Epidemics: The Story of South Africa's Five Most Lethal Human Diseases

5. HIV/AIDS, 1982–: ‘A catastrophe in slow motion’

111 5 HIV/AIDS, 1982– ‘A catastrophe in slow motion’ ‘The country is busy burying its young’ – Superintendent of Hlabisa Hospital1 In two fundamental ways HIv/AIDS differs from the deadly epidemics already dealt with in this book. Firstly, as I write this in November 2011, it is still under way, quietly claiming over 500 lives per day. This means that this chapter lacks the historical perspective of its predecessors or even the knowledge of when and how the epidemic terminated, if indeed it ever does. Secondly, as the subtitle of the chapter indicates, HIv/ AIDS is a slow-moving epidemic, for it takes at least six years for symptoms of HIv infection to manifest themselves,usuallyintheformof diminishedresistance to other diseases, and then another one to two years for it to become terminal as AIDS. Thus it is an epidemic very different in form from those already examined, not only because of its gradual evolution and the 112 opportunities this offers, even as it rages, to investigate it closely and develop drugs and strategies to arrest it, but also because, at the other end of the scale, those without access to such medication take several years to die, placing a lengthy demand on individuals and institutions caring for them. Therefore, although HIv/AIDS does not possess the whirlwind-like features of its predecessors – sudden onset, explosive decimation of the population, and an intensebutshort-livedpresence–itsoverallimpacthas, cumulatively, been no less lethal or widespread: it has claimed, directly or indirectly, some 3.3 million lives in South Africa in the 29 years since it was first diagnosed here in 1982. It may not be a driedagsiekte like Spanish flu, but it does not bear graphic colloquial labels for nothing, for example the two Xhosa tags, ugawulayo (‘the chopper’) and unyathele icable (‘stepping on a live wire’). Tellingly, to some of an older generation it is ‘the big flu’. The pathogen and its course The fact that infection with the human immunodeficiency virus (HIv) occurs primarily during heterosexual or homosexual intercourse – when an infected person’s semen or vaginal secretions containing the virus are transferred into an uninfected person’s system – goes a long way to explain the 113 disease’s high prevalence in South Africa’s population, especially among its sexually active teenagers and young adults. In addition to them, three other groups have been at high risk of infection, viz babies born to HIv+ mothers, who might have been infected in the womb, during delivery or through taking breastmilk; haemophiliacs and transfusion recipients unwittingly receiving HIv-infected blood; and health workers who accidentally came into contact with an infected patient’s blood, most commonly through a needlestick injury. Once in a newly infected person’s bloodstream, the HI virus gradually erodes the body’s ability to resist other pathogens by destroying the CD4 cells at the core of the body’s immune system. When an infected person’s CD4 count drops from the usual 1200 cells per microlitre of blood to 200, his or her immune system is so compromised as to be unable to withstand even quite mild opportunistic, secondary infections. At this point HIv turns into full-blown AIDS from which there is no recovery unless antiretroviral drugs, which check the proliferation of the HI virus, are hastily administered. If they are not, death follows within 12 to 24 months, usually from an opportunistic disease like TB or, less commonly, from pneumonia, influenza or meningitis. HIv/AIDS and TB are therefore synergistic, HIv boosting the incidence of TB so that 114 they in effect constitute two intertwined epidemics that complement each other. At present there is no medical cure or preventive for HIv/AIDS. The epidemic and its course Two subtypes or clades of the HI virus first reached South Africa in the late 1970s, along two distinct pathways. From the United States, where it had begun to manifest itself among gay men at that time, Clade B was probably introduced by one or more gay men. Two SAA air stewards who died in Pretoria in 1982 of a pneumonia that their deficient immune systems could not fight off were the first cases to be recorded in the country. Within a year, 32 more gay men in Johannesburg were diagnosed as being HIv+. yet, this did not concern medical officials unduly, for, in their blinkered naïveté, many believed their cities to be as safe from the...