AIDS and South Africa -- towards a comprehensive strategy. Part I. The world-wide experience.

The spread of HIV infection and AIDS in South Africa is a grave problem that demands immediate action. It is imperative however that issues of confidentiality and sociopolitical situations are understood. Medical staff should maintain a strict confidentiality with their clients who are HIV-positive; they should also advise their clients to inform their sexual contacts. Those who are tested for HIV infection should receive counselling prior to and after the test. Issues of anonymity in reporting and idea of making AIDS a medically notifiable condition need further research and discussion. A surveillance system of HIV infection needs to be established and accompanied by education and counselling measures. Of those who are tested positive initially it is advised that ELISA tests be used for confirmation. HIV testing in general should be formalized and centralized and specified by the law. South African AIDS surveillance should incorporate CDC case definition which includes serological testing. Insight and sensitivity are necessary in the areas of AIDS and HIV testing counselling and surveillance.