Analysis South Africa and United Kingdom

Introduction

HIV infection is recognised as the one of the most serious public health issues in the world and people living with HIV face a number of barriers to care (National AIDS Trust , 2014). This essay draws a comparison between two countries, South Africa and the United Kingdom (UK) in context of people living with HIV. Of particular emphasis in this essay, is the issue of discrimination, stigma, and health providers’ attitudes to the HIV positive people in the two countries.

HIV in South Africa in Comparison with the UK

HIV is one of the most serious public health issues faced by South Africa and South Africa remains the country with the highest incidence of HIV in the world (World Bank, 2018). Moreover, the country also has the fourth-highest adult HIV prevalence rate in the world, making it a serious public health concern (World Bank, 2018). Statistics compiled by the United Nations indicate that the HIV prevalence rate for adults between the ages of 15 to 49 years was 19% in South Africa, which makes it the fourth highest prevalence rates in the world (World Bank, 2018). The latest statistics are from mid 2017, which indicate that total HIV prevalence rate in South Africa is 12.6%, and the prevalence rate for all adults between 15 to 49 years is 17.9% (Staitistics South Africa , 2017). Women show a higher prevalence rates at 21.2%, and the rates for youth between 15 to 24 years is reported at 4.6% (Staitistics South Africa , 2017).

The statistics provided above give an indication of the seriousness of the HIV prevalence in South Africa. In comparison, the HIV prevalence rates in the UK are very low (Avert, 2019 ). Statistics from 2017 indicate that in 2015, there were approximately 102,000 people living with HIV, or a prevalence rate of 1.6 per 1,000 people (Avert, 2019 ). The adult HIV prevalence in South Africa is therefore 0.6 percent. In 2017, there were 4,363 newly diagnosed people with HIV (Avert, 2019 ). Therefore, there is a significant difference in the affliction rates of the two countries, with South Africa having more than 16 times the HIV prevalence rates in the adult population as compared to the UK.

South Africa has responded to this problem with an intensive treatment programme, which also happens to be the largest HIV treatment programme in the world (Wilkinson, 2018). It will be useful to point out that the programme was created after NGOs based in South Africa went to court to get their government to implement a national prevention of mother-to-child transmission programme, which at the time was missing despite high mother-to-child transmission rates (Wilkinson, 2018). In 2004, the South African government created and implemented the national antiretroviral therapy programme, which as of 2018 had 3.1 million people on treatment (Wilkinson, 2018).

Research indicates that the ART programme initiated under the HIV treatment programme has led to the declining rates of the infection in different parts of South Africa (Tanser, Bärnighausen, Grapsa, Zaidi, & Newell, 2013). Due to the lowered rates of transmission of HIV, it has been noted that ART in South Africa represents one of the most successful public health interventions ever undertaken in the country (Tanser, Bärnighausen, Grapsa, Zaidi, & Newell, 2013).

Stigma is one of the important barriers for HIV positive people to access public health services in most parts of the world, because it compromises the well-being of the people living with the infection (Gilbert & Walker, 2010). Stigma has been reported by HIV positive individuals in South Africa as indicated by research (Gilbert & Walker, 2010). Research conducted by Gilbert and Walker (2010) with a sample of 44 patients in an HIV ⁄ AIDS clinic in Johannesburg, South Africa, found that the individuals who were living with the infection reported a high level of felt and anticipated stigma. Moreover, this stigma came in the way of access to treatment and disclosure for a significant number of the people (Gilbert & Walker, 2010). Therefore, stigma faced by HIV infected people in South Africa has serious implications for disclosure and treatment (Gilbert & Walker, 2010). The conclusion of this study was that the stigma felt by the individuals with HIV could compromise the efficacy of the ART programme, because of the impact such stigma had on the decisions made by these individuals to disclose their disease and to get help (Gilbert & Walker, 2010). The research also showed that while the clinic staff, including doctors and nurses held the perception that HIV⁄AIDS was a chronic condition that was increasingly manageable, family members, neighbours and employers did not share these views and had highly stigma oriented approach to the patients living with HIV (Gilbert & Walker, 2010).

It may also be mentioned that the stigma faced by homosexual (particularly men) people living with HIV in South Africa may be higher or more strongly felt than the stigma faced by other HIV patients (Cloete, Simbayi, Kalichman, Strebel, & Henda, 2008). A recent research on the stigma faced by homosexual HIV individuals as compared with heterosexual HIV individuals found interesting comparisons (Cloete, Simbayi, Kalichman, Strebel, & Henda, 2008). The study conducted with anonymous venue-based surveys from 92 HIV-positive homosexual men and 330 HIV-positive heterosexual men found that although internalised stigma was high among all HIV-positive men irrespective of their sexual conditioning, HIV-positive homosexual men reported to experiencing greater social isolation and discrimination as compared to other men (Cloete, Simbayi, Kalichman, Strebel, & Henda, 2008). Events that led to the feeling of discrimination amongst these men included loss of housing or employment (Cloete, Simbayi, Kalichman, Strebel, & Henda, 2008). This report suggested that there is a need to generate mental health interventions, and also facilitate structural changes for anti-discrimination measures for HIV-positive homosexual men in South Africa.

