Much has been said about improving South Africa’s competitiveness. It was a recurring theme at this year’s Investing in African Mining Indaba in Cape Town.
Rather than lamenting macro-economic pressures, we should examine the issue from a logical numbers perspective.
One example of that perspective comes from Albert Einstein, who said: “Compound interest is the eighth wonder of the world. He who understands it, earns it. He who doesn’t, pays it.”
As a family physician who has practised in Soweto for more than 20 years, I’m acutely aware of this principle as I see and treat patients and specifically as I deal with the HIV/Aids pandemic. As a South African I’m also deeply aware of the impact of this scourge on the mining sector.
South Africa has made some remarkable strides in the roll-out of antiretrovirals, but the virus continues to steal loved ones from families and continues to gnaw at our country’s greatest asset – its people.
I regularly conduct voluntary male medical circumcisions (MMCs), which save individual lives and reduce families’ health risks. But I also know MMCs could radically improve our country’s economic performance, especially in labour-intensive sectors such as mining, agriculture and transport. It is these that have large numbers of workers most at risk in what we term the five Ms: men, migrant, mobile, marginalised and with money.
This does not imply that other population groups do not spread HIV, but the group described above is most vulnerable. For them, circumcision is particularly important: the simple, one-off procedure reduces the lifetime risk of contracting HIV by up to 60 percent. This saves individual lives. Apart from the HIV transmission risk during heterosexual sex, circumcision lowers the risk of other sexually transmitted infections (STIs), as well as urinary tract infection and the risk of penile cancer. It lowers cervical risk in female sexual partners and improves hygiene.
From the perspective of saving individuals, MMC deserves investment and focus. The case for its widespread use is even more apparent if it is widely used. The multiplier effect, or what could be termed compound interest, delivers powerful benefits. Let us assume that one person infected with HIV infects five others in his or her life. Those five will go on to infect another 25, who in turn infect 125. By level 10 of this exponential model, there have been nearly 10 million new infections.
Now factor in MMC and its 60 percent reduction in transmission rates: one infected person now infects two others, who go on to infect another four and so on, and by level 10 we have 1 000 new infections.
Implementing MMC widely will trigger a collapse in infections. Its effect will be as dramatic – but with a beneficial, not detrimental result – as the explosion of infections in the 1990s.
This is especially important when you consider our demographics: we are a very young nation with 40 percent of our population under 19 and 37 percent aged 15 to 34, according to Statistics SA. Only 9 percent of South Africans are older than 59.
The 15 to 24 age group is most at risk and it is here where MMC would have the largest benefit in reducing infection.
Employers – especially those with large, young, mostly male workforces – have an obligation and an opportunity to provide MMC.
For 25 years we have focused primarily on psychosocial measures to reduce HIV infections. We now have an opportunity for a simple biomedical procedure that will reap massive dividends for individuals and organisations, with an enormous nation-building dividend. By combining biomedical approaches, such as mother-to-child transmission prevention, MMC, early-start antiretroviral treatment and HIV screening, we can effectively slow, and ultimately stop, the spread of the disease.
For the past decade, there have been about 400 000 new HIV infections every year in South Africa. One of targets of the National Strategic Plan on HIV, STIs and TB is to halve this by 2016.
The plan estimates that achieving its targets will cost R23 billion for 2013/14, rising to R35bn by 2015/16.
The mid-term review of progress in achieving the 2011 UN General Assembly Political Declaration on HIV/Aids targets and elimination commitments suggests that achieving 80 percent MMC coverage in South Africa will prevent half a million new HIV infections and avert 100 000 deaths within a decade.
By 2016, each circumcision performed will avert five new HIV infections. We could eradicate HIV within 20 years.
It has also been estimated that an effective combination-prevention strategy that includes MMC would save R50bn over the next 10 years. Promoting the benefits of MMC via workplace-based HIV programmes will have a dramatic impact on corporate health spending, directly by reducing the burden of disease in the workforce and indirectly by allowing for reduced HIV-related expenditure by the state.
The macro-economic power of MMC as a component of combination prevention is the closest thing we have to a vaccine now. It’s hard to imagine a more powerful opportunity for business to demonstrate its commitment to social and economic development. The mining sector is beginning to grasp the potential of this and must be lauded for doing so.
The African concept of ubuntu has been invoked a lot and has perhaps risked losing its power as a result. What more potent example of ubuntu is there than men undergoing a simple, safe procedure that will benefit thousands of others? Is there a better example than employers and others such as the labour movement empowering those men to have MMC?
Steady reduction of infection rates through one simple procedure will save lives and end untold suffering. It will radically improve our efforts at socio-economic development and competitiveness, and help Africa’s rise as a global economy.
* Dr Don Pupuma is a CareWorks clinical consultant and family physician in private practice in Soweto.