Is the AIDS epidemic in South Africa over?
Hello readers and welcome to my first real blog (the previous one was just to introduce myself). The short answer to the question posed in the title is an unqualified YES. An epidemic is defined as “a disease affecting many persons at the same time, and spreading from person to person in a locality where the disease is not permanently prevalent”. AIDS in SA had all the characteristics of an epidemic in the first 20 years it was present (1985 – 2005). The proportion of the population affected rose dramatically from less than 1% in 1990 to more than 9% in 2001. Total deaths in SA doubled from less than 300 000 per year in the mid-90s to more than 600 000 in 2006 and the average South African’s life expectancy dropped to less than 54 years in 2005 from a high of 62 years in the early 1990s. As a country we were heading towards a cliff with all spheres of life being affected through reduced economic growth, reduced efficiency, a large number of AIDS orphans and a general despondency. The situation was exacerbated by denialism from Government and the lack of readily available antiretroviral treatment (ART) for those that most needed it and could least afford it.
Then the sun came up in South Africa. Government made an about turn in its policy and from 2004 started rolling our ART. It started slowly, with fewer than 50 000 people covered in 2004, but accelerated rapidly over the next decade. The most recent estimates are that more than 2.7m people are receiving ART. Initially, ART was only available to those patients that had a CD4 count (number of white blood cells that can fight the disease) of below 200 cells per µl. Such people were already very sick with the disease, but got better if they stuck to a very regimental programme of ART drugs. However, many people started treatment too late or could not maintain the regimen and still died. In 2012, Government decided to increase the roll-out of ART to try and include AIDS-sick people earlier. The CD4 count threshold was increased to 350 cells per µl. People that only had mild AIDS symptoms were now also able to obtain drugs. The results were dramatic. The total number of deaths in SA fell to just over 450 000 in 2012 and average life expectancy increased dramatically to over 61 years in 2012, almost as high as pre-epidemic levels.
By 2012, Government had cut drug costs to below R90 per patient per month and started moving towards a single dose therapy. Instead of having to take drugs multiple times a day, the single drug therapy was much easier to adhere to. On top of this, from January 2015, the CD4 threshold will again increase to 500 cells per µl. This would mean that people that showed no symptoms, but were tested positive could receive ART. Why would this be necessary? Because being on ART makes you less infectious. Increasing the number of patients with higher CD4 counts, could act as a prophylactic, helping to stem the spread of the disease. Further developments such as a monthly injection (already available, but not yet used in SA) and vaccines (positive signs on a number of fronts) could further drive improvements going forward.
In my recently published research (done with the help of co authors from the University of Stellenbosch and Deloitte) we project that the average life expectancy of a South African could increase to over 65 years over the next decade. This is very good news! For HIV positive individuals, for policyholders in the entry-level life assurance market, for SA life assurers and for the country as a whole.
To make sure that people in SA get the full benefit of the improved AIDS environment, it is imperative that the stigma surrounding this disease be addressed. AIDS does not have to be a killer. Being HIV positive is like having any other chronic condition – recent research has shown that HIV positive individuals who have been on ART for more than 6 months have a lower chance of dying than people with Type 2 Diabetes. Treatment is free – if you get tested and your CD4 count is below 500 cells per µl (from January next year), you can get free ART. Treatment has been simplified – you now have to take one pill a day, which is much easier than having to take insulin injections multiple times a day. Go and get tested and treated!
Reducing the stigma surrounding HIV/AIDS is very important because it will save lives, it will increase productivity and it will allow individuals to get better value for money when it comes to life assurance. But that is a topic for my next blog.
If you want a sneak preview and you have the time and inclination, you can download our full paper on AIDS mortality.
Until next time, keep your talk straight!