The proportion of people 50+ with HIV has doubled in 10 years:
The success of South Africa’s HIV treatment programme — the largest in the world — has also created a slumbering threat: a considerably larger group of people who need to be treated for age-related illnesses such as diabetes, heart conditions and high blood pressure — also called noncommunicable diseases — on top of having to receive HIV care.
Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we’ve got around 6 million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus.
Bhekisisa’s data analysis shows the proportion of older people with HIV doubled over the past decade: people over 50 are now the second biggest HIV-positive group in South Africa today; 15 years ago, they were the smallest group.
If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015.
As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises — which means that people with HIV might live long lives, but not necessarily healthy ones.
With nearly two-thirds of all people with HIV living in sub-Saharan Africa, the continent will keep on bearing the brunt of the epidemic — despite massive gains in curbing new infections over the past 15 years — if health systems aren’t geared to handle the growing number of people who have both HIV and a chronic illness like heart disease or diabetes.
Experts have raised the alarm about this “inevitable price of success” more than a decade ago. Yet, write the authors of an editorial in a March issue of The Lancet Healthy Longevity, without thorough data on older people with HIV in African countries, putting plans for their healthcare in place will be hard — or not be done at all.
And with many countries’ governments, including South Africa’s, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking health conditions of older people with HIV will probably be a low priority.
In the wake of funding cuts, employing health workers to capture and manage health data will be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during a webinar hosted by Bhekisisa and the Southern African HIV Clinicians Society on Thursday — something that, for a public health issue that might be ignored because its fallout isn’t immediately visible — could make the problem so much worse.
What then, does South Africa’s picture look like and could policymakers focus forward to stave off a calamity in the making?
Here’s what the numbers show.
The proportion of people with HIV and who are 50 or older is growing — and faster than increases in other age groups.
In 2015, the count in the 50+ age group was just over 700 000, which translates to about 12% of the total HIV-positive population. The age group 40 to 49 years, though, was about 1.3 million strong, which works out to 22% of the total.
A decade later, the 50-plussers’ total had jumped by 1.15 million to reach 1.85 million and they now make up roughly 24% of the total number of HIV-positive South Africans.
Although the 40 to 49 group’s total also grew by 1.15 million, proportionally they now make up 32% of everyone.
In other words, the proportion of older people with HIV doubled in a decade, but the proportion of people 10 years younger grew only 1.5 times bigger — a result, experts say, of people with HIV living longer, new infections still happening in older people and fewer new cases in the younger group. If this trend carries on, there could be three times as many HIV-positive people over 50 by 2030 as in 2015.
Speeding up, changing ranks
People over 50 are the second biggest HIV-positive group in South Africa today. Fifteen years ago, they were the smallest group.
Around 2012, the 50-plussers moved up one rank, surpassing growth in the under-20s group. But the number of HIV-positive people between 35 and 49 grew rapidly — so much so that by around 2012 they overtook the group aged 20 to 34 and assumed top rank.
In the following years, the 50+ group increased too: people moved out of their late forties and new infections in that age group continued. By 2026 — about 10 years since their previous rank jump — people over 50 will already have been the second biggest group of the HIV-positive population for some time.
The 35 to 49-years group will keep on growing in the next five years, modelled data shows, albeit more slowly than before. Because people are living longer, the older group will grow too as people move into their fifties, and because it’s been expanding for some time already, the group will edge closer and closer to top rank over the coming years.
Living long but not necessarily healthy
This is where the warning lies.
Data from 2020 shows that, when Covid-19 is ignored, one in seven deaths in people between 45 and 64 years old were due to health problems like heart attacks, stroke and high blood pressure that year. In comparison, only one in 20 deaths in that age group were linked directly to HIV.
Above age 65, a quarter of deaths were from these conditions. So few were linked to HIV in this age group that, proportionally, it was hardly a noticeable concern.
So, as the peak of the HIV-infected population shifts into an older age band, more and more people will probably have to be treated for noncommunicable diseases like heart conditions, diabetes, being overweight and high blood pressure — on top of receiving HIV care.
In fact, in a large study in Mpumalanga, in which most people were in their late 40s to early 70s, about half had at least two age-related illnesses.
For example, in this sample of just over 5 000 people, six in 10 had high blood pressure, with it being more likely the older someone is. About 10% of women had bad chest pain, called angina (which happens when the heart doesn’t get enough oxygen-rich blood) and up to 11% of people had high cholesterol.
