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Book Reviews

HIV/AIDS in South Africa. 2nd ed. 2010. Edited by S S Abdool Karim and Q Abdool Karim Reviewed by Mercy Banyini.


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The book comprises seven sections. It is an interesting read. The introductory section provides some background on HIV prevalence worldwide, with South Africa being the largest country estimated to have the highest HIV prevalence rate. The book provides detailed epidemiological information which serves as a foundation for understanding the epidemic. It further marks key milestones in the regional spread of the virus from the first reported cases of AIDS in the early 1980s to the current generalised major epidemic. The disease was originally confined to homosexuals and those who received infected blood products, but the trajectory of the epidemic changed as heterosexual transmission became predominant. The authors discuss how young economically active people and women in particular became vulnerable. Furthermore, the book provides an overview of the temporal trends in the geographical distribution of HIV in South Africa using mathematical modelling techniques to derive incidence estimates from HIV prevalence surveys.
In section 2, the book reflects on the virus, humans and the interactions between the two. This section looks at the immune responses of subtype C-infected individuals. The structure of the virus is discussed, its replication cycle and pathogenesis, and an overview of the natural history of the clade C HIV subtype is given. An account is given of diagnostic tests for HIV infection, emphasising how the tests have been adapted for subtype C viruses. Not only complexity of the cellular immune responses of HIV is discussed in this section but additional data are also given on a small number of rare individuals who appear to have natural resistance to HIV-1 infection.
Section 3 is well presented and provides a clear insight of the prevalence of sexual risk behaviours in South Africa. The authors draw a wide range of personal, interpersonal, social, structural and environmental forces that shape these behaviours. They analyse specific risk reduction interventions that have been demonstrated to be effective locally and internationally and consider some of the particular challenges of implementing and evaluating HIV prevention programmes in South Africa. The book describes the important barriers to condom use across the country and shows how the current interventions to improve the accessibility of condom have the potential to increase their use substantially. It further explores an overview of mother-to-child transmission in South Africa, particularly some of the controversial issues around nevirapine and how to reduce transmission during breastfeeding. The authors provide a description of the interaction between HIV and other STIs and their extent in South Africa. The blood transfusion service strategies to ensure the safety of blood supply, governance of the blood service, the window period of infectivity, the South African blood safety policy and its outcomes are discussed in this section. The book also provides a brief history of injection drug use and of positive prevention and its relevance to HIV prevention in South Africa's generalised AIDS epidemic. The next section covers the focal groups for understanding the HIV epidemic. It gives an analysis of gender issues in the HIV epidemic and highlights the important risk groups of sex workers, adolescents, migrant workers and young women.
Section 5 provides an overview of the impact of AIDS in South Africa. The authors warn that the worst of the impact on the health care system is still to come. Although the greatest burden of the disease will be borne by the public sector, the disease is likely to cause an escalation in medical aid and medical insurance scheme rates. The book further describes the effects on family structure and discusses the complexity of the challenges created by the increasing number of orphans within poor communities. It also provides a detailed analysis of the available statistics on mortality in South Africa, showing how these can be interpreted in a way that increases our understanding of the impact of HIV on the demographics of the country. The final chapter in this section examines the impact of HIV on the young South African democracy. Unfortunately, the political response to HIV in South Africa historically has been rooted in controversy and denial. The authors trace this history and show how even now, HIV has had a serious and negative effect on South Africa's journey to full democracy.
Section 6 gives an overview of the epidemiology, pathogenesis, clinical features, treatment and control of HIV-associated TB. This section gives the detailed ways to minimise opportunistic infections of chemoprophylaxis and vaccinations that are available in South Africa. It also discusses the importance of patients' outcome of issues involved in diagnosis, staging, clinical management and therapeutic choices.
The final section of the book, 'Treating HIV' , discusses some of the implications of the modelling disease processes and dynamics and offers projections of the impact of HIV on TB and the likely impact of behavioural change programmes and programmes to manage curable and treatable STIs. The book concludes by capturing the imperative of a national concerted response to the AIDS epidemic.
The book has enormous value. It addresses fundamental concerns and it demands a full appreciation of quality of the tool. It provides and impressive overview of the HIV epidemic in South Africa and tackles the critical arguments about HIV/AIDS. This book is a must-read for academics, researchers, scholar, policy makers and socio-medical professionals. Human Sciences Research Council Email: mbanyini@hsrc.ac.za HIV/AIDS in South Africa. 2nd ed. 2010.