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South Africa Table of Contents

South Africa

Incidence of Disease

Tuberculosis is the most prevalent disease reported to health officials in the 1990s. European settlers probably introduced this disease into southern Africa in the seventeenth or the eighteenth century, and it was perhaps reintroduced by nineteenth-century gold and diamond miners from Europe or China. Miners of all races lived in unhealthy and unsanitary conditions during the first decades of industrial development, and these conditions contributed to the spread of the disease in the early twentieth century. From the beginning, whites who became ill received better treatment than others. In 1955 tuberculosis reached epidemic proportions among black mineworkers, which prompted the South African Chamber of Mines to improve mineworkers' dwellings and health care services.

About 90 percent of tuberculosis cases reported after 1970 were among blacks. The rate of infection appeared to decline between 1970 and 1985, and the government, citing this decline, ended compulsory tuberculosis vaccinations in 1987. Although tuberculosis among blacks increased after that, health officials believed other causes were important. Overcrowding in urban housing projects increased in the late 1980s, and many tuberculosis patients discontinued treatment after only a few weeks, rather than the prescribed year. The South African National Tuberculosis Association reported that its case load increased from 88,000 cases in 1985 to more than 124,000 in 1990 and continued to increase after that. More than 6,000 people died of tuberculosis and related effects each year in the early 1990s. More than 47,800 new cases of the disease were reported in 1994.

Malaria ranked second among reported diseases, again affecting whites less than other racial groups. This disease reached epidemic levels in the late nineteenth and the early twentieth century, especially in the northern Natal and the lowveld areas of the northern and eastern Transvaal. During the 1960s, there were 2.7 cases of malaria per 100,000 nonwhites, compared with only 1.1 cases per 100,000 whites. As malaria increased during the 1970s and the 1980s, the gap between races widened and these rates rose to 40.5 cases per 100,000 among blacks, Asians, and people of mixed race, compared with six cases per 100,000 whites in the early 1990s. In 1994 health officials reported 4,194 cases of malaria nationwide.

Several factors probably contributed to the changing patterns in malaria incidence. The use of insecticides helped reduce the incidence of malaria temporarily in the 1950s. The 1972 worldwide ban on the insecticide, DDT, though only partially observed in South Africa, was followed by a steady increase in the incidence of malaria. At the same time, mosquitoes and other parasites became more resistant to chemicals and medicines. Residential patterns also changed, and several mosquito-infested areas of the country were permanently settled. For example, the black homelands of Venda, Gazankulu, and Lebowa were established in heavily malaria-infested areas of the northern Transvaal.

Most other diseases decreased between 1970 and 1990. In keeping with world trends, smallpox was virtually eradicated in South Africa by the 1970s. Diphtheria declined to almost negligible levels--fewer than 0.1 cases per 100,000 people--by 1990. Leprosy showed similar trends, diminishing to 0.5 cases per 100,000 in 1990.

Typhoid continues to appear in scattered areas of the country in the 1990s, and most typhoid cases are among blacks. In the early 1990s, between twenty-five and thirty-five cases of typhoid were reported per 100,000 blacks, per year, compared with fewer than eight cases per 100,000 whites, Indians, and coloureds. A total of 581 new cases were reported in 1994. Measles outbreaks remained fairly steady in the early 1990s, with thirty to seventy new cases per 100,000 whites, coloureds, and Indians, and sixty to 150 cases per 100,000 blacks, each year. In 1994 a total of 1,672 cases of measles were reported. Other common ailments, such as gastroenteritis, kill several hundred black South Africans each year, even though these diseases are easily treatable in South African hospitals.

Infectious and parasitic diseases cause roughly 12 percent of all deaths among blacks but only 2 percent of deaths among whites. Health officials attribute the high incidence of infectious diseases in poor areas to the lack of clean water and sewage disposal systems. As a result, these services are high priorities in the government's development plans for the late 1990s.

Heart disease and cancer, which are common in industrialized nations, affect whites more than other racial groups in South Africa. Heart disease accounts for about 38 percent of all deaths among whites in the 1990s, compared with only 13 percent of deaths among blacks. Cancerous tumors are responsible for 18 percent of deaths among whites, but for only 8 percent of deaths among blacks.

Acquired Immune Deficiency Syndrome (AIDS)

Although the incidence of sexually transmitted diseases had declined from 1966 through the 1980s, the overall rate of infection increased after 1990, and among these diseases, acquired immune deficiency syndrome (AIDS) raised the greatest fears. South Africa's first recorded death from AIDS occurred in 1982, although the risks of AIDS were not widely publicized at the time. In 1985 health officials began testing blood to prevent AIDS transmission through transfusion.

By early 1991, 613 cases of AIDS had been reported nationwide, and 270 people were known to have died from the disease. Officials at the South African Institute of Medical Research estimated at that time that 15,000 people were infected with human immunodeficiency virus (HIV). The World Health Organization (WHO) reported 1,123 cases of AIDS in South Africa in 1992. By March 1996, the number of reported AIDS cases had reached 10,351.

Some health researchers estimated that between 800,000 and 1 million South Africans were HIV-positive in the mid-1990s. More than 500--perhaps as many as 700--people were becoming infected each day, according to these estimates, and the rate of infection was likely to double every thirteen months in the late 1990s. These figures suggested that between 4 million and 8 million people would be HIV-positive by the year 2000. Estimates of the number of likely deaths from AIDS in the early twenty-first century ranged as high as 1 million.

As in most of Africa, AIDS is primarily an urban phenomenon in South Africa, but it has spread rapidly into rural areas and has affected a disproportionate number of people between the ages of fifteen and forty. Recognizing the potential impact on the country's economic output, the South African Chamber of Mines, the nation's largest employer, began an aggressive campaign to educate workers and to curtail the spread of AIDS in the 1980s, after the chamber's health adviser warned that AIDS could be the country's most serious health problem by the late 1990s. The industry already had established treatment and counseling services for workers afflicted with sexually transmitted diseases, so it used this network to promote its campaign against AIDS. The Chamber of Mines found an incidence of only 0.05 percent of HIV infection among more than 30,000 mine workers in a baseline study in 1986. It then initiated random blood testing on 2,000 to 3,000 workers each month and found that the rate of HIV infection had risen to 6 percent by 1992.

The government was able to build on the early efforts of the Chamber of Mines to help stem the spread of HIV and AIDS in the 1990s. Government officials, health specialists from the ANC, and others established the National AIDS Convention of South Africa to coordinate the nationwide campaign emphasizing public education. In 1993 the National AIDS Convention, working with the Chamber of Mines, WHO, and other international experts, received financial assistance from the European Union (EU--see Glossary) for its efforts. In 1994 and 1995, however, the campaign became embroiled in funding disputes and was slowed by partisan political debate.

Although health officials were concerned about the spread of AIDS, some were still more concerned about the incidence of tuberculosis in the mid-1990s. They argued that tuberculosis caused as many as thirty-six deaths each day, on average, compared with less than one death per day from AIDS. Moreover, methods for preventing the spread of tuberculosis were already well known and could help in the fight against AIDS. Health officials had reported that people infected with tuberculosis are more susceptible to HIV infection and more likely to develop AIDS symptoms in a shorter time after being infected, and that these AIDS sufferers are likely to die sooner than those free of tuberculosis.

Data as of May 1996

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