High blood pressure combined with high cholesterol is bad for your heart. It can damage your arteries, and especially those that supply oxygen-rich blood to the heart. In turn, this ups the chance of fatty plaques building up along the walls of the blood vessels. This narrows and stiffens the arteries, meaning blood pressure builds up even more and the chance of a blood vessel rupturing increases.
High blood pressure can lead to angina or a heart attack because the heart muscle gets too little oxygen and also cause a suite of other health problems called metabolic syndrome, which includes conditions like diabetes, stroke and heart disease.
Age-related health problems like heart disease, diabetes and being overweight are often linked to inflammation. This is a natural response of the immune system when tissues are damaged, like when we get older.
However, inflammation is even more common with HIV-infection — because of the body’s immune response, damage caused by the virus itself and also the effects of ARV treatment — and studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people.
“In future, every clinic nurse will have to be Nimart trained,” said Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society at last week’s webinar.
Nimart nurses — short for Nurse-Initiated Management of Antiretroviral Treatment — are specially trained in how to prescribe ARVs and how to manage long-term patients.
But, experts say, the flip side is also true if South Africa is to deal with the ageing HIV epidemic — every Nimart nurse will have to be equipped to deal with noncommunicable diseases in this population too.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
Tiger Brands offers first settlement in deadly listeriosis outbreak case:
South Africa’s largest food producer, Tiger Brands, has agreed to settle claims from certain groups in the listeriosis class-action lawsuit, seven years after the country experienced the world’s deadliest listeriosis outbreak.
The 2017-18 outbreak caused 218 deaths out of more than 1 000 infections as a result of people consuming contaminated processed food products — mainly polony cold meat and vienna sausages — which were produced at the Tiger Brands facility in Polokwane and distributed from its Germiston facility.
On Monday, Tiger Brands confirmed that attorneys representing its lead reinsurer QBE Insurance Group Limited had presented a settlement offer to the plaintiffs’ attorneys as “part of a roadmap to a possible overall resolution of the listeriosis class action”.
“The lead reinsurer, having primary conduct of the defence of the class action against Tiger Brands, has with Tiger Brands’ support and agreement authorised the insurers’ attorneys to make settlement offers to specific named persons,” the company said in a statement.
It said these were members of classes of claimants who suffered damage as a result of listeriosis caused by genotype L1-SL6-ST6-CT4148 of listeria monocytogenes (ST6) — the outbreak strain.
These are claimants who contracted (or whose mothers contracted) listeriosis caused by ST6; claimants whose legal breadwinners, on whom they were legally dependent, died of listeriosis caused by ST6 and claimants whose legal dependents, who were in their care, contracted listeriosis caused by ST6.
The settlement offer, made on 25 April, includes an undertaking to pay the claimants’ proven or agreed compensatory damages in terms of section 61 of the Consumer Protection Act. “The offer is subject to certain conditions and has been made without admission of liability and in full and final settlement of the claims of the claimants.”
The listeriosis class-action attorneys said in a statement that they welcomed Tiger Brands’ “effective admission of liability for the world’s deadliest listeriosis outbreak in 2017-18, which claimed the lives of over 200 people, primarily children, and impacted more than 1 000 South Africans”.
Two law firms, Richard Spoor Inc. Attorneys and LHL Attorneys are the class attorneys.
The attorneys commended Tiger Brands, its shareholders and insurers for agreeing to compensate victims, saying: “This reflects a positive move towards corporate accountability, responsible citizenship and justice for victims.
“The current proposal provides for full compensation to claimants for all proven damages, subject to a settlement mechanism that still needs to be finalised including how individual damages will be assessed and how claimants will be categorised under the settlement structure.”
The development is a breakthrough because it is the first settlement offer made since the class-action was certified in December 2018, Nilesthra Padayachee, a director of Richard Spoor Inc. Attorneys, told the Mail & Guardian.
“Even though the settlement … refers to a group of individuals, we are really hoping to achieve an overall settlement that will encompass all class members,” she said.
“It is the initial settlement offer, so there will be a greater conversation between us and the defendants. We are in the process of arranging a meeting with our class representatives to also canvas the offer with them.
“But we do welcome it as a great first step. Essentially, what we need to do is decide between us on the settlement mechanism that will be created to finally be able to compensate the claimants.”
