The epidemiology of human immunodeficiency virus in South Africa

We review the epidemiology of human immunodeficiency virus (HIV) in South A frica where the prevalence of HINT infection is among the highest in the wo rld. The epidemic reached South Africa relatively recently but the prevalen ce of infection has increased rapidly and there are significant differences among provinces. Although few 15-year-old people are infected the prevalen ce increases rapidly with age thereafter, especially among women. The preva lence of herpes simplex virus type 2 exceeds that of HIV and curable sexual ly transmitted infections are common. 'Circular migration' may help to expl ain the high rates and rapid spread of HIV in the region. The incidence of tuberculosis has increased dramatically as a result of the HIV epidemic. An tiretroviral therapy for the prevention of vertical transmission has been s hown to be effective in local conditions but transmission through breast-fe eding remains problematical. While some epidemiological models have been de veloped, much more needs to be done in this regard in order to plan, coordi nate and evaluate an effective response to the epidemic. We conclude by dis cussing some of the research that is needed and steps that could be taken t o reduce the continued spread of the infection.