SA's HIV/Aids epidemic rages unabated. The country has the world's highest infection rate: 5m are living with HIV, compared with 3m in India and 1m in the US. Both countries have much bigger populations than SA, and this raises the question: why is the disease continuing to have a stranglehold on the country?
Francois Venter, the president of the Southern African HIV Clinicians Society & Reproductive Health and the HIV Research Unit at Wits University, cites horrifying statistics: one in eight South Africans lives with HIV. Half a million South Africans die of the disease every year. It is the most common underlying cause of death in this country.
WHAT IT MEANS
 One in eight people in SA lives with HIV
Infections are increasing among those above 40
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"We could draw some hope were we able to imagine that the statistics were a little inflated; but SA's statistics are among the most accurate in the world," Venter says. "We know more about HIV/Aids than we do about cancer."
He says the disease gallops unchecked through the population because prevention campaigns have hit their target in some pockets of the population, but remain ineffective in others.
A look at the most recent figures confirms this. Infection among 15-20 year olds is declining, but it is growing - steeply and consistently - among South Africans older than 40. At the same time, married and widowed women are emerging as one of the groups most vulnerable to the disease.
According to Venter, these trends are symptomatic of the fact that in SA prevention programmes hint that HIV is a disease that affects the young, the promiscuous and the single. The unsophisticated message preaching ABC - abstain, be faithful, condomise - may have hit its mark among teens, but it goes unnoticed by other sectors of the population.
"Human sexuality is not spoken about in SA. There are sexual networks we don't understand," Venter reflects, saying that messages that focus on youth tend to be one-dimensional, and won't hold relevance for the same people 20, or even 10, years hence.
If SA's response to prevention is inadequate, are there any areas where the country has achieved success?
"SA has a rich repository of knowledge about HIV. The fact that there are relatively few myths surrounding the disease proves that the population is well educated about HIV/Aids," says Venter. He adds a caveat, however: this education has not translated into a lower rate of infection, primarily because people have not imposed it on their understanding of risk and sexual behaviour.
Government's antiretroviral (ARV) programme represents another success story that is tempered by a "but".
"On paper, it's an excellent programme," Venter concedes.
Indeed, it is the biggest programme of its type in the world, with 380 000 people accessing ARV drugs through the government initiative and a further 90 000 through the private sector. But, says, Venter, during the two years that the drugs have been available, 1,5m people have died of Aids.
"The moral here is that treatment is no match for prevention," Venter says. It's a message borne out by the frustrations of mother-to-child prevention programmes. Venter says as many as 70 000 children are infected with HIV every year - infections that could easily be prevented by simple and safe interventions that, sadly, are not being made available to enough people.
On a more positive note, Venter says that government's condom distribution campaign has had a marked effect on behaviour, with condom use increasing dramatically over the past 10 years. Though here, too, there is room for improvement.
"Used consistently, condoms can be very effective in preventing transmission. However, that effectiveness diminishes significantly if use is not consistent."
How should we tackle the disease in the future? "The war analogy has become clichéd, but it's applicable. We need to mount a co-ordinated attack on HIV/Aids," Venter says. "It requires unwavering commitment from our leaders. We need to move beyond rhetoric and blame. We need sober, calm, yet urgent reflection on where this battle is headed; we need to mobilise resources; and we need creative thought."
Venter rues the fact that this has not happened to date. "Fifty percent of our people are dying of this disease. We need to take action."
