Everybody could be shouting from a rooftop that there are about 7.7 million HIV-positive South Africans (UNAids, 2018).
This represented a whopping 13.5% of our population in 2018.
It can be assumed that our 2020 benchmark remains similar to that.
There is certainly shock value that this figure has manifested over time. TB prevalence is another great public health concern. It has been the leading cause of death for the period 2015 to 2017.
Then there is the growing pandemic of diabetes. The adult diabetes population is estimated to be 4.5 million. This is a staggering number and reflects the rapid rise of diabetes type 2.
It is understandable that any sounds about the above disease burden has been overwhelmed by the noise of Covid-19.
However, long after Covid-19 is gone our chronic disease burden will remain.
The burning question is, really, how did we reach the figure of 7.7 million HIV-positive cases in South Africa?
This is against the framework of HIV/Aids being considered a preventable communicable disease. We have had decades of prevention programmes. HIV/Aids is fundamentally acquired through behavioural pathways since it is a sexually transmitted infection.
At base level, if people use condoms consistently then there is minimal risk of transmission. (And to explain that headline, 0.07mm is about the width of the latex rubber barrier on the average condom).
Medical intervention has been successful to prevent mother-to-child transmission. This leaves human behaviour as the only real vector of transmission through sexual activity. The failure of condom usage in South Africa is obviously due to a very complex set of circumstances but it does point to the danger of assuming that when we tell people to do something (because it is good for them) that they will comply.
At surface level, it seems so simple to inform people to variously “abstain, be faithful, condomise and/or do not have concurrent partners”.
That staggering figure of a 7.7 million HIV-positive population does not validate this simplicity.
The failure of prevention programmes to arrest the HIV burden has important relevance to Covid-19. If communities are told to stay at home or face the might of the army/police – is this enough to elicit behavioural change?
Documentation of Covid-19-related non-compliant behaviour is showing that life is going on as usual in several places. One can also speculate on what is occurring in the rural areas, which are out of reach of most media coverage.
The problem of social distancing can be seen in a similar light – we are social by nature and naturally drawn to each other. Yet we are now required to avoid this contact. It will not be straightforward to change this innate behaviour. Further, we need to maintain it over the time the pandemic requires.
In another light, we can consider whether cancer labels on cigarette boxes have stopped people from smoking? Correspondingly, has the threat of arrest reduced alcohol-induced road fatalities? This suggests that an adjusted approach is needed for Covid-19. Somehow we need to empower individuals and communities to take responsibility and engage in sustainable, health-appropriate behaviour.
The escalation of the chronic disease burden in South Africa (and globally) is of shattering concern for Covid-19 developments. Worldwide Covid mortality trends are well established now in terms of the risk to elderly and co-morbity (people with chronic conditions). These are the critical vulnerable populations. When the Covid-19 chapter eventually passes, epidemiologists will pause to consider the chronic disease burden in South Africa at inception of Covid-19. It is a critical marker in terms of how the disease progresses.
Prevention campaigns for HIV and TB seem to have been lost in the noise of familiarity. In many respects “community fatigue” about these topics seems to have set in. Dangerous levels of complacency appear to kick in past a certain point of exposure to the facts. Beyond HIV and TB, the disease burden of diabetes, hypertension and heart disease have also been marching on. In fact, a look at South Africa’s mortality statistics is very interesting.
Between 2015 and 2017 (these years represent the most recent official statistical releases) the following observation is inescapable: The top leading natural causes of underlying death are consistently TB, diabetes, cerebrovascular disease, heart disease, HIV, influenza and hypertension.
For ease of understanding these can be illustrated as absolute numbers and number of deaths per day.
The numbers are not intended to take any relevance away from what Covid-19 may do. However, it is practical to note that, in 2017, influenza and pneumonia was the seventh leading cause of death. At least 18,837 people passed away from this, and this was reflected as an average of 52 deaths per day.
The number itself does reveal why scientists are so concerned about Covid-19. If this virus is for example, 10 times stronger than annual seasonal flu (and there are increasingly huge doubts about this) – this figure could increase by the corresponding factor. The number 18,837 is clearly significant and does raise some question marks in terms of why the flu itself and its dangers have not attracted much historical public health attention. We can rightly reflect on whether we have been doing enough to protect vulnerable populations from seasonal influenza.
All things considered, we have the Covid-19 pandemic immediately in front of us. The economic and social future of our country rests on a holistic, successful prevention and treatment program. We need to find a way for people to embrace social distancing and adopt the corresponding value set in their inner worlds.
But we need to remind ourselves that nearly 8 million South Africans managed to get themselves infected with HIV despite the fact that it’s meant to be a disease that’s far harder to catch than the coronavirus, and the preventative measures are understood and accessible to most.
That statistic is also a reminded of the chronic disease fault line that is embedded in our Covid-19 epidemic. We can’t afford to drop that ball.
The author is a registered counsellor with 12 years’ experience in the health and employee wellness counselling fields. The article has been written from a community health psychology perspective and the views herein are the author’s own. For his professional reasons, his identity has been withheld