Africa is severely affected by the pandemic of HIV infection, with the largest total number of affected individuals in any single country in the world. Between 4-5.5 million people out of a population of about 45 million people are affected. The pandemic overwhelmingly involves HIV sub-type C, and is mostly acquired through heterosexual intercourse. Deaths from the end-stages of HIV infection (AIDS) predominate amongst women in the age range of 15-40 years, and amongst men in the age range of 35-55 years. Enormous pressure is increasingly being exerted by the HIV pandemic on health services, the social structure of many communities, and the economy in general. Life expectancy is falling and the number of "AIDS orphans" is also increasing. The government of South Africa has been hesitant to fully recognize the unique threat posed by HIV infections to the new-found democratic freedoms and economic progress of the country, preferring to categorize the virus infection as simply one of many diseases of poverty and under-development, to be addressed primarily by socio-economic upliftment and general disease prevention, and only secondarily by prioritized, large-scale specific therapeutic interventions. Great emphasis is given to the "ABC" approach of infection prevention (Abstinence, Being faithful to single sexual partners, and using Condoms when at risk). A comprehensive roll-out of specific anti-retroviral therapy is now rather slowly getting under way, claimed to be the "largest and most comprehensive in the world". From the point of view of a science academy, the outstanding considerations are the urgent need for indigenous local scientific capacity to help inform and manage both preventive and therapeutic strategies and best-practices; enhancing local involvement in vaccine generation, trialling and production; discovering effective new immune stimulants and antiviral agents; identifying and dealing with drug-resistant HIV strains; training and empowering the vast numbers of health professionals and other role-players required for the massive anti-HIV campaigns; and catalyzing effective public communication and debates. In this context, it is worth mentioning that it is local scientists who have brought to the fore the insight that acute HIV infection in naive subjects is probably associated with the most infectious state, as the associated high viraemia consists mostly of competent viruses, as opposed to the lower "set-point" viraemia of asymptomatic HIV-positive persons in whose blood and secretions mostly inactive, mutated viruses circulate. Important preventive measures (hardly in use at the present time) can be based on this insight, which needs further detailed study, both in terms of an assessment of its role in bringing about new infections in given populations, and in the search for possible immune-diagnosis prior to specific HIV-directed seroconversion. A second noteworthy example in connection with local scientific effort is the recent indication that non-toxic, stable, broad-spectrum antiviral agents may be present in certain plant extracts isolated in the Western Cape region of South Africa. Clearly, science academies are essential elements in the fight against the further spread of HIV infection and its seriously destructive consequences for our continent.

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