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PSCI 115F Final Essay
HIV/AIDS in South Africa and the United States: A Comparative Essay
By Allison Beers
Growth is biased, leaning more favorably to those institutions and countries with the most money, knowledge, and development. Using South Africa and the United States as examples, one can examine how governmental and societal response to emergencies changes as the countryâs state of development changes. Because of the sense of emergency HIV/AIDS created within South Africa, a series of developmental reforms were initiated, which were difficult to implement due to the draining effect of the disease on the countryâs resources. Yet it was the hostile social stigma associated with HIV/AIDS that prevented the United States government and people from responding appropriately to the disease, actively choosing ignorance instead. The United States was just as ineffective in containing HIV/AIDS at the start of the epidemic as South Africa was in terms of sympathizing with victims and forming policy; its only saving characteristic was its high amount of resources compared to that of South Africa.
Definition of Development
For the purposes of this paper, a developed country shall be one with the following characteristics: gender equality, accessible healthcare, and a responsive government with a concern for its people. These qualities are those that comprise a countryâs ability to provide a safe environment, especially in terms of containing diseases like HIV/AIDS. Quantifying these standards is difficult, yet the following measurements will suffice: HIV prevalence, doctor to patient ratios, availability of medicines, and the number of policies made by the government. These statistics provide insight into the effect that HIV/AIDS has on the countryâs state of development, and vice versa.
Definition of HIV/AIDS in South Africa and the United States
In order to understand the effects of HIV/AIDS on South Africa, it is important to note the lifestyle and history of the country before the virusâs unfortunate outbreak. In fact, South Africa has been plagued with diseases and health care problems since colonial times, yet the government was far more responsive to these outbreaks than they were to HIV/AIDS. In the 17th century during the Dutch colonialism period, small pox, malaria, famines, and other various health challenges emerged. These were followed by tuberculosis, syphilis, bubonic plague, yellow fever, parasites, and malnutrition during 19th century British colonialism (Coovadia et al. 2009). Consequently, various measures including the Public Health Act (1883; smallpox vaccines became required) and the Public Health Amendment Act (1897; separation of preventative and curative care) were put into effect.Â Doctors served the white population while practitioners of orthodox medicine became a staple for the rest of the population. During the period of segregation (1910-1948), there was only one doctor for every 3,600 people, but one doctor for every 308 white Cape Town residents (Coovadia et al. 2009). The problem of HIV/AIDS was not unique in its type but in its magnitude. South Africa had seen healthcare, health policy, and medical challenges in the past, but never on so large a scale. This scale is what created so much current tension between the HIV/AIDS situation and South African development. Contrastingly, the United States prides itself on being one of the most developed countries in the world. It maintains a standard of living incomparable to a majority of other countries; it has a functioning democratic system of government, and a strong army with bases all over the world. Yet, the United States is plagued by moments of corruption and weakness throughout history, including the failure to respond to those in need. America has been the host for cruelly fatal prejudices, especially during the height of the HIV/AIDS epidemic in the 1980s-1990s. Between 1992 and 1993, 78,948 cases of HIV/AIDS were diagnosed, 44,914 of which ended in death (Francis 2012). HIV/AIDS has been a crisis for both South Africa and the United States, crippling the health of each country.
Part 1: HIV/AIDS in South Africa
As a fatal virus, HIV/AIDS has been both the creator and receiver of immense social tension in South Africa by dramatically affecting gender roles. In South Africa, young women are the most affected by HIV/AIDS due to unprotected sex (the leading risk factor of morbidity, accounting for 30.9% of all total deaths) and rape or other forms of violence (second leading risk factor, at 8.4%) (Coovadia et al. 2009). In fact, according to a study by the Human Rights Watch, âwomen in South Africa are more likely to be raped than to learn how to readâ (EIU 2004).Â The South African government, although neglectful during the apartheid years, realized the importance of increasing womenâs protection when its new Constitution (1996) solidified gender equality. In addition, the Domestic Violence Act (1998) prohibited rape and abuse of women, and the Criminal Law for Sexual Matters and Related Offenses was altered in 2007 to give a broader definition of rape (Coovadia et al.Â 2009). In this way, gender inequality has a very circular relationship with HIV/AIDS. While HIV/AIDS is killing young women, its horrific presence is encouraging stricter laws and social reform, which benefits women long-term. It is sad that it has taken such an epidemic for the South African government to realize the necessity of illegalizing acts of violence, yet such is the case â HIV/AIDS spurred development in South Africa for gender equality.
