*EPF510 06/04/2004
HIV/AIDS Rates in South Africa Serve as Warning for Others
(Experts see parallels in Russia, China and India) (740)

By Tara Boyle
Washington File Staff Writer

Washington -- The spike in South Africa's HIV infection rate has been caused by a "perfect storm" of political and cultural factors that should serve as a warning to other nations struggling to combat HIV/AIDS, economists at a World Bank discussion said on June 2.

Historically poor government policies on HIV/AIDS, a large migrant labor force, gender inequality and unsafe sexual practices have exacerbated South Africa's AIDS crisis, panelists said, causing a growth in the HIV prevalence rate from less than 1 percent in 1990 to nearly 25 percent in 2001, according to figures from the United Nations.

"This should stand as a forewarning to other governments about being complacent about HIV/AIDS. While we remain unclear about the specific interplay of factors that caused the virus to spread so rapidly, there are enough patterns of behavior in South Africa that may resonate with other countries," said Kyle Kauffman, an associate professor of economics at Wellesley College in Massachusetts.

In China, for example, Kauffman said, the nation's migrant laborers could contribute to the spread of HIV/AIDS in the same way that they have in South Africa, while in Russia, the government has shown a similar unwillingness to combat HIV/AIDS aggressively, he suggested. And in India, the "subservient role of women to men" in some regions mirrors gender relations in parts of South Africa, he said.

Jeffrey Lewis, manager of the Development Prospects Group at the World Bank, said that India, Russia and China are all experiencing a "creeping up" in their HIV/AIDS rates that should be a cause for alarm. "You see the same stigmatization and denial [in these countries]," he said. "I think in all of these cases the potential for really getting it wrong is enormous."

South Africa is a particularly alarming example for other nations because of how rapidly HIV/AIDS spread through the population -- and because its rate of infection is still climbing, the panelists said.

"We are still very much in the phase of an expanding epidemic in the South African context," Lewis said. The nation's HIV/AIDS infection rate is not expected to "top out" until 2007, he added. "That's to a large extent related to the fact that the deaths start catching up with the new infections, and so the size of the population that's available to be infected has actually begun to shrink," he said.

The disease has had a particularly dramatic effect on adults in South Africa, with one-third of people "in the most productive phases of their lives" infected with HIV/AIDS, Lewis said. In some sectors, such as the military, the rate of infection is more than 60 percent.

The high infection rate has transformed HIV/AIDS from a public health problem to a broad social and economic crisis in South Africa, panelists said.

The World Bank estimates that by 2010, the HIV/AIDS crisis will have caused the real GDP growth rate in South Africa to drop by nearly one percentage point, to 1.25 percent a year. Without AIDS, the rate of real GDP growth would be 3.5 percent in 2010.

Several panelists argued that governments could stem these problems if they decide to combat HIV/AIDS aggressively before infection rates get out of control in their nations. In the early 1990s, for example, Thailand and South Africa had roughly the same HIV/AIDS infection rates, Lewis noted. Today, Thailand's HIV/AIDS rate is less than 3 percent, while South Africa's infection rate has skyrocketed.

"Thailand intervened aggressively through a variety of social programs, through a variety of health interventions, through public awareness campaigns. ... I think the lesson that I take out of this is that for countries that are not as far along the prevalence curve as South Africa, there are turning points in the process. It's certainly very clear that prevention is much more cost-effective than cure or amelioration after the fact," Lewis said.

Keith Hansen, manager of the AIDS Campaign Team for Africa at the World Bank, said that the South African example might be more relevant for nations such as Russia and China than it is for other countries in sub-Saharan Africa. In Africa, many governments recognize that HIV/AIDS is a serious problem, but have not been able to get money for antiretroviral drugs and other treatments to the grassroots level.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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