Re: PROCAARE: REQUEST FOR INFORMATION--HIV INFECTION--SOUTH (fwd)

[Albert Shaw <ashaw@usa.healthnet.org>]

From: "Mary L. Fielder" <worthy@u.washington.edu>

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Mary Fielder, Assistant to                     1001 Broadway, Suite 215
  King K. Holmes, M.D., Ph.D.                  Seattle, WA 98122-4304
  Director, Center for AIDS and STD            Phone: (206) 720-4248
  University of Washington                     Fax: (206) 720-5003
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---------- Forwarded message ----------
Date: Mon, 21 Oct 1996 01:33:01 -0400 (EDT)

From: DONALD_SUTHERLAND@isdtcp3.hwc.ca
To: ASMITH@cafod.org.uk
Subject: Re: PROCAARE: REQUEST FOR INFORMATION--HIV INFECTION--SOUTH 

     Ann: I did some work with Dr. Quarisha Abdool Karim (sp?) Head of SA's 
     AIDS control programme) earlier this year and I had the distinct 
     impression that she knew the data concerning South Africa very well 
     and would be the best source. Good Luck Regards Dr Don Sutherland.



Dear Mary
The only national HIV data in South Africa arises from annual, 
anonymous surveys conducted between October and November among pre -
natal clinic attenders. These surveys have been conducted since 1990 
and to date 6 surveys have been completed with the seventh in 
progress.  These data provide a fairly reasonable picture of trends 
in terms of the spread of HIV through heterosexual contact which is 
the dominant mode of transmission in South Africa. 

HIV Seroprevalence among Prenatal clinic attenders in South Africa: 
1990-1995
Year              Prev (%)
1990               0.76
1991               1.49 
1992               2.69 
1993               4.69  
1994               7.51
1995               10.44  

There are stark age, race and geographical differences in the 
distribution of HIV.


HIV seroprevalence among prenatal clinic attenders by province
                            prevalence (%)
   Province                1994         1995
   KwaZulu/Natal           14.3         18.2
   Mpumalanga              12.1         16.2 
   Free State               9.2         11.0
   Gauteng                  6.4         12.0
   North West               6.7          8.3
   Northern                 3.0          4.9
   Eastern Cape             4.5          6.0
   Western cape             1.2          1.7
   Northern Cape            1.8          5.3

It is clear that there are many epidemics unfolding and we do not 
have a good understanding of all the factors influencing transmission 
dynamics. 

Based on these data it is estimated that there are approximately 2 
million South Africans infected the majority of whom are black and 
are unlikely to even know that they are infected.

These estimates are based on sample sizes close to 20 000.  Three  
population based surveys in KwaZulu/Natal from 1990-1992 indicated 
that these prenatal estimates are conservative. Further that migrants, 
women and young people between the ages of 15 and 30 have 
approximately 3 times more infection.  Perinatal transmission studies 
in select sites demonstrate a transmission rate of about 30% from 
infected mother to infant.  It is estimated that HIV was introduced 
into the "heterosexual population" around 1987 - this is quite an 
explosive progression within a very short space of time.  AIDS is 
fairly rare but an increase in TB cases have been observed with 
the increase largely attributed to new infections in young women - it 
is estimated that about 50% of all TB cases are HIV related 
(reliability of estimates?)    

Hope this information is a  useful start.

Regards

Quarraisha Abdool Karim