South Africaâs development (in terms of healthcare) has allowed HIV/AIDS to spread, causing an epidemic that depletes medical resources even further. It is a constant struggle that has settled at an equilibrium point that benefits no one.Â Incredibly, the spending for the medical private sector was nine times as large as the spending for the public sector in 2005, meaning that one doctor served around 500 people in the private sector but 11,000 people in the public sector (Harris 2011). This suggests that the current healthcare system is too inadequate to handle such a serious epidemic as 73% of all doctors in South Africa practice for the private sector and health insurance is far too expensive for the majority of the population (EIU 2004). The HIV/AIDS epidemic has only worsened the situation because it has âincreased the price of occupational cover, and many insurers are considering stepping back from the mass cover marketâ (EIU 2004). For those who are not fortunate enough to have access to private health care, the state system must suffice.
The presence of HIV/AIDS created a sense of emergency throughout South Africa, and therefore catalyzed healthcare reform. The system of hospitals and health centers is supposedly undergoing reform (hiring health inspectors, enforcing higher standards, providing preventative medicines, etc.). However, there is serious doubt as to whether an appropriate amount of funds will be allocated, especially considering the systemâs past of being incredibly underfunded (EIU 2004). About 75% of the South African population turn to a traditional healer or take traditional remedies; the income from traditional medicines (R3.2bn/year) is almost half that of Western drugs (R7bn/year) (EIU 2004). Even under normal conditions, the healthcare systems are inadequate in serving a large majority of the population. When HIV/AIDS struck, South Africa was grossly unequipped and unprepared, which lead to devastating consequences. In the Kwa-Zulu-Natal province of South Africa alone, 36.5% of the population aged 15-49 in 2001 were infected with HIV (IHDI 2013).Â However, developmental reform is considered to be a result of this virus. The Medicines Amendment Act (1997) was passed (although it made ARV drugs highly priced) because the World Trade Organization ruled it acceptable because South Africa was in a state of emergency (2004). Due to the urgency of containing HIV/AIDS, the healthcare system in South Africa advanced and developed.
HIV/AIDS has created large amount of tension between the South African government and its people, resulting in resource depletion and political negligence.Â First, it took the South African government far too long to respond to the disease: âthe annual antenatal surveillance prevalence rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005â (Coovadia et al 2009). After it was established that HIV/AIDS was a national crisis, several new pieces of legislation emerged, including the case in which âThe Constitutional Courtâ¦ruled that an antiretroviral (ARV) drug, Nevirapine, must be made available to pregnant women with HIV/AIDS throughout South Africa to prevent mother-to-child transmission of the virusâ (EIU 2004). This was perhaps the most beneficial law passed as it focused on preventing the spread of AIDS as opposed to trying to cure it. Attempts to cure the disease were often overpromised and unfulfilled; for example, âthe implementation capacity of the government is proving to be a problem. As at March 2004 only 2,700 patients were receiving ARV drugs, against a planned level of 53,000â (EIU 2004). Barely 5% of those scheduled to receive the ARV drug actually received it, emphasizing HIV/AIDSâs depleting effect on the peopleâs trust in government and resources. Similarly, âhealth-care access for all is constitutionally enshrined; yet, considerable inequities remain, largely due to distortions in resource allocationâ (Harris 1). HIV/AIDS has encouraged governmental reform and development, but its costliness takes away the resources necessary for government to make such changes.
Part 2: HIV/AIDS in the United States
The consequences of the stigma associated with HIV/AIDS extend far beyond those of societal disgrace; in fact, it even extended to Washington, where the Reagan administration was almost completely inept in handling the crisis. President Reagan and his administration made many decisions that benefitted America; their response to HIV/AIDS, however, was definitely not one of them. Donald Francis, a former employee of the Center for Disease Control during the time of the HIV/AIDS crisis, recalls his frustration at the governmentâs refusal to fund HIV/AIDS treatment and research efforts. The plan the CDC proposed to the White House for curbing HIV/AIDS (which Francis helped to draft) was rejected with the commentary, âLook pretty and do as little as you canâ (Francis 2012). It was not ignorance of the effect of HIV/AIDS that prevented the Reagan administration from taking action against the disease but a genuine disinterest, which may or may not have been heightened by homophobia. In some cases, the prejudice is clear; for example, Patrick Buchanan, the White House Director of Communications at the time, was an outspoken homophobe who claimed that homosexuals were victims to HIV/AIDS because they âdeclared war on nature and now nature is exacting an awful retributionâ (Francis 2012). Buchananâs statement is extreme. Not all members of the White House shared the same sentiments, and even if they did, it is likely that they would not express it to such a shocking degree. However, it was this prejudice that won out over the others in the end. At a time when the government was trying to cut back on spending, a disease such as HIV/AIDS that carried such a negative stigma was unlikely to receive any special attention until absolutely necessary. When it was necessary, it was too late â HIV/AIDS epidemic was quickly escalating into a pandemic, affecting parts of Africa and Europe, and there were over 10,000 cases reported in the United States (Francis 2012).Â Due to misguided priorities, the United States government failed to respond appropriately to the HIV/AIDS crisis.
