History of HIV in South Africa

Nowhere in the world is the AIDS epidemic been more devastating than the continent of Africa. For South Africa, political turmoil and a long history of government denial fueled an epidemic that had reached disastrous proportions by the late 1990s and early 2000s. 

Even today, despite plunging death rates and greater leadership on the AIDS war front, the rate of new HIV infections continues to rise year after year. As a result, South Africa remains the country with the largest single population of HIV-infected people in the world.

A child holding an AIDS ribbon
BigFive Images / Getty Images 

South African Demographics

Located at the southern-most tip of the African continent, South Africa has a population of roughly 57 million people (about one-sixth as many as the U.S.) spread over 1.2 million square miles (about one-fourth the size of Texas.)

The country has 11 official languages, including English, with an 81% black and 7.9% white population.

HIV Statistics in South Africa

Estimates suggest that 7.7 million South Africans are living with HIV, representing about 14% of the population (or nearly 1 in 7 citizens). Additional statistics are as follows.

  • The HIV rate among adults is more than 20% (or roughly 1 in 5 people).
  • One in five people aged 15 to 49 years is believed to be infected with HIV.
  • 45% of all deaths in the country can be attributed to HIV.
  • 13% of South African blacks are infected with HIV versus 0.3% of South African whites.
  • It is estimated that there are 600,000 orphaned children as a result of AIDS.

History of HIV in South Africa

The HIV epidemic emerged in South African around 1982. However, as the country was in the midst of the dismantling of apartheid, the HIV problem was, for the most part, largely ignored. Silently, while political unrest dominated the media, HIV began to take hold, both in the gay community and the vulnerable black population.

By the mid-1990s, even as HIV rates had increased by 60%, the government remained slow in its response to what was becoming a public health disaster. It was only in the 1990s that President Nelson Mandela acknowledged his government's grievance response to the crisis. By that time, South Africa had already become the largest population of people living with HIV in the world.

By 2000, the South African Department of Health outlined a five-year HIV/AIDS plan but received little support from South African President Thabo Mbeki. After consulting a group of AIDS denialists headed by Dr. Peter Duesberg, Mbeki rejected conventional HIV science and instead blamed the growing AIDS epidemic on poverty, colonialism, and corporate greed.

Without government support, the five-year plan did not get off the ground as quickly as planned, with few people showing up to receive free antiretroviral medication. In the meantime, HIV among pregnant South African women soared from eight-tenths of 1% in 1990 to over 30% by 2000.

It was only with the removal of Mbeki from office in 2008 that the government took steps to rein in the catastrophe, ramping up efforts to become what is today the largest HIV drugs program in the world.

However, increasing pressure to expand outreach has been undermined by a deteriorating public health infrastructure and the weakening of the South African currency under President Jacob Zuma. To date, less than 30 of people living with HIV are on therapy, while infection rates among young adults continue to rise, unheeded.

With the recent election of Cyril Ramaphosa as the head of the African National Congress (ANC), many hope that the South African economy will make a turnaround and, with it, efforts to bolster the flagging HIV efforts with the country.

Prevalence of HIV and AIDS in South Africa

For decades, the prevailing thought among South Africans was that HIV/AIDS was a disease of the poor. And that remains largely true, with little to stop transmission in poverty-stricken communities.

Among those most affected;

  • Young people ages 15 to 24 years make up the largest proportion of people living with HIV in South Africa, roughly 50%.
  • Women account for nearly 63% of all new infections. Social and economic disparities, female disempowerment, and high rates of rape in South Africa are among the causes for these numbers.
  • Men who have sex with men (MSM) are at high risk of HIV in South Africa, with an estimated prevalence of 33%. A death of HIV-specific services for gay and bisexual men, as well as cultural disapproval in some communities are driving the high rates.
  • Migrant workers are at an exceptionally high risk of HIV, with some mining communities showing infection rates of more than 60%. Male-only populations compounded by high rates of commercial sex trade work in tandem to create a perfect storm for infection.

Successes in the South African HIV Battle

It would be unfair to say that the picture has been all doom and gloom for South Africa. One of its major successes has been the reduction of mother-to-child transmission (MTCT) of HIV. With better surveillance at antenatal clinics and widespread use of prophylactic HIV medications, the rate of MTCT dropped from 8% in 2008 to 2.7% by 2012.

As a result, the HIV death rate has also dropped among children by 20%. Despite this, the implementation of antiretroviral therapy in children has fallen well behind that of adults, and over 70% of all maternal deaths in South Africa attributed to HIV.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Center for Strategic & International Studies (CSIS). The world’s largest HIV epidemic in crisis: HIV in South Africa.

  2. CIA World Fact Book. South Africa.

  3. UN AIDS. South Africa.

  4. Hodes R. HIV/AIDS in South AfricaOxford Research Encyclopedia of African History. doi:10.1093/acrefore/9780190277734.013.299

  5. PBS Frontline. Nelson Mandela’s mixed legacy on HIV/AIDS.

  6. Gow JA. The adequacy of policy responses to the treatment needs of South Africans living with HIV (1999-2008): a case study. J Int AIDS Soc. 2009;12:37. doi:10.1186/1758-2652-12-37

  7. The Guardian. Mbeki Aids denial 'caused 300,000 deaths'.

  8. UNAIDS. 2006 Report on the global AIDS epidemic.

  9. Chapter 6: Sexual violence. In: World Report on Violence and Health. United Nations; 149-174.

  10. ICAP Columbia University Mailman School of Public Health. Expanding effective HIV prevention, care and treatment for men who have sex with men in South Africa.  

  11. Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012;16(6):1605-1621. doi:10.1007/s10461-012-0183-4

  12. Burton R, Giddy J, Stinson K. Prevention of mother-to-child transmission in South Africa: an ever-changing landscape. Obstet Med. 2015;8(1):5-12. doi:10.1177/1753495X15570994

Additional Reading

By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.