
SA's health recovery underway after deep scars left by Mbeki's Aids denial
Those eulogising the 'good old days', when former president Thabo Mbeki was at South Africa's helm, would do well to have a good look at the latest national life expectancy figures released by Statistics South Africa (StatsSA).
In 2025, life expectancy of men is 64 years and for women it is 69. In 2002, by comparison, life expectancy was 52 for men and 57 for women.
Those numbers explain the devastating impact Mbeki's Aids denialism – coupled with his fight against the use of antiretroviral drugs – had on ordinary people afflicted by the HIV virus.
People died in their hundreds of thousands.
Another event which had a hard-hitting impact on South African life expectancy was the Covid pandemic, which saw drops for males of three years (from 62.8 to 59.8) and 3.6 years for females (from 68.8 to 65.2).
StatsSA says that as public health programmes expand and treatment coverage improves, particularly among women of reproductive age, the country's long-term outlook continues to stabilise.
ALSO READ: South Africans living longer: Here's the life expectancy rate in 2025
The good news is that progress in health care has also resulted in major improvements in child survival.
The infant mortality rate declined dramatically, from 61.9 deaths per 1 000 live births in 2002 to 23.1 in 2025.
In the same period, the death rate among children under the age of five went down to 26.1 child deaths per 1 000 live births from 79.9 per 1 000 live births.
And despite what many critics claim is our tendency to have too many children, StatsSA figures show the fertility rate has been declining over the years.
That is unusual for a developing country and different from the trend in many African countries.
Coupled with an increasing population of older people, the declining birth rate will mean headaches for social planners – for things like pensions and health care – in the future.
NOW READ: South Africans are living longer and need to plan for longer retirement – here's how
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Daily Maverick
5 hours ago
- Daily Maverick
Promising new monthly pill moves to phase-three trials in HIV prevention revolution
A new antiretroviral pill has shown promising results and is now entering large-scale trials. Spotlight reports on new findings on the pill. There are several antiretroviral formulations proven to prevent HIV infection: a daily pill, two different jabs that offer protection for two and six months, respectively, and a vaginal ring for women that has to be replaced monthly. In a few years, a long-acting pill may join the ranks, if it works. The pill, for now called MK-8527, has the potential to prevent HIV infection for up to a month in its current formulation. It is a nucleoside reverse transcriptase translocation inhibitor, which means it disrupts a specific step in the cycle by which the virus makes copies of itself. The pill is now moving on to pivotal phase-three trials after promising results from a smaller phase-two study presented at the International Aids Society (IAS) conference held in Kigali, Rwanda. The phase-two study, conducted in trial sites in South Africa, the US and Israel, showed that MK-8527 was well tolerated and had a safety profile similar to a placebo. It also showed the levels of the antiretroviral were at the required levels in participants' bodies, although the study was not designed to determine whether it is effective. Whether MK-8527 actually prevents HIV infection will now be tested in two large phase-three studies in multiple countries, including South Africa. In these studies, the efficacy of the monthly pill will be compared with that of a daily HIV prevention pill already widely available in South Africa's public sector. The daily pill contains the antiretroviral drugs tenofovir disoproxil fumarate and emtricitabine. Latest findings The phase-two study looked at three different doses of the monthly pill – 3mg, 6mg and 12mg – as well as a placebo. The 350 participants, about one third of whom were from South Africa, were given one pill (either an active pill or placebo) every month for six months. They were monitored for at least two months afterwards. None of the participants acquired HIV during the study. The researchers enrolled adults who were at a low risk of being exposed to HIV and excluded pregnant and breast-feeding women, and people who had previously used MK-8527 or a similar antiretroviral drug called islatravir, said Dr Kenneth Mayer, a professor of medicine at Harvard Medical School, who presented the findings in Kigali last week. The levels of the antiretroviral in the blood of all the participants were measured on day one and two, on the last day of taking the pill, and again at the first follow-up visit after stopping the pill. Based on these results, Mayer said there doesn't appear to be a build-up of drug in the body that might prove toxic over time. This supports evaluating the use of a monthly pill over a longer time period (than the six months in the study), he said, 'without concern that increasing drug levels will cause toxicity after a longer period of monthly administration'. About 20 participants across the three active pill arms were monitored more closely to measure the levels of MK-8527 triphosphate in their blood at each study visit. Results showed that the 6mg and 12mg doses kept levels at 'above the threshold of protection' for just more than 28 days. Apart from staying in the body for a long time, it also seems that the drug works very quickly. Mayer told delegates that modelling, informed by measurements of how the drug is taken up in the body, suggests that the pill could offer protection against HIV infection potentially as soon as an hour after taking