Once the overwhelming amount of patients infected by HIV/AIDS pushed discrimination into the background, the United States government began enacting policies to combat its prevalence, only to find that its resource advantage had been dramatically damaged by the programsâ late start. In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act (to be managed by the U.S. Health Resources and Services Administration (HRSA)). Perhaps the most important provision of this act was that it provided $220.5 million in federal funds for HIV-related programs (HRSA 2011). The most recent attempt to control HIV/AIDS was the inception the U.S. National HIV/AIDS strategy (NHAS), which was gathered under President Obama. However, âHIV programs have generally been flat funded or received small percentage increases which are not at levels estimated to be necessary for full implementation of the NHASâ (Holtgrave et al 2012). While HIV/AIDS prevalence has certainly decreased since the 1980s-1990s, the United States is still experiencing the same implementation problems it did in the past, but on a smaller scale. Had the government taken steps earlier in the process, it could have saved valuable resources and money by not having to treat as many patients because not as many people would be affected today.
Even though the United States may possess and distribute antiretroviral drugs, the drugs are useless if the patients do not use them correctly, which is often the case due the diseaseâs stigma, transmittance, and a long incubation period.Â The presence of antiretroviral drugs has no doubt allowed for the prevention of HIV/AIDS and a slower increase in its spread; however, âproblems with adherence have prevented many from realizing the full benefits of treatmentâ (Leeman et al. 2010). This unfortunate lack of cooperation stems from several qualities of HIV/AIDS. First of all, the disease has a long incubation period of around ten years; that is, victims and potential victims do not see the immediate consequence of the diseaseâs presence. This leads to the second problem: there is no cure, and in order to keep it contained, a person needs to change their daily habits and behaviors. Illegal drug users who are used to sharing needles will either have to stop using drugs (unrealistic for most addicts) or find clean needles. The most effective preventative method for homosexual men â abstinence â is also not a likely lifetime behavioral change. It has also been a problem for patients with HIV/AIDS to seek help and treatment, although it seems that if the patient develops a strong, personal relationship with his doctor that cooperation is more effective (Leeman et al 2010). Because of the characteristics of this disease, HIV/AIDS has had a nulling effect on the resources made available by the United States government, increasing its prominence in the community.
Part 3: Governmental and Social Responses to HIV/AIDS
Society in both the United States and South Africa adopted a hostile attitude towards HIV/AIDS during the first epidemic; however, the United Statesâ society has become increasingly more compassionate than that of South Africaâs due to its developed judicial system. While South Africa is the only African country to legalize homosexuality, it remains a large problem. Cary Johnson of the International Gay and Lesbian Human Rights Commission commented that the rate at which gay, lesbian, and transgender people in Africa were dying had âa speed and breadth reminiscent of the impact of the epidemic on gay men in New York, San Francisco and other North American and European cities in the 1980sâ (Wakabi 2007). Yet the âofficial hostility to gaysâ that characterized the United States HIV/AIDS epidemic decades ago has since subsided, especially with the Supreme Court rulings on Californiaâs Proposition 8 and the elimination of the Defense of Marriage Act (Drucker 2012). While homophobia may be prevalent in the U.S. still, the government is taking much larger strides to equalize gay rights. Meanwhile, in South Africa, no such progress is seen. Individuals with HIV/AIDS are often ostracized in their communities, forcing an unhealthy social dynamic where âfamilies often reject patients, children taunt their sick parents and spouses conceal their HIV status from each other, according to health workers in [towns of South Africa]â (Dixon 2004). The lack of trust between community members in this society breeds HIV/AIDS at an alarming rate, causing many people to seek traditional healers due to the high cost and low availability of doctors. Flora Mogano, a traditional healer in South Africa interviewed by the Los Angeles Times, âclaims to have cured many patients with prayer and sees the disease as a punishment of sin,â a view that many South Africans seem to take (Dixon 2004). This is a view common in South African society, placing the blame on the victim of HIV/AIDS. Unfortunately, this view makes it difficult for patients to seek treatment for fear of losing respect in the community. Progressive views have yet to emerge. Because of the nature of the disease, HIV/AIDS catalyzed hostile societies in both the U.S. and South Africa, yet the development of the U.S. allowed its society to reform, while the South African stigma remains stagnant.
