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HIV in Africa demands complex cultural responses

BMJ 2013; 346 doi: (Published 29 April 2013) Cite this as: BMJ 2013;346:f2517
  1. Chris Ellis, general practitioner, Pietermaritzburg, KwaZulu-Natal, South Africa
  1. cristobalellis{at}

After a quarter of a century of AIDS in Africa, Chris Ellis reflects on the cultural changes the epidemic has brought—and the future

I practise in the province of KwaZulu-Natal in South Africa, which has one of the highest, if not the highest, incidences of HIV and AIDS in the world. Over the past 25 years we have watched as this epidemic started slowly, gained momentum, and then, overwhelming our social, medical, and economic resources, turned our hospitals into hospices. As antiretroviral drugs became more available, the pictures and prognoses of the epidemic have changed, and we are now seeing a slight downturn in the number of cases.

One recent evening a man came into the surgery carrying a young woman and laid her down. She was in her 20s and easy to carry because her body was so wasted. She died within the hour. The practice nurse and I waited with the corpse for the undertakers. As they dispassionately loaded the frail body into the van, I imagined what it must have been like in medieval England during the black death.

In KwaZulu-Natal alone …

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