it. How safe is it? Since HIV-prevention medicines are offered to healthy people, or at least people who are not living with HIV, the safety of these drugs is particularly closely watched. This is because the risk-benefit trade-off is different than it is for people who are living with HIV and might be willing to accept more side effects if it means the medicines are keeping them alive and healthy. The most common side effects reported in the phase-two study were headache, nausea and fatigue. The rates of these side effects were similar between participants who got the antiretroviral pills and those who got the placebo. One concerning event in the 3mg arm was a spontaneous abortion at six weeks into a pregnancy. According to Mayer, this was seen as a serious adverse event related to the study drug. He explained that although he didn't have all the details from the safety records, he understood that the participant had previously experienced pregnancy losses, but most if not all were induced. 'She did not have any other medical conditions that were associated with adverse pregnancy outcomes, so we had to consider the event related to the study medication, out of an abundance of caution, since this was a safety trial,' Mayer told Spotlight. Participants had tests done to check their CD4 levels (an indicator of immune system health) and lymphocyte (a type of white blood cell) counts at each study visit. A significant drop in either or both of these indicators would lead to the drug being stopped. Mayer explained that CD4 and lymphocyte counts were specifically monitored because the monthly pill has the same mechanism of action as another drug called islatravir, which in high doses resulted in a decrease in both these counts. 'MK-8527 is chemically different [to islatravir], but since they both inhibit these steps in the virus life cycle, it was important to monitor these parameters during the safety trial,' Mayer said. 'Fortunately, we did not see a significant trend affecting these clinical lab values.' Only two participants dropped out of the study because of side effects in the two higher dose groups. One person from the 12mg arm dropped out because of hypaesthesia, which is a loss of sensation or numbness. Another person in the 6mg arm left because their CD4 and/or lymphocyte count dropped to levels that met the study's rules for stopping the pill. In the next few years, the larger phase-three studies should provide much more extensive and detailed data on the safety and side effect profile of MK-8527. Is there a place for a monthly pill? At last year's Aids conference, delegates celebrated the success of the PURPOSE 1 and 2 trials that showed remarkable protection offered by lenacapavir, a long-acting HIV-prevention jab. It reliably offers protection against HIV infection for six months at a time. In June, it was approved for use by the US Food and Drug Administration for HIV prevention. It was previously approved only as treatment for hard-to-treat HIV. In July, the World Health Organization released guidelines recommending its use for HIV prevention. Lenacapavir has not yet been registered by the South African Health Products Regulatory Authority. Although most of the focus in HIV circles is still on lenacapavir, experts told Spotlight that even though MK-8527 may potentially only protect against HIV for about a month at a time, it could still be a useful option for HIV prevention. 'There is a real place for a long-acting, non-injectable PrEP [pre-exposure prophylaxis)]. And we believe there really is a role for a monthly pill – they are small [and] easy to take,' said Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation and director of the Desmond Tutu HIV Centre. 'There is potential for giving all 12 pills in one go or three pills in one go, or any variation,' she added. This potential future option, provided it works, comes at a time when there is plenty of financial upheaval with the sudden termination of research funding and aid by the US. For Bekker, the hope is that a pill for prevention may prove to be an affordable and accessible option. Mitchell Warren, executive director of the Aids Vaccine Advocacy Coalition, told Spotlight that a monthly pill for prevention will not replace but add to the existing basket of HIV prevention options. 'It may help people who have a hard time adhering to daily pill-taking. It will help people who don't want to get an injection,' he said. 'It [MK-8527] is just 12 pills a year – that's a remarkable advance.' Next steps — the phase-three trials Merck, the pharmaceutical company that's developing the pill, announced that, later this year, MK-8527 will be evaluated at clinical trials sites across the globe in two large phase-three studies called EXPrESSIVE-10 and EXPrESSIVE-11. The studies will determine the safety and tolerability of the monthly pill, and whether it works as well as or better than the standard of care at preventing HIV. 'If MK-8527 is found to be comparable or superior to daily oral PrEP, it could be a game-changer for the HIV prevention field, offering people a simple way to protect themselves which would not require daily medication or injections,' said Mayer. Warren said that, like the PURPOSE studies, if a woman becomes pregnant during the study, she will have the option to give consent again and continue. This allows researchers to collect data on pregnant and breast-feeding women too. Although results from the phase-three studies are at least two years away, Merck appears set to try to roll out the product as soon as possible if it is successful. 'We are pursuing very optimistic and aggressive timelines,' said Dr Rebeca Plank, a scientist in clinical research at Merck, during an IAS press conference. DM This article first appeared in Spotlight.


