Despite the savage effects of HIV, infected South Africans are living longer

There has been a marked increase in the life expectancy of South Africans over the past five years, according to the model of the Actuarial Society of South Africa (ASSA).

According to the ASSA 2008 model, life expectancy in South Africa improved from 54.1 (the average years the average South African is
expected to live for) in 2005 to 57.6 in 2010.

The average for males was 51.8 in 2005 and for females it was 57.2. That improved to 54.5 for males in 2010, and 60.8 for females.

The greater rollout of antiretrovirals (ARVs) and the increased provision of prevention of mother-to-child transmission of HIV have probably added at least three years to life expectancy, particularly for females, says Rob Dorrington, a professor of Actuarial Science at the University of Cape Town.

According to the United Nations Department of Economic and Social Affairs Population Division’s “World Population Prospects: The 2008 Revision”, the life expectancy of South Africans improved only from 51.8 in 2005 to 52 in 2010.

But Prof. Dorrington says he has worked on the ASSA 2008 model, adding that the UN Population Division model assumes a higher level of mortality due to HIV.

This model further assumes a standard life table for non-HIV mortality, which is not appropriate for South Africa. In particular, it does not allow for the relatively higher mortality of young men in South Africa, says Prof. Dorrington.

Furthermore, the UN model underestimates the extent of the rollout of ARVs and their impact on mortality, he adds.

The role of global funds

Dr Brian Brink, chief medical officer at Anglo American, says greater investments in health, particularly in preventing or fighting HIV and Aids, tuberculosis and malaria – by the Global Fund to Fight AIDS, Tuberculosis and Malaria; The Bill & Melinda Gates Foundation; and the US President’s Emergency Plan for AIDS Relief (Pepfar) – had a major impact on the improvement in South African life expectancy.

“The healthcare responses to fight deaths due to TB, malaria and HIV and Aids have been important factors,” he adds.

“There have also been big shifts in healthcare policies in terms of HIV and Aids response. Previously, there was a denial, but [former Health Minister] Barbara Hogan and [current Health Minister] Aaron Motsoaledi were responsible for a turnaround in policy, which has resulted in huge improvements.

“More than 70% of all TB patients in South Africa are infected with HIV, so these two are closely linked – and the big killers. So one must commend the efforts by the new ministers of Heath in South Africa to improve the healthcare response to these diseases,” says Dr Brink.

United Nations report

The remarks by Prof. Dorrington and Dr Brink, on the impact of the increased rollout of ARVs and the effectiveness by the Global Fund, the Gates Foundation and Pepfar, were endorsed by a recent UN report.

In October 2010, Reuters published the UN Statistics Division’s “The World’s Women 2010” report, indicating that new treatments have brought a slight rise in life expectancy in sub-Saharan Africa.

In the period from 1990 to 1995, life expectancy at birth in southern Africa – South Africa, Namibia, Botswana, Swaziland and Lesotho – was 64 for women and 59
for men. That fell to 51 for women and 49 for men between 2000 and 2005, but rose slightly between 2005 to 2010 to 52 for women and 51 for men, according to the UN report. (Source: Reuters, 21 October 2010)

In eastern, western and central Africa, where some countries were hard hit by Aids, life expectancy increased slowly but steadily over the same period and now stands at 57 for women and 54 for men.

The report by the UN Department of Economic and Social Affairs attributed the modest uptick in southern Africa to the development and improved availability of medical treatments for HIV.

Sub-Saharan Africa remains the region worst affected by HIV, accounting for some two-thirds of all people living with the virus across the globe.

But another UN report in September 2010 said new infections fell by more than a quarter in 22 countries between 2001 and 2009.

In South Africa, at least 5.7 million people out of a population of 50 million are infected with HIV and an estimated 1 000 people die each day due to Aids-related complications.

But the country now has the world’s largest programme to treat the disease with ARVs, which can prolong the life of those suffering from HIV/Aids, according to the UN report.