Denial to make policies regarding HIV/AIDS by both the American government and the South African government have drastically increased the impact of the epidemic on each country. The Presidents during the HIV/AIDS epidemic were ignorant of the true devastating power of the disease and blinded by misguided prejudices. In the United States, âPresident Reagan presided over 5 years of a burgeoning epidemic before he first uttered the word âAIDSâ in publicâ (Drucker 2012). President Reagan not only failed to push for HIV/AIDS treatment; he failed to address it altogether. This denial of attention allowed for HIV/AIDS to spread much quicker and easier than it should have. In a study to quantify the effect of government ignorance during the epidemic, the âconservative calculation of the number of HIV infections that could have been prevented ranged from 4394 (15 percent incidence reduction because of needle exchanges) to 9666 (33 per cent incidence reduction)â (Drucker 2012). Clearly, the slow response of the United States government to HIV/AIDS dramatically hurt the entire countryâs public health and contributed to one of the most fatal epidemics of all time. Similarly, Thabo Mbeki, the President of South Africa at the height of the epidemic, refused to even associate HIV with AIDS and neglected to encourage his government to make any policy related to the topic (Coovadia, et al. 2009). In fact, âIn the most striking example of poor stewardship, the national HIV/AIDS epidemic was allowed to spreadâ¦the annual antenatal surveillance prevalence rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005â (Coovadia, et al. 2009).Â Parallel to the negligence from the American government, the South African government failed to respond appropriately to HIV/AIDS, giving the disease full power to overwhelm the country with its horrible fatality rates. In this way, both the South African government and the American government gave HIV/AIDS full reign over the health of the nation, denying its citizens sympathy and help during the spread.
Upon realizing the horrifying magnitude of HIV/AIDS, both the United States and South African governments enacted policy reform â only to find that each lacked the appropriate amount of resources to implement such policies.Â In the United States, the most instrumental policy in containing HIV/AIDS has been the National HIV/AIDS Strategy (NHAS). As discussed previously, this policy is underfunded (Holtgrave, et al. 2012). The government is at least funding some or most of the program â enough to make prevalence decrease. According to the Center for Disease Control, HIV/AIDS related deaths and incidences reached a peak in the early 1990s and has been declining ever since (CDC 2001). South Africa, on the other hand, has had a very difficult time implementing policy at all. In fact, âJust after it took power a decade ago, the African National Congress government promised a comprehensive AIDS treatment policy. It has taken 10 years to arriveâ (Dixon 2004). The arrival of the policy does not even guarantee full implementation of the policy, which has proven to be a bigger problem, since the percentage of people who were promised ARV drugs but are actually receiving them is at about 5% (EIU 2004). Due to its intense lack of resources, South Africa has not seen such a promising trend as the U.S. has â the deaths related to HIV/AIDS show little to no signs of declining (Treatment Action Campaign 2006). While both the American and South African governments are unable to entirely fulfill their promises to treat HIV/AIDS, the United States is at an obvious advantage due to its development, therefore containing the disease more effectively.
An argument that is often put forth about the delay in governmental response to HIV/AIDS is that no one could have predicted how widespread it would become â it was innocent ignorance of the executives, not prejudice, that perpetrated fatal silence. Diseases are not uncommon, so âPresident Mbekiâ¦lumps AIDS in with other illnesses, such as tuberculosis and cholera, questioning why people donât make as much of a fuss about themâ (Dixon 2004). What President Mbeki clearly refuses to realize is that death certificates in South Africa often list these other such diseases as causes of death, but the victims caught those other diseases as a result of their immune deficiency (Dixon 2004). It is not the case that Mbeki had not been informed of the gravity of HIV/AIDS; he simply refuses to acknowledge it. Likewise, in the United States, President Ronald Reagan went five years without formally giving a speech on HIV/AIDS, while other levels of government acted accordingly. While the federal government silently neglected its citizens, âstate and locally funded programs offeredâ¦better access to HIV testing and treatment, addiction care, andâ¦general medical treatmentâ (Drucker 2012). Obviously, there is communication between state governments and federal governments; therefore, it cannot be the case that the federal government (executive branch in particular) was innocently unaware of the full scope of HIV/AIDS when the state governments clearly were. There are undoubtedly other factors at hand besides ignorance of the scope of the disease; factors that caused the executives to purposely fall into the shadows of negligence â pride and prejudice.
It can be said that HIV/AIDS has done more harm than good in terms of the lives it has taken, yet it catalyzed long-term policies that are on track to improve the quality of life compared to before HIV/AIDS. If only it did not take a crisis to necessitate progress in equality (in terms of gender, healthcare, etc.), governments worldwide would be far more responsible. Even though they are drastically different, the United States and South Africa handled the same crisis in a nearly identical way, until the resources and development of the United States overwhelmed the prevailing sense of prejudice and negligence towards HIV/AIDS. Extrapolating on this idea, it is most likely that if South Africa had the resources that the United States did, treating HIV/AIDS would be a much smaller problem, as the politics of the disease would fade into the background. Dr. James Mason, the Director of the CDC during the HIV/AIDS crisis, stated, âthere are certain areas which, when the goals of science collide with moral and ethical judgment, science has to take a time outâ (Francis 2012). Although this is a discouraging claim, especially from the head of one of the most important science departments in the world, it proved to be true. It is a testament to the prejudice of the society at the time that saving lives and preventing the spread of disease would be considered immoral simply because of the nature of the lives being saved. Choice, not ignorance, was the main factor at play in the HIV/AIDS crisis.
