HIV and AIDS in South Africa: what is an appropriate public health response?

Ninety-eight cases of acquired immune deficiency syndrome (AIDS)were reported in the Republic of South Africa by the end of1987, and 166 by mid-December 1988. By 12 February 1990, 353cases of AIDS had been reported: 326 in South Africans and 27in people from either elsewhere in southern Africa or abroad.The South African patients comprised two main groups: whitemen with the pattern of infection typical of homosexual andbisexual men; and heterosexuals exhibiting the pattern commonin much of central and southern Africa. There have been a smallnumber of people with haemophilia affected with AIDS, but onlyone injecting drug user with AIDS to date. There is evidenceof considerable spread of the epidemic into the South Africanblack population; migrant labour, the high prevalence of sexuallytransmitted diseases and suspicion of government-directed familyplanning programmes have all contributed to this. Seropositivityrates in South African blacks are noted to be rising rapidlyand the doubling time is considered to be about 8.5 months.The government and some employers have adopted discriminatorymeasures to control the disease, including the screening ofmigrant workers and the repatriation of those found to be seropositive.Public health leadership from the state authorities has beeninappropriate. We argue for greater involvement of homosexual,worker, community and public health personnel in developingpolicies of control for human immunodeficiency virus (HIV) infectionin South Africa, if the response is to be ethical, non-discriminatory,sensitive, prevention-orientated and effective.