The Citizen
a day ago
- The Citizen
Measles outbreak in Gauteng: 181 cases confirmed, public urged to vaccinate
The Gauteng Department of Health has intensified its public health response following further measles cases across the province. Between January 1 and June 13, 181 laboratory-confirmed measles cases were reported, primarily in Johannesburg, Tshwane, and Ekurhuleni. In the latest reporting period, Gauteng recorded 15 new measles cases. Local nurse Nhlanhla Mofokeng explained what measles is and how to curb its spread. She defined measles as a highly contagious viral infection that mainly affects children but can infect anyone who is unvaccinated. 'It spreads through droplets in the air when an infected person coughs, sneezes, or talks. Measles symptoms appear about seven to 14 days after exposure,' she said. Signs and symptoms: • High fever; • Dry cough; • Runny nose; • Red, watery eyes; • Tiny white spots inside the mouth (Koplik spots); • A blotchy red rash that usually starts on the face and spreads downward. 'A person is contagious four days before and four days after the rash appears. Many people assume measles is just a rash and fever, but it can lead to severe complications,' she added. She mentioned these complications: • Pneumonia; • Diarrhoea and dehydration; • Ear infections (which might lead to hearing loss); • Brain swelling (encephalitis); • Death, especially in malnourished children or those with weakened immune systems. 'Children under five years, unvaccinated people of any age, people with weakened immune systems (HIV+ individuals) and pregnant women are at risk of contracting measles. 'Prevention is always better than cure. The measles vaccine is safe and free at public clinics across SA. It is given as part of the Measles, Mumps, and Rubella vaccine (MMR) at six months (extra dose during outbreaks), 12 months and 18 months,' she mentioned. Mofokeng said vaccination is the best protection because if enough people are vaccinated, the virus cannot spread; this is called herd immunity. She added that during the outbreak, people must ensure children are vaccinated by checking their Road-to-Health card. The nurse advised adults unsure of their vaccination status to visit a clinic for advice. 'If your child shows symptoms, keep them at home and visit a health facility immediately. Inform your school or crèche if a child was diagnosed. They may need to take steps to prevent further spread,' said Mofokeng. What to do if you suspect measles? • Step one: Seek medical care immediately; early detection can prevent serious illness. • Step two: Isolate the patient to avoid spreading the virus to others. • Step three: Follow the instructions from your clinic or doctor. ALSO READ: SASSA announces August payment dates for all social grants ALSO READ: Two arrested in Kwa-Thema for house robbery and possession of unlicensed firearms


Daily Maverick
2 days ago
- Daily Maverick
Why are fewer women breastfeeding in SA despite its enormous benefits?