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HIV/AIDS in South Africa is a prominent health concern; South Africa is believed to have more people with HIV/AIDS than any other country in the world.
The 2007 UNAIDS report estimated that 5,700,000 South Africans had HIV/AIDS, or just under 12% of South Africa's population of 48 million. In the adult population the rate is 18.5%. The number of infected is larger than in any other single country in the world. The other top five countries with the highest HIV/AIDS prevalence are all neighbours of South Africa.
In 2010, only 88% of people in South Africa with advanced HIV/AIDS were receiving anti-retroviral treatment (ART). In 2004, 2005 and 2006 the figures were 4%, 15% and 21% respectively. By 2009, nearly 1 million or about 2% of all adult South Africans were receiving ART.
In 2010, an estimated 280,000 South Africans died from the effects of HIV/AIDS. In ten years preceding, it is estimated that between 42% and 47% of all deaths among South Africans were HIV/AIDS deaths. However, the Death Notification Forms Survey of 2010, which estimates a 93% completion rate, shows that out of a total of 543,856 deaths nationwide (Appendix C4), only 18,325 deaths were attributed to HIV/AIDS Diseases (B20-B24, Table 4.5).
Although new infections among mature age groups in South Africa remain high, new infections among teenagers seem to be on the decline. HIV/AIDS prevalence figures in the 15–19 year age group for 2005, 2006 and 2007 were 16%, 14% and 13% respectively.
The Human Sciences Research Council, a South African institution, estimates 10.9% of all South Africans have HIV/AIDS. Additionally, the Central Intelligence Agency estimates that 310,000 individuals died in South Africa from HIV/AIDS in the year 2009. The rising prevalence rate has increased from 10.6% in 2008 to 12.2% in 2012. In 2012 alone, the Human Science Research Council (HSRC), reported 470,000 new diagnoses—or nearly 1,100 new infections every day. That's 100,000 more than was seen just one year earlier in 2011. Driving these statistics is the decreasing, rather than increasing, public knowledge about HIV. According to the HSRC report, only 26.8% of the 38,000 people surveyed understood how HIV was transmitted or ways to prevent it. That's down from 30.3% in 2008, with evidence showing that South Africans under 50 are having an increasing number of sexual partners and lower condom use.
According to the latest data from UNICEF, Eastern and Southern Africa currently have 5% of the world’s population but 50% of people living with HIV. The region also has 48% of new HIV infections among adults, 55% among children, and 48% of AIDS related deaths. South Africa alone has 5.6 million people living with HIV, or 17.3% of its population. More specifically, the Southern-Africa sub-region is the most severely affected by the epidemic. Three of the countries in this region have the highest prevalence rates in the entire world. Swaziland is the highest at 26%, Botswana has 23.4%, and Lesotho has 23.3% (UNICEF).
Main article: HIV/AIDS in South African townships
A 2008 study revealed that HIV/AIDS infection in South Africa was distinctly divided along racial lines: 13.6% of black Africans in South Africa are HIV-positive, whereas only 0.3% of whites living in South Africa have the disease. False traditional beliefs about HIV/AIDS, which contribute to the spread of the disease, persist in townships due to the lack of education and awareness programmes in these regions. Sexual violence and local attitudes toward HIV/AIDS have also amplified the epidemic.
HIV/AIDS is more prevalent among females, especially those under the age of 40. Women made up roughly 4 in every 5 people with HIV/AIDS aged 20–24, and 2 out of 3 of those aged 25–29. Although prevalence is higher among women in general, only 1 in every 6 HIV/AIDS infected people with multiple sex partners are women.
By pregnant women
HIV prevalence among pregnant women is highest in the populous KwaZulu-Natal province (37%), and lowest in the Western Cape (13%), Northern Cape (16%) and Limpopo (18%) provinces. In the five other provinces (Eastern Cape, Free State, Gauteng, Mpumalanga and North West) at least 26% of women attending antenatal clinics in 2006 tested HIV-positive.
The latest HIV data collected at antenatal clinics suggest that HIV infection levels might be levelling off, with HIV prevalence in pregnant women at 30% in 2007, 29% in 2006, and 28% in 2005. The decrease in the percentage of young pregnant women (15–24 years) found to be infected with HIV also suggests a possible decline in the annual number of new infections.
