Lessons from Tropical Africa for Addressing the HIV/AIDS Epidemic in South Africa

  • Alan Fleming


The main epidemic of HIV and AIDS, in the majority population of South Africa, is the geographical extension southwards of the pandemic in East and Central Africa. Heterosexual contact is the dominant mode of transmission. This one fact determines the pattern of impact of AIDS on society, on demography and on the economy: the clinical expression in adults and children is affected largely by the mode of transmission, so society’s response and its attempt to contain the epidemic will be meaningful only insofar as there is an understanding of the heterosexual partner contact networks in South Africa.


Human Immunodeficiency Virus Type Herpes Zoster Global Impact South African Medical Journal Oral Manifestation 
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  1. 1.
    P. Piot and M. Caraël, ‘Epidemiological and sociological aspects of HIV-infection in developing countries’, British Medical Bulletin, 44 (1988), pp. 66–8; A.F. Fleming, ‘AIDS in Africa’, Baillière’s Clinical Haematology, 3 (1990a), pp. 177–205.CrossRefGoogle Scholar
  2. 2.
    C.W. Hunt, ‘Migrant labour and sexually transmitted disease: AIDS in Africa’, Journal of Health and Social Behaviour, 30 (1989), pp. 353–73.CrossRefGoogle Scholar
  3. 3.
    Fleming, ‘AIDS in Africa’.Google Scholar
  4. 4.
    C.R.B. Prior and G.C. Buckle, ‘Blood donors with antibody to human immunodeficiency virus–the Natal experience’, South African Medical Journal, 77 (1990), pp. 623–5.Google Scholar
  5. 5.
    J. Chin, ‘Current and future dimensions of the HIV/AIDS pandemic in women and children’, Lancet, 336 (1990), pp. 221–4.CrossRefGoogle Scholar
  6. 6.
    S. Berkley, W. Naamara, S. Okware et al., ‘AIDS and HIV infection in Uganda–are more women infected than men?’, AIDS, 4 (1990), pp. 1237–42; Chin, ‘Current and future dimensions’; Rwandan HIV Seroprevalence Study Group, ’Nationwide community-based serological survey of HIV-1 and other human retrovirus infections in a central African country’. Lancet, i (1989), pp. 941–3.Google Scholar
  7. 7.
    Berkley et al. ‘AIDS and HIV infection’.Google Scholar
  8. 8.
    Fleming, ‘AIDS in Africa’.Google Scholar
  9. 9.
    K.M. de Cock, B. Barrere, M.F. Lafontaine et al., ‘Mortality trends in Abidjan, Côte d’Ivoire, 1983–1988’, AIDS, 5 (1991), pp. 393–8.CrossRefGoogle Scholar
  10. 10.
    R.M. Anderson, S. Gupta and W. Ng, ‘The significance of sexual partner contact networks for the transmission dynamics of HIV’ Journal of Acquired Immune Deficiency Syndromes, 3 (1990), pp. 417–29.Google Scholar
  11. 11.
    R.W. Ryder, W. Nsa, S.E. Hassig et al., ‘Perinatal transmission of the human immunodeficiency virus type 1 to infants of seropositive women in Zaire’, New England Journal of Medicine, 320 (1989), pp. 1637–42.CrossRefGoogle Scholar
  12. 12.
    P. Paterlini, S. Lallemant-Le Coeur, M. Lallemant et al., ‘Polymerase chain reaction for studies of mother to child transmission of HIV-1 in Africa’, Journal of Medical Virology, 30 (1990), pp. 53–7.CrossRefGoogle Scholar
  13. 13.
    M. Lallemant, S. Lallemant-Le Coeur, D. Cheynier et al., ‘Mother-child transmission of HIV-1 and infant survival in Brazzaville, Congo’ AIDS, 3 (1989), pp. 643–6;CrossRefGoogle Scholar
  14. P. Lepage, F. Dabis, D.-G. Hitimani et al., ‘Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda’. AIDS, 5 (1991), pp. 295–300;CrossRefGoogle Scholar
  15. P.G. Miotti, G. Dallabetta, E. Ndovi et al., ‘HIV-1 and pregnant women: associated factors, prevalence, estimate of incidence and role of foetal wastage in central Africa’ AIDS, 4 (1990), pp. 733–6;CrossRefGoogle Scholar
  16. M. Temmerman, F.A. Plummer, N.B. Mirza et al.,‘Infection with HIV as a risk factor for adverse obstetrical outcome’, AIDS 4 (1990), pp. 1087–93.CrossRefGoogle Scholar
  17. 14.
