HIV and AIDS Scenarios for South Africa in 2025

A rigorous process was followed when developing the scenarios. This section highlights the main points that informed the scenarios and provides a summary of the four scenarios in order to outline the context, effect and responses in each. The scenarios include demographic and financial projections. Further information is contained in the Live the Future - Information Pack.

Abbreviations

Scenarios


The season autumn has been used in the name of the scenario as it visually captures the essence of the scenario: in autumn the trees continue to grow taller, while the leaves die and are shed. In this scenario, sectors of the economy continue to grow and thrive, while other parts shrivel. The Autumn of Limited Opportunity looks at what our society and economy could look like in 2025 if all the role players (government, business, labour, communities and individuals) take, or fail to take, certain actions. [read more]

The season winter has been used in the name of the scenario as it visually captures the essence of the scenario: in winter the world seems bleak and hopeless, nothing grows, and life retreats. So too, in this scenario. The economy is stagnant, and social circumstances are depressed. The Winter of Discontent looks at what our society and economy could look like in 2025 if all the role players (government, business, labour, communities and individuals) take, or fail to take, certain actions. [read more]

The season spring has been used in the name of the scenario as it visually captures the essence of the scenario: in spring, the world is full of hope and optimism as the world comes back to life after the cold and hardship of winter. Spring is alive with possibility, new beginnings and the possibility of a brighter future. So too in this scenario. Greater cooperation and coordination improves economic and social conditions for increasing numbers of people. The Spring of Hope looks at what our society and economy could look like in 2025 if all the role players (government, business, labour, communities and individuals) take, or fail to take, certain actions. [read more]

The season summer has been used in the name of the scenario as it visually captures the essence of the scenario: summer is a symbol of life. During summer the trees are green, flowers bloom, and the birds sing. The scenario depicts a society which is blooming. Through collaboration the economy and society are thriving in a way that everyone is able to reap the fruits. South Africa is now indeed a better place for all. The Summer for All People looks at what our society and economy could look like in 2025 if all the role players (government, business, labour, communities and individuals) take, or fail to take, certain actions.[read more]


Key Driving Forces



The Key Question that informed the Scenarios

How will HIV and AIDS and our responses shape the future of South Africa by 2025? The answer lies in understanding what the key driving forces are, how they interact and how they are likely to play out in the future.

Key Driving Forces
There are two kinds of key driving forces, namely:

  1. Inescapables: These are elements that are a given. They will form part of any future scenario, e.g. the epidemic is with us for the next 20 years. Based on our research we will still be dealing with the burden of the epidemic on our country in 20 years’ time.

  2. Uncertainties: These are elements that are likely to influence the scenarios, but how they play out is uncertain. Depending on future developments they could go either way, e.g. today we may believe that we will not find a cure for HIV and AIDS in the next 20 years, but in five years from now there may well be a cure that will change our beliefs and the course of the epidemic.

Based on the synthesis of existing scenario studies, and further discussions, the following key driving forces were identified:

Inescapables

  1. The epidemic is with us for the next 20 years.

  2. Some poverty, inequality and unemployment remain.

  3. Government resources have limits.

  4. Increased demand on and depletion of natural resources.

  5. People on the move.

  6. Climate change.

  7. Activist energy.

  8. Orphans.

  9. Other diseases.

Uncertainties

  1. Will there be a ‘magic bullet’?

  2. Who has the power? What kind? How will it be used?

  3. How do we respond to inequality and with what effect?

  4.  What do we believe about HIV and AIDS? What works? Traditional versus modern medicine? Prevention? Treatment? Care?

  5. What will the South African and global economy be?

  6. What is happening on the African continent?

  7. What human and natural resources will we have?

  8. Can we all work together?

  9. Will the goodwill continue?


Scenario Statistics



Issue ASSA2003 estimates for 2005 Winter of Discontent by 2025 Autumn of Limited Opportunity by 2025 Spring of Hope by 2025 Summer for All People by 2025
Adult HIV prevalence (20-64)     19% 18% 13% 11% 7%
People living with HIV and AIDS (millions) 5.2m 5.4m 4.2m 3.4m 2.4m
New infections p.a. 539 000 491 000 312 000 275 000 111 000
Cumulative new infections 2005-2025 N/a 8 738 000 5 926 000 5 165 000 2 864 000
Cumulative infections averted 2005-2025 N/a  (used as baseline) 2 812 000 3 573 000 5 874 000
AIDS sick p.a. 529 000 786 000 530 000 500 000 339 000
AIDS deaths p.a. 326 900 445 000 303 000 292 000 201 000
Cumulative AIDS deaths 2005-2025 N/a 8 160 000 6 708 000 6 790 000 5 672 000
Cumulative AIDS deaths averted
2005-2025
N/a (used as baseline) 1 452 000 1 370 000 2 488 000
People on ART p.a. 124 000 439 000 1 255 000 771 000 1 127 000
Life expectancy at birth 51 50 55 56 59
AIDS orphans – maternal (millions) 0.8m 1.7m 1.4m 1.4m 1.0m
Cumulative programme costs (2005 – 2025 in R billions)* N/a 144b 261b 207b 284b

* Cumulative programme costs are the costs that the public health sector are likely to incur in managing the effects of HIV and AIDS. These costs exclude various social grants.


Realistic Assumptions



Issue Winter of Discontent Autumn of Limited Opportunity Spring of Hope Summer for
All People
Magic bullet? No cure and no effective and widely used vaccine or microbicide for HIV or AIDS No cure and no effective and widely used vaccine or microbicide for HIV or AIDS No cure and no effective and widely used vaccine or microbicide for HIV or AIDS No cure and no effective and widely used vaccine or microbicide for HIV or AIDS
Status awareness by 2010 One in five One in three One in three 40% of all
60% of HIV positive
Condom usage Youth: 40%
Adults: 25%
Youth: 70%
Adults: 40%
Youth: 70%
Adults: 40%
Youth: 90%
Adults: 60%
Partner change Very frequent Frequent Less frequent Less frequent
VCT take-up p.a. in 2010 6% 16% 22% 25%
ART access by 2025 15% 68% 40% 95%
AIDS deaths p.a. 445 000 303 000 292 000 201 000
Cumulative AIDS deaths 2005-2025 8 160 000 6 708 000 6 790 000 5 672 000
Cumulative AIDS deaths averted
2005-2025
(used as baseline) 1 452 000 1 370 000 2 488 000
People on ART p.a. 439 000 1 255 000 771 000 1 127 000
Life expectancy at birth 50 55 56 59
AIDS orphans – maternal (millions) 1.7m 1.4m 1.4m 1.0m
Cumulative programme costs (2005 – 2025 in
R billions)*
144b 261b 207b 284b

* Cumulative programme costs are the costs that the public health sector are likely to incur in managing the effects of HIV and AIDS. These costs exclude various social grants.


Response in 2025



In developing the different Live the Future - HIV and AIDS Scenarios, we had to ask a few key questions to determine the scenario content.The leading question was: How will HIV and AIDS and our responses shape the future of South Africa by 2025?
To answer this question, we in turn asked the following questions for each of the scenarios:
1. Will there be a magic bullet?
2. What do we believe about HIV and AIDS?
3. What kind of leadership is there?
4. How does government, business, civil society and the donor community respond?
4.1. Government response
4.2. Business sector response
4.3. Civil society response
4.4. Donor community response
5. What condition is the South African economy in?
6. How is business affected by HIV and AIDS?
7. What is the medical response?
8. What are the socio-economic issues?
9. What are the underlying psychosocial issues fuelling the HIV epidemic?
10. What about the children?
11. What has happened to the legal system?
12. What natural resources will be available?
13. What is happening on the African continent?
14. What is happening in terms of media / communications?
15. What are some critical time frames and events?
Download the responses 

 

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