Scale-Up of ART in South Africa Begins to Turn the Tide

Because of the devastating HIV epidemic and the unavailability of antiretroviral therapy (ART) in government clinics and hospitals until 2004, life expectancy in South Africa declined significantly. Now, two studies suggest that this bleak picture is changing. Both were conducted in rural KwaZulu-Natal, where rates of poverty are high and >20% of adults are HIV infected. ART has been rapidly scaled up in this area — first for patients with CD4 counts <200 cells/mm³ and later for those with CD4 counts <350 cells/mm³ who either are pregnant or have tuberculosis.

Bor and colleagues examined changes in adult life expectancy in the area between 2003 — the year before public-sector provision of ART to adults began — and 2011. During this period, a…