    M.R. Braddick, J.K. Kreiss, J.E. Embree et al., ‘Impact of maternal HIV infection on obstetrical and early neonatal outcome’, AIDS, 4 (1990), pp. 1001–5.CrossRefGoogle Scholar
  18. 15.
    Ryder et al., ‘Perinatal transmission’.Google Scholar
  19. 16.
    Chin, ‘Current and future dimensions’.Google Scholar
  20. 17.
    E.A. Preble, ‘Impact of HIV/AIDS on African children’, Social Science and Medicine, 31, 6 (1990), pp. 671–80.CrossRefGoogle Scholar
  21. 18.
    A.F. Fleming, ‘Opportunistic infections in AIDS in developed and developing countries’ Transactions of the Royal Society of Tropical Medicine and Hygiene, 84 (1990), suppl. 1, pp. 1–6;Google Scholar
  22. S.B. Lucas, ‘Missing infections in AIDS’ Transactions of the Royal Society of Tropical Medicine and Hygiene, 84 (1990), suppl. 1, pp. 34–8.Google Scholar
  23. 19.
    Fleming, ‘AIDS in Africa’.Google Scholar
  24. 20.
    Fleming, ‘Opportunistic infections’.Google Scholar
  25. 21.
    R. Widi-Wirski, S. Berkley, R. Downing et al., ‘Evaluation of the WHO clinical case definition of AIDS in Uganda’ Journal of the American Medical Association, 260 (1988), pp. 3286–9.CrossRefGoogle Scholar
  26. 22.
    C.P. Conlon, A.J. Pinching, C.U. Perera et al. ‘HIV-related enteropathy in Zambia: a clinical, microbiological, and histological study’, American Journal of Tropical Medicine and Hygiene 42 (1990), pp. 83–8; Fleming, ‘Opportunistic infections’.Google Scholar
  27. 23.
    Fleming, ‘Opportunistic infections’; Z. Mugaruka, J.H. Perriëns,. Kapita and P. Piot, ‘Oral manifestations of HIV-1 infection in Zairian patients’, AIDS, 5 (1991), pp. 237–8.Google Scholar
  28. 24.
    M. Schiodt, I.Bygbjerg, P. Bakilana et al. ‘Oral manifestations of HIV-infection in Tanzania’. Second International Symposium on AIDS and Associated Cancers in Africa, Naples, 7–9 October 1987, Abstracts, p. 106.Google Scholar
  29. 25.
    Mugaruka et al. ‘Oral manifestations’.Google Scholar
  30. 26.
    Fleming, ‘AIDS in Africa’; Fleming, ‘Opportunistic infections’.Google Scholar
  31. 27.
    Fleming, ‘AIDS in Africa’; Fleming, ‘Opportunistic infections’; K.M. de Cock, E. Gnaore, G. Adjorlolo et al., ‘Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast’, British Medical Journal, 302 (1991), pp. 496–9; A.E. Pitchenik, ’Tuberculosis control and the AIDS epidemic in developing countries’, Annals of Internal Medicine, 113 (1990), pp. 89–90.Google Scholar
  32. 28.
    O.O. Simooya, M.N. Maboshe, R.B. Kaoma et al., ‘HIV infection in newly diagnosed tuberculosis patients in Ndola, Zambia’, Central African Journal of Medicine, 37 (1991), pp. 4–7.Google Scholar
  33. 29.
    B. Standaert, F. Niragira, P. Kadende and P. Piot, ‘The association of tuberculosis and HIV infection in Burindi’, AIDS Research and Human Retroviruses, 5 (1989), pp. 247–51.CrossRefGoogle Scholar
  34. 30.
