South Africa is an upper-middle income country, but is a country of stark contrasts. The extreme inequality evident in South Africa means that one sees destitution, hunger and overcrowding side-by-side with affluence. South Africa has a per capita GNP of USD3690 p.a. (in 1998 dollars); yet about 15% of adults are illiterate. 9,2% of children under 5 are malnourished. Life expectancy has fallen from 62 years in 1990 to 48 in 1999 as a consequence of AIDS. It is estimated that 13% of the population and 25% of adults in South Africa are HIV-positive. The infant mortality rate is 45 per 1000 live births. The maternal mortality rate is 230 per 100 000 live births. Of the 44 million people in the country in 2000, about 8 million were surviving on less than the international dollar a day poverty line and 18 million were living on less than 2 dollars per day. 37% of households survive on less than R1000 per month (in 2002 Rands), and 60% of the poor get no social transfers. Health expenditure is 7% of GNP, but less than half of this is public spending.