Aggressive marketing campaigns by the formula milk industry, hunger and malnutrition and insecure employment are among the factors causing a decline in breastfeeding in the country. While global exclusive breastfeeding rates have seen a slight increase in recent years, South Africa is still lagging behind with a concerning decline in exclusive breastfeeding rates from 32% in 2016 to 22% in 2024. Civil society and the Department of Health say the current trend means the country is unlikely to achieve the World Health Assembly breastfeeding target of at least 50% by the end of 2025, and 70% in 2030 unless women receive support beyond education campaigns. The Department of Health in collaboration with various stakeholders hosted an event to mark the beginning of World Breastfeeding Week at Loftus Park Shopping centre in Pretoria on 1 August 2025. It aimed to intensify awareness about the long-term health benefits of exclusive breastfeeding for both the mother and child, as part of ongoing efforts to increase the rate of breastfeeding in the country. Multiple factors contribute to the decline in breastfeeding. Chantell Witten, the health systems director at iLifa Labantwana with expertise in breastfeeding and nutrition, told Daily Maverick that some of these factors were lack of support, income and formula marketing through health centres and professionals. 'Given the lack of maternity protection and stable employment opportunities, South African mothers are not protected to enjoy a successful breastfeeding journey. Furthermore, the insidious marketing of formula through health professionals undermines government efforts to promote, support and protect breastfeeding,' said Witten. World Breastfeeding Week is a global movement aimed at promoting breastfeeding and creating a conducive environment that supports mothers who breastfeed their babies, ultimately contributing to their wellbeing. Speaking to Daily Maverick, Edzani Mphaphuli, the Executive Director of Grow Great Campaign, said the first 1,000 days, from conception to a child's second birthday, were the most important for shaping lifelong health, learning and wellbeing. 'During this period, the brain develops rapidly, and the foundations for emotional, cognitive and physical growth are laid. If children are undernourished or neglected during this time, they risk becoming stunted. Stunting has irreversible effects on brain function, school performance and future productivity. Breastfeeding plays a central role in preventing stunting. It provides complete nutrition, supports immunity, and fosters emotional bonding. Supporting mothers to breastfeed is not just about nutrition, it is about brain development, emotional security, and human potential. Every child deserves the chance to grow great from the very beginning, and that means ensuring their mothers are nourished, supported and cared for too,' Mphaphuli said. Shared responsibility So this makes the decline concerning for the department, health and nutrition practitioners and civil society organisations in the space. The department says exclusive breastfeeding is a shared responsibility, 'extending beyond just the role of mothers, with families, communities, healthcare systems and employers having important roles to play. Breastfeeding is not just about reaching country and global targets, but also about supporting infant health and development, as well as maternal wellbeing.' Witten echoed this point, saying breastfeeding promotion and support programmes had multiple benefits, such as 'saving children's lives, better health outcomes, lower economic and environmental impact. It's good for mothers, children and the economic development of the country… Programmes to support mothers and their children are not prioritised, and (mothers should be) protected from profit-driven industries like the formula industry,' said Witten. Significant impact A mother's nutrition does not drastically affect the quality of breast milk, but it has a significant impact on her ability to continue breastfeeding. Mphaphuli said the campaign aimed to reduce child stunting and malnutrition through multiple programmes and interventions. She added that mothers' bodies prioritised the baby 'drawing nutrients from the mother's own reserves, often depleting her energy, muscle, and bone mass. Without proper food, mothers feel exhausted, anxious, and overwhelmed. Breastfeeding is physically demanding, and doing it while hungry can be debilitating,' says Mphaphuli. In a written response to Daily Maverick, Mphaphuli said that many mothers supported by Grow Great's Flourish programme and community health workers reported stopping breastfeeding due to hunger and stress. 'Hunger increases cortisol in the mother's body — this stress hormone transfers into breast milk, leaving babies fussy and colicky, which creates a cycle of emotional strain. This cycle makes breastfeeding even harder. What a mother eats while breastfeeding is determined not just by knowledge, but by what she can afford. Finances drive dietary choices. When money is tight, nutritious foods like fruit, vegetables, protein and dairy are often replaced with cheaper, calorie-dense but nutrient-poor alternatives. Financial support is therefore essential to help mothers eat well and breastfeed with confidence. Without it, the risk of burnout, poor mental health, and early breastfeeding cessation increases, contributing to poor growth and stunting in infants, especially in vulnerable households,' Mphaphuli said. The Grow Great Flourish programme is an intervention supporting breastfeeding and early child development in South Africa. It provides antenatal and postnatal support groups, led by trained local women who are mothers themselves. Mphaphuli said the programme demystified breastfeeding, covering topics like how milk was produced, how to latch, and how to manage common challenges. 'The safe, non-judgmental environment encourages mothers to ask questions and support each other. Beyond the sessions, WhatsApp groups keep the community connected, allowing mothers to share concerns and receive encouragement around the clock. Nearly all Flourish moms breastfeed, and 62% do so exclusively. This stands in stark contrast to the national average. Grow Great also trains community health workers to deliver in-home breastfeeding support. These workers reinforce critical messages and help mothers persevere. Together, these programmes are preventing stunting by ensuring that babies receive the best start in life, beginning with breast milk.' DM