The Age of Aids [home page]

South Africa: The World's Largest AIDS Epidemic

Living with HIV (2005)*: 5.5 million (18.8% pop.)
Receiving Drugs (2005): 178,000-235,000 (21% of those who need them)
Est. AIDS Deaths (2005): 320,000

Protestors demanding access to antiretroviral drugs
hiv-infected baby

Part Two: Chapter One Political Indifference

chinese condom distribution

Part Two: Chapter Three The Struggle to Get the Drugs

doctor with patient

Part Two: Chapter Seven 40M Infections Today -- And 40M to Come


By the early 1990s, the danger of HIV was clear. The virus had already decimated the gay, hemophiliac, and injecting drug user communities in the United States and Europe. HIV prevalence rates in countries surrounding South Africa were frightening.

But South Africa was in the middle of a historic transition from 40 years of a brutal apartheid government to a new, democratic one led by Nelson Mandela. Although South African AIDS activists hoped he would address the growing numbers of HIV cases, Mandela's government, which took power in 1994, had much to occupy its attention; AIDS fell low on the agenda. Mandela barely mentioned the disease during his presidency, and delegated the AIDS portfolio to his deputy president, Thabo Mbeki. During Mandela's tenure, infection rates doubled every year.

In 1999, after campaigning on a platform promising action against AIDS and wearing a red AIDS ribbon on his lapel, Mbeki was inaugurated as president. Dr. Salim Abdool Karim, who had treated South African HIV patients since the 1980s, was optimistic. "I was quite hopeful because Mbeki came into power with a different message, a message of we've got a job to do and we're going to deliver," he recalls. But six months later, everything changed. Mbeki began questioning the link between HIV and AIDS, and decided to ban the life-saving antiretroviral drugs, arguing they were too toxic. He acknowledged South Africa's AIDS problem, but argued its causes were myriad, and included poverty and poor nutrition. "Can a virus cause a syndrome?" Mbeki asked. "How? It can't."

As the world reacted with shock and dismay, Mbeki sent a passionate personal letter to President Bill Clinton, U.N. Secretary-General Kofi Annan and other leaders outlining his views.

"As an essential part of our campaign against HIV/AIDS, we are working to ensure that we focus properly and urgently on the elimination of poverty among the millions of our people," he wrote. He stressed the different nature of the African epidemic; that the virus was primarily transmitted heterosexually, and that the problem was getting worse instead of better. "It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV/AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical," he argued. And he equated the condemnation of scientists who questioned the link between HIV and AIDS to the oppression of blacks under apartheid. "We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited."

The debate continued in South Africa as AIDS raged out of control: Almost 25 percent of pregnant South African women were infected. Activists took the government to court and in 2002 the country's highest court ruled that the government could not deny treatment to its citizens, ordering it to provide antiretroviral drugs immediately to pregnant women. However, widespread distribution didn't start until 2004, shortly before national elections. Mbeki was reelected president.

Today, South Africa provides antiretrovirals free to anyone who needs them and produces some of its own generic versions of the drugs. More and more clinics and support services help people with HIV. But the consequences of government inaction all those years is tragic: Today, 16 percent of the general population has the virus, as do almost 30 percent of pregnant women. A 2005 national survey showed that 33 percent of South African 25-29 year olds were HIV-positive.

Mbeki has announced that he will not run again in the 2008 national elections. Jacob Zuma, a prominent member of the African National Congress is widely considered to be his successor. In the spring of 2006, however, Zuma was put on trial for the rape of a family friend. During the trial, Zuma said that he didn't use a condom in what he said was consensual sex with his accuser; despite knowing she was HIV positive, he thought the risk of contracting the disease was "minimal." He also said that he showered after the encounter to further protect himself. AIDS activists immediately fielded a flurry of calls to AIDS hotlines about whether showers protected people from HIV. Zuma was acquitted and reinstated to his post of deputy president in May 2006.

The Zuma trial, 16 years into South Africa's epidemic, is evidence of the continuing misinformation continues to hamper efforts to control the disease. As Dr. Karim warned in his interview with FRONTLINE, "The peak of the epidemic hasn't been reached in this country yet."

* Note: Figures reflect most recent statistics from UNAIDS and the World Health Organization.

  • Related Links
  • Living With HIV: Dorothy Maksalatiba
    Dorothy Maksalatiba, a middle-aged woman living in South Africa, didn't believe HIV existed until shortly before she and her son were diagnosed. Her family's life has been transformed since antiretroviral drugs were made available under President Bush's Emergency Plan for AIDS Relief. But she worries because the $15 billion program is only funded for five years.
  • UNAIDS Country Profile: South Africa
    This page has UNAIDS statistics on HIV/AIDS in South Africa, an epidemiological fact sheet and analysis of the problem. It notes that South Africa has finally started implementing prevention and treatment efforts, but that:"A key challenge for the HIV/AIDS programme and the comprehensive plan is to accelerate the pace of implementation."
  • Showers, Sex and AIDS: A Newsweek Special
    The international edition of Newsweek examines how Jacob Zuma's trial has impacted the fight against HIV/AIDS.
  • Profile of Zackie Achmat
    Pulitzer Prize-winning writer Samantha Power wrote this profile of Zackie Achmat, a prominent AIDS treatment activist in South Africa, for the New Yorker in 2003. The article provides an excellent overview of HIV/AIDS' frightening growth in South Africa, and the complicated evolution of President Thabo Mbeki's stance on HIV/AIDS, as well as the specific story of Achmat, who refused to take life-saving drugs until they were available to all South Africans.
  • Treatment Action Campaign
    Founded by Zackie Achmat, Treatment Action Campaign is the main organization that has fought for the right of South Africans to access antiretroviral drugs. The organization's main challenges have been overcoming drug companies' resistance to lowering prices, and President Thabo Mbeki's doubts. Though a 2003 high court decision made it imperative for the government to provide the drugs, access is still spotty, and TAC's mission continues.
  • South Africa Country Profile
    Avert chronicles the complete story of AIDS in South Africa, including a page devoted to statistics.

home | introduction | watch online | the virus | maps: the global picture | timeline: 25 years of aids | interviews
past & future | quiz | join the discussion | artifacts | best of the web | today in hiv/aids 
site map | dvd/vhs | press reaction | credits | privacy policy | FRONTLINE series home | wgbh | pbs

posted may 30, 2006; updated june 19, 2006

background photo copyright © 2006 corbis
web site copyright © 1995-2014 WGBH educational foundation