In the UK, the ‘UK Stigma Index 2015’ surveyed more than 1,500 people living with HIV and their findings indicate that significant number of people hold stigmatising attitudes towards HIV positive individuals ( Stigma Survey UK, 2015). Stigma does not only have social and psychological impacts, it also has a health impact. The ‘UK Stigma Index 2015’ reported that one in five people have been excluded from family events, 20% people reported sexual rejection ( Stigma Survey UK, 2015). In a survey conducted in 2014, 35 percent of the Black and Ethnic Minority HIV positive individuals surveyed reported to being discriminated against because of their HIV status (National AIDS Trust , 2014, p. 75). Of more concern is the finding that 50 percent of the Black and Ethnic Minority HIV positive individuals reported to being discriminated against by healthcare workers, which included doctors, and hospital staff (National AIDS Trust , 2014). Immigrants who are HIV positive have also reported to facing difficulties in accessing treatment, care and support (National AIDS Trust , 2014).

Barriers to care can seriously compromise the HIV programmes in any country. If there are barriers to care, the implications can be felt not only for the current HIV positive population of the country, but also for the transmission rates of the infection (Bogart, et al., 2013).

In South Africa, research suggests that there is a significant difference in the perspectives of the health care workers in HIV care settings and the HIV patients, which may act as barriers to care (Bogart, et al., 2013). The research conducted by Bogart, et al. (2013) used qualitative data collected from semi-structured interviews with 11 healthcare providers and 10 patients, as well as 8 focus groups with 41 patients. This research found that there were significant differences in perspectives, although a common perspective was that both patients and providers identified HIV stigma as a sizeable barrier (Bogart, et al., 2013). However, the perception towards the barrier was different with patients reporting that stigma-related issues were not in their control, and also reporting to discrimination fears with respect to employment status; on the other hand, providers reported to believing that were responsible for overcoming their internal stigma (Bogart, et al., 2013). It is important to note the finding from Bogart, et al. (2013) that the concerns of the HIV patients regarding inconvenient clinic hours, long queues, appointment scheduling, and disrespectful staff, were not shared by providers. Therefore, there are some significant gaps in the providers’ ability to appreciate the concerns of the patients and responding to the need for greater patient satisfaction (Bogart, et al., 2013). This may be linked to the access issues for people living with HIV and other research which suggests that there is a concern about early mortality rates in people living with HIV and accessing ART in South Africa (Lawn, Harries, Anglaret, Myer, & Wood, 2008). It is emphasised that improving access to care in the period immediately after diagnosis has better impacts on survival after diagnosis and access rates are impacted by the attitudes of the health care providers in HIV care settings (Lawn, Harries, Anglaret, Myer, & Wood, 2008).

In the UK, research suggests that discrimination by health care providers remains a serious impediment in access to care (Elford, Ibrahim, Bukutu, & Anderson, 2008). Research conducted in 2004-2005 with people living with HIV attending NHS outpatient HIV clinics in north east London suggested that almost one-third of respondents reported to being discriminated against because of their HIV infection, with almost half of this discrimination occurring at the hands of health care providers (Elford, Ibrahim, Bukutu, & Anderson, 2008). Recent research confirms the experience of discrimination for transgender HIV people in UK, including in the health care settings, which compromises their access to care for their condition (Hibbert, et al., 2018).

It will be useful to point out that the UK government has taken steps to respond to the issue of discrimination faced by people living with HIV (Chinouya, Hildreth, Deborah Goodall, & Hudson, 2017). Currently, the legislative response is found in the Equality Act 2010, which replaced the Disability and Discrimination Act 1995, and which offers protection to people living with HIV from discrimination in the areas of employment, education and access to services (Chinouya, Hildreth, Deborah Goodall, & Hudson, 2017). In South Africa as well, there are laws, including constitutional laws that protect people living with HIV from discrimination. Such laws include the Bill of Rights in South African Constitution and the Promotion of Equality and Prevention of Unfair Discrimination Act 2000. In context of prevention of discrimination in employment settings, relevant laws are contained in the Labour Relations Act 1995 and the Employment Equity Act 1998. Therefore, both South Africa as well as the UK have laws for protection of people living with HIV from unfair discrimination.

Conclusion

Although HIV affects a much higher population in South Africa than it does in the UK, both countries have national treatment programmes in place which are free of cost to those affected by the infection. With regard to stigma and discrimination, HIV positive people in both countries have reported to there being a high incidence of stigma, which in both countries is seen to be a barrier to care for HIV positive people. Both countries have laws in place for responding to unfair discrimination against HIV positive people. Nevertheless, recent research in both countries indicate continuing stigma even in health care settings. There are also serious gaps in the perceptions of HIV positive people and the health care providers in South Africa, which is a matter of concern in the context of access to care. To conclude, there is not much difference in terms of treatment for HIV patients, and issues of discrimination as well as legal responses by the state in the two countries.

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