    F. Davachi and N. Mayemba, ‘AIDS in infancy’, Postgraduate Doctor Caribbean, 7 (1991), pp. 56–63.Google Scholar
  35. 31.
    F.K. Nkrumah, R.G. Choto, J. Emmanuel and R. Kumar, ‘Clinical presentation of symptomatic human immunodeficiency virus in children’, Central African Journal of Medicine, 36 (1990), pp. 116–20.Google Scholar
  36. 32.
    H.J. Lambert and H. Friesen, ‘Clinical features of paediatric AIDS in Uganda’, Annals of Tropical Paediatrics, 9 (1989), pp. 1–5; P. Lepage, P. van de Perre, F. Dabis et al., ‘Evaluation and simplification of the World Health Organization clinical case definition for paediatric AIDS’, AIDS, 3 (1989), pp. 221–5; O. Müller, P. Musoke, G. Sen and R. Moser, ’Paediatric HIV-1 disease in a Kampala hospital’, Journal of Tropical Paediatrics, 36 (1990), pp. 283–6.CrossRefGoogle Scholar
  37. 33.
    R.A. Bobat, H.M. Coovadia and I.M. Windsor, ‘Some early observations on HIV infection in children at King Edward VIII Hospital, Durban’, South African Medical Journal, 78 (1990), pp. 524–7.Google Scholar
  38. 34.
    F. Spielberg, C.M. Kabeya, T.C. Quinn et al., ‘Performance and cost-effectiveness of a dual rapid essay system for screening and confirmation of human immunodeficiency virus type 1 seropositivity’, Journal of Clinical Microbiology, 28 (1990), pp. 303–6; S. Nick, E. Chimfuembe, G. Hunsmann and A.F. Fleming, ‘Simple and inexpensive detection and confirmation of anti-HIV-1 in sera from Africa’, AIDS, 5 (1991), pp. 232–3.CrossRefGoogle Scholar
  39. 35.
    G.A. Lloyd, ‘HIV-infection, AIDS, and family disruption’, in A.F. Fleming, M. Carballo, D.W. FitzSimons, M.R. Bailey and J. Mann (eds), The Global Impact of AIDS (New York: Alan R. Liss, 1988), pp. 183–90; M. Carballo and M. Caraël, ‘Impact of AIDS on social organizations’, in Fleming et al., The Global Impact pp. 81–93.Google Scholar
  40. 36.
    M. Over, S. Bertozzi, J. Chin, B. N’Galy and K. Nyamuryekung’e. ‘The direct and indirect cost of HIV infection in developing countries: the cases of Zaire and Tanzania’, in Fleming et al., The Global Impact pp. 123–35; F. Davachi, P. Baudoux, K. Ndoko, B. N’Galy and J. Mann, ‘The economic impact on families of children with AIDS in Kinshasa, Zaire’, in Fleming et al., The Global Impact pp. 167–9.Google Scholar
  41. 37.
    C. Beer, A. Rose and K. Tout, ‘AIDS - the grandmother’s burden’, in Fleming et al., The Global Impact pp. 171–4.Google Scholar
  42. 38.
    P. Onyanga and P. Walji, ‘The family as a resource’, in Fleming et al., The Global Impact pp. 301–6.Google Scholar
  43. 39.
    B.M. Nkowane, ‘The impact of human immunodeficiency virus infection and AIDS on a primary industry: mining (a case study in Zambia)’, in Fleming et al., The Global Impact pp. 150–60.Google Scholar
  44. 40.
    J.T. Rowley, R.M. Anderson and T.W. Ng, ‘Reducing the spread of HIV infection in sub-Saharan Africa: some demographic and economic implications’, AIDS, 4 (1990), pp. 47–56.CrossRefGoogle Scholar
  45. 41.
    R. Schall, ‘On the maximum size of the AIDS epidemic among the heterosexual black population of South Africa’, South Africa Medical Journal, 78 (1990), pp. 507–10.Google Scholar
  46. 42.
