[procaare] South Africa: Is the HIV/AIDS epidemic beginning to level off?

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South Africa: Is the HIV/AIDS epidemic beginning to level off?
-[Healthlink],(24.10.03).
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South Africa: Is the HIV/AIDS epidemic beginning to level off?

AIDS experts have raised doubts about a new study suggesting South Africa's HIV/AIDS
epidemic peaked in 2002 and was expected to level off as fewer new infections were
reported.

The study, published in the recent issue of the African Journal of AIDS Research, said
that the epidemic in South Africa peaked last year with about 4.69 million people living
with HIV/AIDS and had started to level off. It also noted that HIV incidence rates in the
15 to 49 age group had decreased "substantially" from 4.2 percent in 1997 to 1.7 percent
in 2003.

These projections were based on a new statistical model developed by Dr Olive Shisana,
executive director of HIV/AIDS research at the Human Sciences Research Council (HSRC), and
Thomas Rehle, an independent consultant in international health and disease control. The
study used data from the Department of Health's national antenatal HIV prevalence survey
and the 2002 Nelson Mandela/HSRC Study of HIV/AIDS, Dr Thomas Rehle told PlusNews. "This
is an updated scenario and the model is not based on out of the sky assumptions, but real
data from the field," he said.

The researchers attributed the decrease in HIV prevalence to changes in sexual behaviour
following the introduction of HIV prevention programmes and "the impact of rising HIV/AIDS
related mortality". But leading South African HIV/AIDS researcher Rob Dorrington, director
of the Centre for Actuarial Research at the University of Cape Town, was sceptical about
the findings.

Earlier studies of South African's HIV/AIDS epidemic had projected much higher HIV
prevalence and mortality rates. The Actuarial Society of South Africa's statistical
model - ASSA 2000 - predicts that without major behavioural or medical changes, life
expectancy is likely to fall to 41 years by 2009. By then it expects that 16 percent of
the total population will be infected with HIV.
A report by the US Census Bureau projected that as many as 37.9 percent of sexually active
adult South Africans could be HIV-positive by 2010, when there could be as many as 900,000
AIDS-related deaths each year.

According to Dorrington, the new model was based on "a lot of assumptions". Consequently,
the study results were "simply derived as a direct result of the assumption of future
prevalence", he told PlusNews.

AIDS experts have also questioned the use of data from the Nelson Mandela/HSRC study, as
the findings had not been through a peer-review process. But Rehle called for researchers
to "focus on the debate on the interpretation of the currently available research".

"Although our projections of the future HIV/AIDS burden in South Africa are relatively
moderate compared to the projections made by various other researchers, the projected
morbidity and mortality due to HIV/AIDS underscore nonetheless the same conclusion: the
importance of acting now to fight the epidemic with an increased commitment from all
levels of society," the study concluded.

Source: IRIN, PLUSNEWS, 22 October 2003
HealthLink Bulletin 24/10/2003
Web: http://www.hst.org.za

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