Between 2005 and 2008, the number of older teenagers with HIV/AIDS has nearly halved. Between 2002 and 2008, prevalence among South Africans over 20 years old have increased whereas the figure for those under 20 years old have dropped somewhat over the same period.
Condom use is highest among the youth and lowest among old people. More than 80% of men and more than 70% of women under 25 years old use condoms, and slightly more than half of men and women aged 25–49 claim to use condoms.
More than 30% of young adults and more than 80% of older adults are aware of the dangers posed by HIV/AIDS. Knowledge about HIV/AIDS is lowest among people older than 50 years—less than two thirds know the truth about the disease.
Further information: HIV/AIDS in South African townships
In 2008, more than half (55%) of all South Africans infected with HIV reside in the KwaZulu-Natal and Gauteng provinces.
Between 2005 and 2008, the total number of people infected with HIV/AIDS have increased in all of South Africa's provinces except KwaZulu-Natal and Gauteng. Nevertheless, KwaZulu-Natal still has the highest infection rate at 15.5% In the province with the lowest infection rate, the Western Cape, the total number of people with HIV/AIDS doubled between 2005 and 2008.
Condom use has increased twofold in all provinces between 2002 and 2008. The two provinces where condoms were least used in 2002 were also the provinces where condoms are least used in 2008, namely the Northern Cape and the Western Cape.
HIV/AIDS prevalence among sexually active South Africans by province are:
- KwaZulu-Natal: 25.8%.
- Mpumalanga: 23.1%
- Free State: 18.5%
- North West: 17.7%
- Gauteng: 15.2%
- Eastern Cape: 15.2%
- Limpopo: 13.7%
- Northern Cape: 9.2%
- Western Cape: 5.3%
The comparison done in 2003 of the results from four forecasting methods predicted the difference between an HIV/AIDS scenario versus a no-HIV/AIDS scenario for annual growth rates between 2002 and 2015. According to the study, real growth in GDP would be 0.6 percentage points lower than if there were no HIV/AIDS, but per-capita growth in GDP would be 0.9 percentage points higher. Growth in population would have been 1.5 percentage points lower, and growth of the labour force would be 1.2 percentage points lower, but the unemployment rate would be 0.9 percentage points lower as well.
The South African branch of the company Daimler-Chrysler estimated that in 2002 expenses related to HIV/AIDS were equivalent to 4% of all its salaries in South Africa. A study done in 2000 by South Africa's second largest company, Sasol, indicated that 15% of its local workforce was HIV positive, of which 11% had AIDS. According to the CEO of South Africa's largest company, SAB Miller, the cost of HIV/AIDS include costs associated with increased absenteeism, reduced productivity, increased turnover, and healthcare costs.
HIV/AIDS poses a real threat to South Africa’s political structure. HIV/AIDS creates instability throughout a country, especially in the government and those in power. The disease can cause conflict and/or thrives in it. This fact has increasingly dangerous effects on economies and governments, which can lead to failing states. Failing states are often a hotbed for terrorism. Colin McInnes says in an International Affairs article that the mid 90s-beginning of the century was “marked by examples of failing states creating problems for international security, while in the wake of 9/II a link was drawn between failing states and international terrorism, notably by the Bush administration in the United States”. The effects are not immediate as well, they linger as people get sicker and sicker and keep dying. A journal article by Robert Ostergard even says that people in the highest government positions are being brought down by the disease. He reports that “President Mugabe of Zimbabwe has admitted that three of his cabinet- level ministers have died from AIDS”. When this happens (and it is more than likely happening in governments all over Africa), the policy making is disrupted and decision making is inconsistent. As bodies pile up, governments, militaries, communities, healthcare systems, and infrastructures crumble.
HIV/AIDS is also a military threat, and not just a healthcare crisis, because “it has become an 'accepted assumption ... that the rates of HIV are higher among the military and other uniformed forces than among the general population”. It has been reported that at one point in time, military members were between 2-3 and 2-5 times more likely to be infected than the general population. These numbers rise even further during times of conflict. One of the main reasons that has been attributed to this group being affected more is that the military is composed mostly of sexually active 15-24 year olds, which is the demographic most at risk of contracting the disease. Drugs, peer pressure, and access to sex workers compounds the danger of contracting HIV/AIDS, while rape as a weapon of terror also spreads HIV/AIDS. This threatens national security because of a host of issues: “Flight times in African militaries have been significantly affected because crew have been too ill to fly; there is concern that soldiers may be wary of helping comrades with blood injuries in combat through fear of infection; and unit cohesion may suffer if some members are HIV-positive and others are not. The high rate of infection among the officer corps and NCOs will not only affect leadership and experience, but may mean the loss of informal networks crucial to the efficient operation of complex institutions such as the military".