    N. Abel, T. Barnett, S. Bell, P. Blaikie and S. Cross, ‘The impact of AIDS on food production systems in east and central Africa over the next ten years: a programmatic paper’, in Fleming et al., The Global Impact pp. 145–54.Google Scholar
  47. C.M. Chela, I.D. Campbell and Z. Siankanga, ‘Clinical care as part of integrated AIDS management in a Zambian rural community’, AIDSCare, 1 (1989), pp. 319–25; I.D. Campbell, ‘AIDS care and prevention — a community approach. Part I: structuring a response’, Postgraduate Doctor Middle East. 13 (1990), pp. 641–6; I.D.Campbell, ‘AIDS care and prevention — a community approach. Part II: structuring a response’, Postgraduate Doctor Middle East 13 (1990), pp. 722–4.Google Scholar
  48. 44.
    R.W. Goodgame, ‘AIDS in Uganda — clinical and social features’, New England Journal of Medicine, 323 (1990), pp. 383–9.CrossRefGoogle Scholar
  49. 45.
    Panos Institute and Save the Children, AIDS and Children: A Family Disease — Mini-Dossier 2 (London, 1989), p. viii.Google Scholar
  50. 46.
    Ibid.; S.H. Kapiga, G. Nachtigal and D.J. Hunter, ‘Knowledge of AIDS among secondary school pupils in Bangamayo and Dar-es-Salaam, Tanzania’, AIDS, 5 (1991), pp. 61–7.CrossRefGoogle Scholar
  51. 47.
    R.W. Ryder, M. Ndilu, S.E. Hassig et al., ‘Heterosexual transmission of HIV-1 among employees and their spouses at two large businesses in Zaire’, AIDS, 4, 8 (1990), pp. 725–32; M. Kamnega, R.W. Ryder, M. Jingu et al., ‘Evidence of marked sexual behaviour change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire’, AIDS, 5 (1991), pp. 61–7.CrossRefGoogle Scholar
  52. 48.
    S. Moses, F.A. Plummer, E.N. Ngugi et al., ‘Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group’, AIDS, 5 (1991), pp. 407–11.CrossRefGoogle Scholar
  53. 49.
    A.F. Fleming, ‘Prevention of transmission of HIV by blood transfusion in developing countries’, in Fleming et al., The Global Impact pp. 357–67.Google Scholar
  54. 50.
    A. du P. Heynes, E. Kuun and R.L. Crookes, ‘The risk of transmitting HIV by blood and blood products from the South African Blood Transfusion Service’, 31st Annual Congress of the Federation of South African Societies of Pathology, Warmbaths, 30 June-3 July, Abstract H18 (1991), p. 125.Google Scholar
  55. 51.
    Global Blood Safety Initiative of the WHO and League of the Red Cross and Red Crescent Societies, Guidelines for the Appropriate Use of Blood, WHO/GPA/INF/89, 18, WHO/LAB/89. 10 (Geneva: WHO, 1989).Google Scholar
  56. 52.
    I.R. Friedland, K.P. Klugman and A.S. Karstaedt et al. ‘AIDS — the Baragwanath experience. Part I. Epidemiology of HIV infection at Baragwanath Hospital, 1988–1990’, South African Medical Journal 82 (1992), pp. 86–90.Google Scholar
  57. 53.
    I.R. Friedland and J.A. McIntyre, ‘AIDS–the Baragwanath experience. Part II. HIV infection in pregnancy and childhood’, South African Medical Journal, 82 (1992), pp. 90–4.Google Scholar
  58. 54.
    A.S. Karstaedt, ‘AIDS–the Baragwanath experience. Part III. HIV infection in adults at Baragwanath Hospital’, South African Medical Journal, 82 (1992), pp. 95–7.Google Scholar
  59. 55.
    C.W. Allwood, I.R. Friedman, A.S. Karstaedt and J.A. McIntyre, ‘AIDS–the Baragwanath experience. Part IV. Counselling and ethical issues’, South African Medical Journal, 82 (1992), pp. 98–101.Google Scholar

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© Palgrave Macmillan, a division of Macmillan Publishers Limited 1996

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  • Alan Fleming

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