The evolving HIV epidemic in South Africa

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Abstract
In this paper we trace the evolution of the HIV epidemic in South Africa, placing it in historical context, and including an insider's view of the national response to it. The paper is written as a tribute to our mentors Zena Stein and Mervyn Susser, for whom the eighth decade of their lives—the 1990s—was the most challenging of all. Immersed in the struggle against the AIDS epidemic in their native South Africa, they had to bring to bear all of their past experience, and then some. While working with the opposition to the old Apartheid regime, Zena and Mervyn had already anticipated a need for general training and remodelling in public health after the transition to a democratic society. It soon became clear, however, that history was overturning these plans. As South Africa came under the threat of a catastrophic AIDS epidemic, Zena and Mervyn found their lives largely taken over by a new struggle, the control of HIV/AIDS. By the time of Nelson Mandela's release from prison, it was clear that in the absence of a sustained courageous national intervention, HIV/AIDS was going to have a devastating impact, especially among Black Africans, due to the migrant labour system. Zena and Mervyn were among the first to try to alert the government-in-waiting to the pattern of the epidemic. Their key roles and contributions in the Maputo conference of 1990 remain a testimony to their commitment to the problem of AIDS in South Africa (see below; also see companion paper by Ida Susser focusing on women and HIV/AIDS). Since then, and continuing into the present, the largest part of their time has been dedicated to this foremost public health problem of our times, especially training of HIV epidemiologists in South Africa (including the authors).