These effects of HIV/AIDS on military forces make an already unstable region even weaker.
The four main HIV/AIDS awareness campaigns in South Africa are Khomanani (funded by the government), LoveLife (primarily privately funded), Soul City (a television drama for adults) and Soul Buddyz (a television series for teenagers). Soul City and Soul Buddyz are the most successful campaigns although both campaigns experienced a slight loss of effectiveness between 2005 and 2008. Khomanani is the least successful campaign, although its effectiveness has increased by more than 50% between 2005 and 2008.
The dubious quality of condoms which are distributed is a setback to these efforts. In 2007, the government recalled more than 20 million locally manufactured condoms which were defective. Some of the contraceptive devices given away at the ANC's centenary celebrations in 2012 failed the water test conducted by the Treatment Action Campaign.
Co-infection with tuberculosis
In 2007, it was estimated that one third of HIV infected people will develop TB (tuberculosis) in their lifetimes. In 2006, 40% of TB patients were tested for HIV. It has been the government policy since 2002 to cross-check all new cases of TB for HIV infection.
Although STI prevention is part of the government's HIV/AIDS programmes, as it is in that of most countries, in South Africa HIV/AIDS prevention is done in conjunction with TB prevention. Most patients who die from HIV-related causes die from TB or similar illnesses. In fact the Health Department's programme of prevention is called the "National HIV and AIDS and TB Programme". In line with United Nations requirements, South Africa has also drawn up an "HIV & AIDS and STI Strategic Plan".
In 1983, AIDS was diagnosed for the first time in two patients in South Africa, and the first recorded death owing to AIDS occurred during the same year. By 1986, there were 46 recorded AIDS diagnoses. Estimates from 2000 indicated that 5% of actual infections and only 1% of actual deaths due to AIDS were reported prior to 1990. Prior to 1990, AIDS was more common among men who have sex with men. By 1990, less than 1% of South Africans had AIDS. By 1996, the figure stood at around 3% and by 1999 the figure had reached 10% AIDS infection started reaching pandemic proportions around 1995.
The earliest cases of HIV in Africa were discovered in the 1960s (Poku).
This is the decade when the true HIV/AIDS epidemic broke out (Poku).
In 1985, the South African government set up the country's first AIDS Advisory Group.
In 1990, the first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive. It was estimated that there were between 74,000 and 6,500,135 people in South Africa living with HIV. Antenatal surveys have subsequently been carried out annually.
In 1993, the HIV prevalence rate among pregnant women was 4.3%. By 1993, the National Health Department reported that the number of recorded HIV infections had increased by 60% in the previous two years and the number was expected to double in 1993.
In August 1995, the Department of Health awarded a R14.27 million contract to produce a sequel to the musical, Sarafina!, about AIDS that would reach young people. The project was dogged by controversy, and was finally shelved in 1996.
From 6–10 March 1995, the 7th International Conference for People Living with HIV and AIDS was held in Cape Town, South Africa. The conference was opened by then-Deputy President Thabo Mbeki.
In January 1996, it was decided that South Africa's national soccer team, Bafana-Bafana, would contribute to the AIDS Awareness Campaign by wearing red ribbons to all their public appearances during the African Nations Cup.
On 5 July 1996, South Africa's health minister Nkosazana Zuma spoke at the 11th International Conference on AIDS in Vancouver. She said:
- Most people infected with HIV live in Africa, where therapies involving combinations of expensive anti-viral drugs are out of the question.
In February 1997, South African government's Health Department defended its support for the controversial AIDS drug Virodene by stating that "the 'cocktails' that are available [for the treatment of HIV/AIDS] are way beyond the means of most patients [even from developed countries]". Parliament had previously launched an investigation into the procedural soundness of the clinical trials for the drug.
In 1999, the South African HIV prevention campaign loveLife is founded.
In 2000, the Department of Health outlined a five-year plan to combat AIDS, HIV and STIs. A National AIDS Council (SANAC) was set up to oversee these developments.
The South African government successfully defended against a legal action brought by transnational pharmaceutical companies in April 2001 of a law that would allow cheaper locally produced medicines, including anti-retrovirals, although the government's roll-out of anti-retrovirals remained generally slow.
In 2001, Right to Care, an NGO dedicated to the prevention and treatment of HIV and associated diseases, was founded. Using USAID's PEPFAR funding, the organisation expanded rapidly and after ten years (2011) had over 125 000 HIV-positive patients in clinical care.
In 2002, South Africa's Constitutional Court ordered the ordered the government to remove restrictions on the drug nevirapine and make it available to pregnant women in all state hospitals and clinics to help prevent mother-to-child transmission of HIV, following a court challenge by Treatment Action Campaign and others.