Tjaart Kruger, the chief executive of Tiger Brands, said the announcement represented an important milestone and followed on measures already taken in February to offer interim relief in the form of advance payments to identified claimants with urgent medical needs.
“It also demonstrates our commitment to continue to work closely with our insurers and their appointed attorneys to explore a resolution of the entire class action,” Kruger said.
Tiger Brands said it and the insurers’ attorneys were engaging with the plaintiffs’ attorneys to ensure timely implementation of the offer and settlement of proven or agreed compensatory damages as soon as possible.
“The next step to give effect to the settlement offer is for the offer to be conveyed by the plaintiffs’ attorneys to those claimants who qualify and then for the damages of those claimants who accept the offer to be quantified.”
It is expected that the process to present the offer to these qualifying claimants will take several weeks and that arrangements to quantify their damages will follow over the ensuing weeks.
The class action, which is being managed in two stages, is still at the first stage during which liability is to be determined by the court.
“Only if Tiger Brands is found to be liable will the issue of causation arise, in the second stage of the class action, as well as an assessment of compensation payable to qualifying claimants for damages suffered,” it said
The listeriosis class attorneys said Tiger Brands’ decision to settle claims was based on the “incredible investigative work of the National Institute of Communicable Diseases (NICD), under the direction of Health Minister Aaron Motsoaledi”.
“Their scientific investigation, which conclusively traced the outbreak to Tiger Brands’ Polokwane facility, has been internationally peer-reviewed and praised. These findings have since been confirmed by world-renowned epidemiologists, including Tiger Brands’ own experts.”
Padaychee concurred. “The NICD’s investigation has yielded the evidence that Tiger Brands’ own experts have reviewed now and it’s on the basis of that that we believe this offer was made.”
Before any settlement can be finalised, it must be presented to the high court, which will determine its fairness as the ultimate guardian of class member interests. While this process will require time, the listeriosis class attorneys are confident that “Tiger Brands’ renewed and demonstrable commitment to the victims will ultimately lead to a comprehensive resolution of all claims”.
While this is a significant breakthrough, serious challenges remain, they added.
“Many victims of the outbreak have not yet come forward and therefore have not yet been identified or located,” they said, noting that Motsoaledi had requested a full update and had “shown his commitment” to assisting with providing department of health records to help confirm and trace victims.
The health department welcomed the decision by Tiger Brands to finally settle the listeriosis class action “to bring this lengthy legal matter to finality and closure to the affected families whose loved ones succumbed to this deadly, but preventable and treatable, disease”.
It acknowledged the roles of all parties involved including the NICD, Tiger Brands, Richard Spoor Inc and LHL Attorneys “who put the sufferings of the victims and their families at the centre stage during a protracted legal process”.
The NICD is providing the medical records to enable decision-making in the process during the investigation of the outbreak.
“The department is also appealing to those with enough evidence suggesting a causal link between the outbreak of listeriosis and the loss of their loved ones, to come forward so that their clinical records can be accessed for assessment to establish if indeed they have valid claims eligible for settlement, and also to find lasting closure after grief.”
Listeriosis is a serious, but treatable, disease caused by the bacterium Listeria monocytogenes.
“The bacteria is widely distributed in nature and can be found in soil, water and vegetation. Animal products and fresh produce such as fruits and vegetables can be contaminated from these sources.
“The outbreak highlighted the importance of consistent and strict adherence with food safety practices in the processing and handling of ready-to-eat foods, especially for mass supply,” the department added.
Blockchain-based financial reporting has potential to empower SMMEs:
In South Africa, where economic volatility, high youth unemployment and tightening fiscal space continue to define the national mood, small businesses are often hailed as the engines of inclusive growth.
But despite their potential, SMMEs (small, medium and micro enterprises) face a host of structural barriers, chief among them is the high cost of compliance. Financial audits, though crucial for credibility, funding and tax alignment, are often prohibitively expensive for small players operating on razor-thin margins.
Enter blockchain-based financial reporting, a digital innovation that promises not only to reduce the costs of auditing but to embed transparency, traceability and trust directly into the architecture of the enterprise itself. For South Africa’s SMMEs and start-ups, this is a structural revolution with real potential to level the financial playing field.
Audits are traditionally backward-looking. Financial statements are compiled, reviewed manually and reconciled, often months after transactions occur. The process is time-consuming, labour-intensive and expensive. For a small business juggling payroll, marketing, operations and growth, a full-scale audit can feel like a detour it cannot afford.
