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The evolving HIV epidemic in South Africa

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The evolving HIV epidemic in South Africa. Salim S. Abdool Karim, MBChB, PhD and Quarraisha Abdool Karim, PhD. The authors.

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slide1

The evolving HIV

epidemic in South Africa

Salim S. Abdool Karim, MBChB, PhD

and

Quarraisha Abdool Karim, PhD

slide2

The authors

Salim S Abdool Karim, MBChB, PhD, is a clinical infectious diseases epidemiologist whose current research interests are in microbicides and vaccines to prevent HIV infection and implementation of antiretroviral therapy in resource constrained settings.

Quarraisha Abdool Karim, PhD, is an infectious diseases epidemiologist whose current research interests are in understanding the evolving HIV epidemic in South Africa; factors influencing acquisition of HIV infection in adolescent girls; and sustainable strategies to introduce HAART in resource-constrained settings.

slide3

Learning objectives

  • At the end of this lecture the student will:
  • Be able to define transmission dynamics of HIV
  • Have an understanding of the evolution of the HIV
  • epidemic in South Africa through 5 distinct periods
  • Know the distinct features of the South African HIV
  • epidemic
  • Gain knowledge of the essential interventions against
  • HIV/AIDS.
slide4

Transmission dynamics

  • Prevalence
    • - How much disease at a point in time
    • - Existing infected people
          • Implications for health impact
          • Indicates the need for health care
  • Incidence rate
    • - New infections in those without the infection
    • - Rate at which new infections are acquired
    • over a period of time
          • More sensitive for assessing growth of epidemic
          • Sensitive marker of effect of interventions
slide5

South Africa\'s HIV/AIDS epidemic

  • About 10% of global burden of infection
  • Major and Minor epidemic
  • Distinctive features of major epidemic
    • - Prior to 1987 HIV infection rare in general pop
    • - High prevalence
    • - Highest rates of infection in young women
    • - Predominantly subtype C

Source: Abdool Karim Q, Abdool Karim SS. South Africa: Host to a new and emerging HIV epidemic. Sex Trasm Inf 1999; 75: 139-140

Abdool Karim Q, Abdool Karim SS. Epidemiology of HIV infection in South Africa. AIDS 1999; 13: S4 - S7.

slide6

HIV Infection in ANC attendees in South Africa

40

30

HIV prevalence (%)

20

10

0

1988

1990

1992

1994

1996

1998

2000

2002

Source: National Department of Health, Pretoria, South Africa

slide7

Introduction of HIV in SA: Pre 1987

  • 1982 – First reported cases of AIDS
  • Epidemic largely limited to:
          • - Men who have sex with men
      • - Transfusion recipients and
      • - Haemophiliacs
  • Clade B
slide8

HIV infection in selected groups from 1985 - 1987

Source: Abdool Karim SS. Making AIDS a notifiable disease- is it an appropriate policy for South Africa? S Afr Med J, 1999; 89: 609-611

Dusheiko GM.Regional prevalence of hepatitis B, delta, and human immunodeficiency virus infection in southern Africa: a large population survey. Am J Epidemiol. 1989; 129(1):138-45.

slide9

HIV Infection in ANC attendees in South Africa

40

30

HIV prevalence (%)

20

10

0

1988

1990

1992

1994

1996

1998

2000

2002

Source: Department of Health

slide10

Age and gender distribution of HIV infection

in South Africa

10

Male

JUN/JUL 1992

Female

8

6

Prevalence (%)

4

2

0

<9

10-14

15-19

20-24

25-29

30-39

40-49

Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. Prevalence of HIV infection in Rural South Africa. AIDS 1992; 6: 1535 - 1539

slide11

HIV Infection in ANC attendees in South Africa

40

30

20

HIV prevalence (%)

10

0

1988

1990

1992

1994

1996

1998

2000

2002

Source: Department of Health

slide12

HIV incidence rates in a cohort of

sex workers in KwaZulu-Natal

Source: Abdool Karim SS, Ramjee G and Gouws E – Data from COL-1492 trial

slide13

Prevalence and incidence of HIV: Hlabisa clinic

attendees aged 15-49: 1992-2001

Source: Williams BG, Gouws E, Wilkinson D, Abdool Karim SS. Estimating HIV from Age Prevalence data e epidemic situation. Statistic in Medicine 2000.

slide14

Temporal trends in the age-specific prevalence of HIV

infection in antenatal clinic attendees in Hlabisa

Source: Wilkinson D, Abdool Karim SS, Williams B, Gouws E. High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for Intervention Trials. J Acquir Immune Defic Syndr 2000; 23: 405-409

slide15

HIV Infection in ANC attendees in South Africa

40

30

20

HIV prevalence (%)

10

0

1988

1990

1992

1994

1996

1998

2000

2002

Source: Department of Health

slide16

40

1999

2000

2001

30

Prevalence (%)

20

10

0

Gauteng

Limpopo

Free State

East Cape

North West

Mpumalanga

Western Cape

Northern Cape

KwaZulu- Natal

Province

Prevalence among antenatal clinic attendees by

Province 1999 – 2001

Source: Dept. Health – 12th National HIV and Syphilis Sero-prevalence survey of women attending

public antenatal clinics in South Africa 2001

slide17

Tuberculosis caseload and antenatal HIV prevalence

in Hlabisa district

Source: Hlabisa Hospital Records

slide18

AIDS in King Edward Hospital -1998

  • 54% of Medical in-patients were HIV+
  • 84% of HIV+ met WHO AIDS case criteria
  • 56% HIV+ co-infected with tuberculosis
  • Case fatality rates: HIV+ = 22% vs HIV- = 9%

Source: Colvin M, Dawood S, Kleinschmidt I, Mullick S, Lalloo U. Int J STD AIDS 2001, 386-389

slide19

350

300

250

200

PERCENTAGE OF 1985-1990 AVERAGE

150

100

50

0

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

Age specific mortality rate

1985 baseline for men

1996-1998

1999-2000

AGE

Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001

slide20

Age specific mortality rate

1985 baseline for women

3.500

3.000

2.500

1994

1996

2.000

1997/8

Ratio

1998/99

1.500

1999/2000

1.000

0.500

0.000

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

Age

Source: Dorrington R, Bourne D, Bradshaw D, Laubscher R, Timæus IM. The Impact of HIV/AIDS on Adult Mortality in South Africa. MRC Technical Report. 2001

slide21

Conclusion

  • Current epidemic phase has 5 parallel effects:
    • - Continuing large numbers of new HIV infections
    • - Ongoing high mother-to-child transmission rates
    • - Rising morbidity and its impact on health services
    • - Rapidly rising deaths
    • - Increase in numbers of orphans
  • Essential to intervene with:
    • - Prevention of new infections
    • - PMTCT programmes
    • - Care including OI prophylaxis and ARV treatment
    • - Social services for families impacted by AIDS deaths
    • - Programs and social services for orphans
slide22

Conclusion

  • HIV affecting mainly young women in SA, highlighting the importance of:
    • - interventions targeting youth
    • - addressing gender inequity
    • - greater involvement of men in prevention programs
  • South Africa is experiencing a devastating epidemic
slide23

Acknowledgements

  • Sources of Data
    • - National Department of Health, Pretoria, South Africa
    • - Debbie Bradshaw, South African Medical Research Council
    • - Rob Dorrington, University of Cape Town
    • Brian Williams, WHO, Geneva
    • Eleanor Gouws, WHO, Geneva
    • Cheryl Baxter, CAPRISA
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