According to the National HIV and Syphilis Antenatal Sero-prevalence Survey of 2005 and 2007, the percentage of pregnant women with HIV per year was as follows:
According to a 2006 study by The South African Department of Health, 13.3% of 9,950 Africans that were included in the poll had HIV. Out of 1,173 whites, 0.6% had HIV. These numbers are confirmed in a 2008 study by the Human Sciences Research Council that found a 13.6% infection rate among Africans, 1.7% among Coloreds, 0.3% among Indians, and 0.3% among Whites.[dubious– discuss]
In 2007, it was estimated that between 4.9 and 6.6 million of South Africa's 48 million people of all ages were infected with HIV (human immunodeficiency virus), which is the virus that causes AIDS (acquired immunodeficiency syndrome).
AIDS denialism in South Africa
- See also HIV/AIDS denialism in South Africa.
On 9 July 2000, then President Thabo Mbeki opened the International AIDS Conference in Durban with a speech not about HIV or AIDS but about extreme poverty in Africa. In the speech, he confirmed his belief that immune deficiency is a big problem in Africa but that one can't possibly attribute all immune deficiency related diseases to a single virus.
On 4 September 2000, Thabo Mbeki acknowledged during an interview with Time Magazine (South African edition) that HIV can cause AIDS but confirmed his opinion that HIV should not be regarded as the sole cause of immune deficiency. He said:
- ...the notion that immune deficiency is only acquired from a single virus cannot be sustained. Once you say immune deficiency is acquired from that virus, your response will be anti-retroviral drugs. But if you accept that there can be a variety of reasons ... then you can have a more comprehensive treatment response.
On 20 September 2000, then President Thabo Mbeki responded to a question in Parliament about his views. He said:
- All HIV/AIDS programmes of this government are based on the thesis that HIV causes AIDS. [But...] can a virus cause a syndrome? ... It can't, because a syndrome is a group of diseases resulting from acquired immune deficiency. Indeed, HIV contributes [to the collapse of the immune system], but other things contribute as well.
In 2001 the government appointed a panel of scientists, including a number of AIDS denialists, to report back on the issue. The report suggested alternative treatments for HIV/AIDS, but the South African government responded that unless alternative scientific proof is obtained, it will continue to base its policy on the idea that the cause of AIDS is HIV.
Despite international drug companies offering free or cheap anti-retroviral drugs, the Health Ministry remained hesitant about providing treatment for people living with HIV. Only in November 2003 did the government approve a plan to make anti-retroviral treatment publicly available. Prior to 2003, South Africans with HIV who used the public sector health system could get treatment for opportunistic infections but could not get anti-retrovirals.
The effort to improve treatment of HIV/AIDS was damaged by the attitude of many figures in the government, including President Mbeki. The then health minister, Manto Tshabalala-Msimang, advocated a diet of garlic, olive oil and lemon to cure the disease. Although many scientists and political figures called for her removal, she was not removed from office until Mbeki himself was removed from office. These policies led to the deaths of over 300,000 South Africans.
In August 2007, President Mbeki and Health Minister Tshabalala-Msimang dismissed Deputy Health Minister Nozizwe Madlala-Routledge. Madlala-Routledge has been widely credited by medical professionals and AIDS activists. Although she was officially dismissed for corruption, it was widely held that she was dismissed for her more mainstream beliefs about AIDS and its relation with HIV.
The United States announced in March, 2013 that their support to South Africa will be cut in half by 2017 due to the economic crisis and compulsory budget cuts.
Role of the media in South Africa's epidemic
The South African press took a strong advocacy position during the denialism era under Thabo Mbeki. There are numerous examples of journalists taking the government to task for policy positions and public statements that were seen as irresponsible.:44 Some of these examples include: attacks on Health Minister Manto Tshabalala-Msimang’s “garlic and potato” approach to treatment, outrage at Mbeki’s statement that he never knew anyone who had died of AIDS, and coverage of the humiliating 2006 Global AIDS Conference.
It could be claimed that the news media have taken a less aggressive stance since the end of Mbeki’s presidency and the death of Tshabalala Msimang. The emergence of Jacob Zuma as party and state leader heralded what the press saw as a new era of AIDS treatment. However, this also means that HIV is afforded less news coverage. A recent study by the HIV/AIDS and the Media Project has shown that the quantity of HIV-related news coverage has declined dramatically from 2002/3 (what could be considered the pinnacle of government denialism) to the more recent “conflict resolution” phase under Zuma. Perhaps HIV has fallen into the traditional categories of being impersonal, undramatic, "old" news. The number of health journalists has also declined considerably.
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