Where are we now? Where are we going? The demographic impact of HIV/AIDS in South Africa

Abstract

This article covers many aspects of the epidemic of HIV/AIDS in South Africa. They range from the development of vaccine to the behaviour of adolescents. But they also show that authors have failed so far to have a significant impact on the course of epidemic. It is hoped that in the next 10 years this is to be changed and the intervention will significantly reduce transmission. But without detailed information concerning the future course and demographic impact of the epidemic, it will be difficult to plan our response and manage interventions such that they have the greatest possible influence. The authors need to understand how the demand for health services will change, how the productivity of labour will decline, how the dependency ratio will change and how this will affect social services. Various demographic forecasting models have been constructed, of which the Doyle model is probably the most widely appreciated. Several other models have been developed and used to make predictions concerning the future course of the epidemic. Two particularly useful source documents are the HIV/AIDS and Human Development Report and the National STD/HIV/AIDS review compiled by the South African Medical Research Council. However, few demographic models have been in peer-reviewed journals and the need for more extensive modelling work remains urgent. In this commentary authors consider what they know about the epidemic in South Africa, discuss what is needed to make reliable forecasts of its future course and effects given different kinds and levels of response, and discuss how such modelling activities should proceed.