12 hours ago
Graphs that paint the picture of HIV in SA
Eight million people are living with HIV with more than six million being on treatment.
Behind these big numbers lurk a universe of fascinating epidemiological dynamics.
In this special briefing, Spotlight editor Marcus Low unpacks what we know about the state of HIV in South Africa. This is part 1 of 3.
Four decades ago, hardly anyone in South Africa had HIV. Today, roughly one in eight people here are living with the virus. HIV has quite simply become a routine part of life in South Africa.
But thanks to the fact that antiretroviral treatment is keeping several million people alive, HIV is no longer the crisis it was at the turn of the century.
For many, the virus is still an all-too-real part of their lives. It still ranks among the country's top killers.
As we will see in this Spotlight special briefing, there is good and bad news. We have made massive progress in our collective fight against HIV, especially since around 2008. But, as positive as the big picture may be, there are also reasons to be worried.
In the 10 sections of this special briefing, we have used lots of graphs and an interactive table to liven things up. We have drawn almost entirely on estimates from Thembisa, the leading mathematical model of HIV in South Africa and also the basis for UNAIDS' country numbers.
The big picture
Total PLHIV in SA
Graphic: Spotlight
South Africa has the world's biggest HIV epidemic. Eight million people, or 12.8% of the population, lived with the virus in 2024. Despite the massive progress we've made in the last 20 years, this absolute number has kept increasing, and, at least by this measure, the epidemic has kept getting bigger.
But while more people are living with HIV, dramatically fewer people are dying of HIV-related causes than two decades ago - we've gone from 281 000 HIV-related deaths in 2005/06 to 53 000 in 2023/24. This is mainly because antiretroviral medicines have kept several million people alive who would otherwise now be dead.
The rate of new infections has also declined a lot, as shown in the above graph.
South Africa's HIV epidemic is closely entwined with our tuberculosis (TB) epidemic. This is because untreated HIV breaks down the immune system, which then makes people vulnerable to falling ill with TB.
Accordingly, TB is the top cause of HIV-related deaths in South Africa.
Recovering life expectancy
Just what a big deal HIV has been in South Africa is clear from estimates of life expectancy in the country.
As HIV killed more and more people through the nineties and early 2000s, life expectancy dropped precipitously from 63.2 in 1990 to 53.2 in 2004. But then, as antiretroviral treatment started keeping more and more people alive, it increased again. It stood at 66.1 in 2024.
Graphic: Spotlight
There is much history that is not captured in this graph. Perhaps most notably, the introduction of antiretroviral treatment in South Africa's public sector was intentionally delayed by the state's policy of Aids denialism under then-president Thabo Mbeki.
While the dramatic improvement from 2005 onward is impressive, life expectancy didn't have to drop as low as it did in the first place.
The blip you can see on the right of the graph is a result of the Covid-19 pandemic. While significant, the broader trend is driven by HIV and the recovery from HIV.
A massive treatment programme
Of the eight million people living with HIV in South Africa, about 6.2 million or roughly four in five, were on treatment in 2024.
This means South Africa has the world's most extensive HIV treatment programme by some distance. We take it somewhat for granted these days, but to treat so many people is a tremendous success story for which many healthcare workers, activists, government officials, donors, and others deserve great credit.
That said, it is concerning that about one in five people with the virus are not on treatment. Treatment is recommended for everyone living with the virus. Though we focus on treatment coverage here, these numbers are often split further into the UNAIDS 95-95-95 targets.
READ | Trump's HIV funding cuts will hit diabetes and cervical cancer treatment hard. Here's why
In 2024, 95% of people living with HIV had been diagnosed, 81.5% of those diagnosed were on treatment, and 92% of those on treatment were virally suppressed - meaning the amount of virus in their blood was below a low threshold.
The key takeaway from these numbers is that the most significant gap in South Africa's HIV response is in helping people who have already been diagnosed to start and stay on treatment.
*Check back tomorrow for part 2 of this series. You can also find the complete version of this #InTheSpotlight special briefing as a single page on the Spotlight website.
Note: All of the above graphs are based on outputs from version 4.8 of the Thembisa model published in March 2025.
We thank the Thembisa team for sharing their outputs so freely. Graphs were produced by Spotlight using the R package ggplot2. You are free to reuse and republish the graphs. For ease of use, you can download them as a Microsoft PowerPoint slide deck.
Technical note: The Thembisa model outputs include both stock and flow variables. This is why we have at some places written 2024 (for stock variables) and 2023/2024 (for flow variables). 2024 should be read as mid-2024. 2023/2024 should be read as the period from mid-2023 to mid-2024.
