South Africa

Mark Lurie, Ph.D., an Assistant Professor of Medicine and Community Health (Research) at Brown University School of Medicine has been involved in the HIV/AIDS epidemic in South Africa since 1996. He joined Brown with the support of the NIH/NIDA funded T32 to continue his research. He is a recent recipient of an NIMH K01 award that provides him with the opportunity to examine the effect of antiretroviral therapies (ART) on sexual behavior and treatment adherence in South Africa.

Although South Africa has less than 1% of the world’s population, it accounts for nearly 10% of the global burden of HIV infection. The epidemic has been described as “explosive”, and there are no signs that the epidemic has yet reached a plateau. Heterosexual transmission now accounts for over 90% of infections. The molecular epidemiology of HIV-1 in South Africa suggests two independent epidemics: the first, beginning in the early 1980s in which HIV spread largely through homosexual contact, was followed by the heterosexual epidemic which began around 1987. It is estimated that out of a total population of 42 million, there are currently 5 million South Africans infected with the virus (UNAIDS).

Migration, or population movement, continues to be an important risk factor for HIV in South Africa. South Africa’s developed transportation infrastructure combined with the lifting of apartheid laws has made for a significantly more mobile population. There are 2.5 million “registered” migrants in South Africa, and countless more an undocumented. In one rural district, more than 60% of young men spent most nights away from home. Dr. Lurie’s studies found that migrant men were 2.4 times more likely to be infected with HIV than non-migrant men. Migrant men also had significantly more casual partners than non-migrant men. Condom use in South Africa is low with only about 20% of men reporting ever having used a condom. The prevalence of HIV among sex workers on some South African gold mines has been measured at 70%.

Articles have been published in various journals such as Sexually Transmitted Diseases and AIDS on the study of the impact of migration on HIV-1 transmission in South Africa and HIV concordance and discordance among migrant and non-migrant couples in South Africa.