If prevention is better than cure, how is South Africa measuring up when it comes to halting the progress of the HIV pandemic? From the look of things, our performance is not only poor, it is deteriorating.

The number of HIV positive people in South Africa is estimated to be about 5.7 million people. This equates to an infection rate of 11.7% among the general population. The infection rate is estimated to be 21.3% among adult women, and an even more alarming 29.1% amongst pregnant women who visit antenatal clinics.

Given these statistics, in which almost one in thee pregnant women in South Africa is HIV positive, it is no bold claim to assert that the HIV pandemic has reached crisis proportions. Not all news on the HIV frontier is gloomy, however, as the anti-retroviral treatment programme seems to have expanded to the point that it is starting to meet the demand. However, merely treating those already infected does not contain the disease in any way. A recent survey released by the Human Sciences Research Council (HSRC) has measured not only the prevalence of the disease, but also provides data on some of the information campaigns being run, and their relative success.

The roots of South Africa's massive Aids pandemic, which is killing close to 1 000 people a day, lie in the country's colonial past, says scientist and Aids expert Dr Hoosen "Gerry" Coovadia.

Industrialisation in the late 19th century and its demand for labour started a break-up of black culture and traditions, which "sucked people into a vortex of urban settlement", he told Sapa, speaking at the 2009 International Aids Society (IAS) conference in Cape Town.

Coovadia is co-chairperson of the conference, and a world authority in the field of Aids research and policy making. He was responding to the question: Why is the prevalence of HIV and Aids so high in southern and South Africa - one in every five people have the disease - compared to other parts of the world.

Coovadia said his view, echoed by a number of colleagues, was the long-term effects of the history of South Africa, and southern Africa in general, might account for the scale of the HIV epidemic in the region.

Executive Summary

Introduction

South Africa has one of the highest rates of rape reported to the police in the world and the largest number of people living with HIV. The rate of rape perpetration is not known because only a small proportion of rapes are reported to the police. There is considerable concern about the links between these two problems. Obviously HIV can be transmitted in the course of rape and this compounds the human rights violation of the rape. Research has established that men who rape and are physically violent towards partners are at more likely to engage in sexual risk taking than other men and this has raised a concern that they are more likely to be infected with HIV. The aim of this research was to understand the prevalence of rape perpetration in a random sample community-based adult men, to understand factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV.

Methods

The study was conducted in three districts in the Eastern Cape and KwaZulu Natal Provinces - spanning geographical areas: rural, urban and city. It was a crosssectional with a two stage random sample. The sample was drawn by Statistics South Africa. Following a cluster design, 222 enumeration areas (ea) were selected and 20 households approached per ea for interview. One man aged 18-49 years interviewed per household. Interviews followed a questionnaire and were administered via APDAs (Audio-enhanced Personal Digital Assistants). A finger prick specimen of blood was requested for HIV testing and collected as a blood spot which was dried.

Fifteen percent of South African school children between the ages of 12 and 17 years would knowingly spread HIV, the SABC reported on Wednesday.

This was revealed in a study of more than 15 000 school children by an international group of epidemiologists based in Canada.

The organisation's Nobantu Marokane said that most of the learners who said they would spread the virus had been abused.

"These learners were not tested so they did not know if they were HIV positive. In most cases, these learners have been exposed to some kind of abuse."

This was not necessarily sexual abuse, she said.

"It might not have been sexual abuse butthe thinking to say because it happened to me, I might be HIV positive, they were opening themselves up to riskier behaviour by saying that they would spread it intentionally," she said.

The study also revealed that 15% of South African school children had been forced to have sex.

"We used forced sex without consent, so they understood the term that this was forced, it was not coercion, it was forced sex without consent and that is the number of our learners that said 'yes, this has happened to me'.

"And for me what is striking is that... this is happening to more boys than girls...," Marokane said.