Blockchain challenges this model by creating a continuously updated, decentralised ledger of transactions that is both immutable and accessible in real-time. Once a financial event is recorded, whether it’s a payment, invoice or expense, it is time-stamped, cryptographically secured and visible to relevant parties.
This system of “trustless” verification can dramatically cut the need for costly manual audits. According to Madzinga and Tinarwo (2023), this architectural shift can significantly reduce audit effort by up to 30% through real-time verification, thereby lowering audit fees and increasing accuracy.
For auditors, this doesn’t spell obsolescence, it marks a reorientation. Auditing becomes a process of overseeing system design, exception reporting and real-time analytics, rather than combing through reams of paperwork to catch historical errors. This aligns with the broader academic consensus that blockchain will shift auditors’ roles toward more analytical and consultative functions.
What makes this shift profound is not just the technical architecture but the access it enables. In today’s economy, formal compliance is often the ticket to growth. Without it, entrepreneurs can’t access bank loans, apply for government tenders or attract investors. Yet, for many SMMEs, especially in townships and rural areas, the cost of accounting services alone keeps them locked out of formal financial channels.
Blockchain-based reporting tools, when integrated with mobile platforms and user-friendly interfaces, can help such businesses create verifiable financial histories automatically, with minimal overhead. Imagine a spaza shop owner generating a blockchain-secured income statement simply by using a mobile point-of-sale device. Or a freelance creative sharing tamperproof payment records with a bank to apply for credit. This is more than digitisation; it is economic inclusion.
South African start-ups, particularly those in tech, logistics and renewable energy, often rely on international investors and accelerators. But cross-border funding comes with strings attached — transparency, traceability and accountability. The traditional approach, hiring auditors, preparing reports, verifying bank statements, is not only slow but often distracts lean teams from their core innovation goals.
With blockchain, start-ups can maintain real-time ledgers visible to investors, regulators and even customers. By integrating smart contracts and self-executing agreements coded on the blockchain, they can automate not just payments but compliance checks, tax deductions and milestone-based funding disbursements.
For a Cape Town fintech looking to scale across Africa or a Limpopo agri-tech start-up pitching to a Dutch venture capitalist, this kind of digital credibility could be game-changing. Blockchain holds strong promise for enhancing trust between stakeholders and ensuring tamperproof assurance mechanisms, especially in high-stakes environments.
While the most dramatic benefits are likely to be felt by small businesses, the implications for large firms and public institutions are equally significant. Corporates could streamline internal controls, reduce fraud risk and shorten audit cycles, savings that can be redirected toward innovation, training and social investment. Real-time auditing can also reduce insider risk, particularly in sectors like procurement, mining and construction, where complex supply chains often obscure financial accountability.
In the public sector, blockchain-based reporting could transform how the government tracks budgets, monitors expenditure and audits departments. Although the adoption curve is steeper, the potential is enormous.
Real-time visibility into departmental spending could not only reduce audit backlogs but offer a bulwark against corruption, something South Africa has learned, painfully, is not a theoretical risk. As identified in the literature, blockchain adoption in the public sector could foster a new era of financial accountability, especially when paired with capacity-building and digital infrastructure investment.
There are secondary gains, too. With integrated tax logic, blockchain systems can automate VAT calculations and submissions. They can allow businesses to access real-time dashboards showing profit margins, tax liabilities and risk exposures. And, as regulatory clarity grows, they can help build investor trust, not just locally, but globally.
Importantly, this is not about surveillance. Data permissions can be managed to protect privacy while still allowing selective transparency for those who need it, be it funders, banks or auditors. South Africa is not short on challenges. But it also isn’t short on creativity, talent and digital capability. The opportunity now is to rethink financial infrastructure, not just as a system for big banks and corporations, but as a shared utility for every entrepreneur, every co-op and every side hustle.
To get there, we need collaboration — from the South African Revenue Service to local fintechs, from regulators to township incubators. We need sandbox testing, education and low-cost blockchain platforms that meet people where they are.
Blockchain-based financial reporting is not a panacea. But it can shift the narrative, from gatekeeping to accessibility, from inefficiency to automation, from distrust to verifiable truth. And in a country where trust is both fragile and vital, that might just be its most powerful feature.
Yonela Faba is a University of Cape Town PhD student and writer with blockchain, finance and policy analysis expertise. He has a background in academia and banking. Linkedin: Yonela Faba.
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