It found that women live longer than men in all regions of the world, typically by about five years, but are more likely than men to die from cardiovascular disease, particularly in Europe.

The longest lived women are to be found in Japan, with an average life expectancy of 86; while the longest lived men are in Iceland, where the figure is 80.

At the other end of the scale, life expectancy in Afghanistan and Zimbabwe is below 45 for both men and women.

The report said there had been a “noticeable recovery” in longevity in eastern Europe and the former Soviet Union, where life expectancy plummeted following the collapse of communist rule in the late 1980s and early 1990s.

Men, in particular, are living longer due to reductions in heart disease deaths.

More positive signs in South Africa

A recent report in South Africa, entitled “South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008”, noted that HIV prevalence at a national level has decreased among children aged two to 14 – from 5.6% in 2002 to 2.5% in 2008.

From 2002 to 2008, there have been marked changes in condom use, with both males and females reporting similar levels of condom use at last sex.

Among people aged 15 to 49, reported last-sex condom use has risen significantly from 31.3 % in 2002 to 64.8% in 2008.

Among individuals of 15 years and older, awareness of HIV status doubled from 2005 to 2008, according to the report.

Challenges

“There is still a substantial weakness of the healthcare system in the public sector. The private sector health system is very strong. But we need to invest substantially, especially in the rural areas, in terms of healthcare strengthening,” says Dr Brink.

The South African government, and specifically Dr Motsoaledi, is pressing the right buttons and addressing key issues, such as improving immunisation, dealing with other diseases such as diarrhoea, and improving the access to clean water as well as sanitation.

“But to strengthen the public health sector, we need to build partnerships. We cannot leave this fight to government alone; we need to invest in the partnerships between government, the private sector and civil society,” says Dr Brink.

Poverty

When asked to reflect briefly on the role of circumstantial factors in limiting life expectancy, such as poverty and lack of access to water and education, Prof. Dorrington responds: “Poverty and the lack of services, particular in the rural areas, contribute hugely to the overall lower mortality in South Africa.

“In the early 1990s, before HIV/Aids, life expectancy in South Africa was probably some 12 to 14 years lower than the average for the ‘more developed’ countries.”

Richard Stearns, the US president of World Vision, in his hard-hitting book, The Hole in Our Gospel, claims that 26 500 children are dying every day because of preventable causes related to poverty.

He adds that the average income in America is $38 611 per person per year, or about $105 per day.

That is in stark contrast to the global picture: In all, 2.6 billion people globally live on less than $2 per day, while one billion live on $1 per day.

Dr Brink says economic growth is critical if South Africa is to win the fight against HIV and Aids.

The government can facilitate economic growth, but it is the private sector that will be at the heart of it.

Around the world, the mining industry is experiencing a boom. In fact, countries producing commodities through natural resources are expanding and growing rapidly – but South Africa is actually moving backward.

Why? Because of an over-regulatory environment that is inhibiting growth, Dr Brink warns.

A few final words

Dr Brink says the HIV Counselling and Testing campaign by the government, to encourage South Africans on a massive scale to establish their HIV/Aids status, was a “fantastic achievement”.

“My concern is: Having established their status, we need to follow up to get support, treatment and care; and I am not sure we are dealing with it effectively.

“We also have huge challenges on the prevention side. We need to find ways to measure the effectiveness of our prevention strategies and to make people accountable for their actions,” he adds.

Prof. Dorrington says there is no magic bullet to eradicate the disease, or to improve the effectiveness in the fight against the HIV/Aids pandemic.

He says that without a cure, the eradication of the disease will depend largely on behavioural change.

Apart from the (increased) use of condoms, people have been seemingly stubbornly resistant to change.

Dr Brink says tackling the pandemic of Aids should be a national flagship project that every minister should speak about during every public address.

It should be part of the business of every civil society and every private company.

With an increased intensity and a collective will by the government, civil society and the private sector, there could potentially be a massive reduction in HIV infections and ultimately a substantial difference in life expectancy.

Fanie Heyns