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THE HIV/AIDS HEALTH ISSUE IN SOUTH AFRICA

  • 21 Pages
  • Published On: 15-12-2023
Introduction

The Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is one of the major health challenges affecting public health in South Africa (Rimien et al., 2019). Despite South Africa’s efforts to avail medications for controlling and reducing viral transmission, HIV/AIDS still poses a significant health challenge to the public. The disease has already devastated thousands of families across the country. Deaths resulting from HIV/AIDS have orphaned millions of children and disrupted the normal structure of the community (Joska et al., 2020). HIV/AIDS has affected almost every sector of life. The pandemic has largely contributed to the increase in health expenditures in South Africa. The critical level of care required by the patients is forcing the government to divert resources that would otherwise be used to finance other development projects (Gamarel et al., 2017). Apart from overburdening the overall health and social support expenditures in the country, the virus is claiming the lives of hundreds of health practitioners in South Africa (Rimien et al., 2019). The HIV/AIDS pandemic in South Africa is a complicated public health issue that requires a strategic approach from the national governmental organizations, non-governmental organizations, and international organizations.

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Historical Context of HIV/AIDS in South Africa

South Africa reported its first HIV case in 1982, a time when the country was fighting to end the apartheid system (Hodes, 2018). The government ignored the HIV/AIDS problem as the country was facing other serious challenges such as political unrest. The media outlets did not react to the pandemic immediately (Joska et al., 2020). Politics dominated major headlines at the time and the public was not immediately made aware of the pandemic. HIV silently began to take hold mostly among the gay population of South Africa and the black population.

Three years after the first case was reported, the department of health initiated a public awareness campaign. The campaign included the use of coffins and skeletons to convey messages about HIV/AIDS in the country (Hodes, 2018). The campaign however did not convey messages on the mode of transmission. In 1987, the apartheid government sought to restrict the civil liberties of infected persons (Moshabela et al., 2017). South Africans diagnosed with HIV were quarantined while immigrants who had the disease or were suspected to have been infected were deported back to their countries.

By 1990, HIV/AIDS prevalence in South Africa had reached an all-time high. The country was at this time transitioning from apartheid to democracy and the government was facing a myriad of challenges which included corruption and abuse of power (Duko et al., 2018). There was no elaborate plan by the government to handle the HIV/AIDS issue. The department of health was unable to take the appropriate measures to curb the spread of the disease. Infected people could not access the life-saving antiretroviral treatment (Sabi and Rieker, 2018). These factors led to the rise of public health activist movements in the country. Members of these movements sought to compel the government to enable public access to testing and treatment of the virus (Duko et al., 2018). The movements further sought to force the government to undertake the necessary steps to curb the spread of the virus.

The efforts of the activists saw the formation of The National Aids Convention of South Africa (NACOSA) in 1991 (Geffen and Welte, 2018). This organization sought to strengthen partnerships among civil groups, health workers, and development agencies in a bid to curb the spread of HIV on the. In 1993, the South Africa government published its first plan to intervene HIV/AIDS pandemic issue (Moshabela et al., 2017). Despite all these activities, the response to the pandemic remained inadequate and ineffective. Cultural challenges impeded the government’s efforts in addressing the HIV/AIDS issue. For instance, it was a taboo among some South African communities to talk openly about sex.

Current Developments of HIV/AIDS Pandemic Issue

Currently, South Africa has the highest HIV prevalence rate in the world. Out of the 58 million people in the country, 7.7 million are estimated to have contracted the virus (Avert, 2020). In the Southern Africa region, South Africa alone accounts for 30% of all new HIV infections (Amuche at al., 2017). Of the 240,000 new infections in 2018, 71,000 were from South Arica (Avert, 2020). The burden of the pandemic has profound implications on the development of South Africa. The high rates of HIV-related infections and deaths have compromised household stability and investments in children (Duko et al., 2018).

The government of South Africa has made commendable efforts to address the HIV/AIDS issue. Steps undertaken by the government include enhanced clinical testing and financing the anti-retroviral program (ART) (Avert, 2020). Today, South Africa has the largest antiretroviral treatment in the world (Amuche et al., 2017). This program is largely financed from domestic resources. As a result of the ART program, the national life expectancy in the country has increased from 56 to 63 years (Rimien et al, 2019).

There has been notable progress in the testing and suppression of the virus. A report by the world health organization indicates that 90% of the people living with HIV have so far been tested and 87% of them have enrolled in the treatment program (Avert, 2020). The prevalence, however, remains high especially in the Western Cape and in KwaZulu-Natal areas.

HIV/AIDS Health and Social Policies in South Africa and a Comparative Analysis with the United States
Access to Testing

The government of South Africa has launched a number of HIV testing and care programs. The two recent nationwide testing initiatives are the National HIV testing and the National HIV/AIDS counseling campaign (Joska et al., 2020). These initiatives were part of the government’s policy to have people working in the private sector and the higher education sector get tested for the virus. As a result of this policy, more than 10 million people have since been tested (Avert, 2020). There have however been discrepancies in the number of women when compared to that of men who present themselves for testing. More women are tested as compared to men. Men are reportedly worried about queuing outside the testing facilities (Gamarel et al., 2017).

Access to HIV testing is a priority in many other countries. In the United States, for instance, the government has undertaken measures to include annual HIV testing for people aged between 15-65 years (Amuche e al, 2017). Such measures include the expansion of the national health insurance program. The rate of people who turn in for HIV testing in the United States of America is however low as compared to that of South Africa (Sabi and Rieker, 2017). In the United States, people have a low disease risk perception while others are afraid of being stigmatized after diagnosis.

Access to Care and Treatment

The United Nations program introduced the 90-90-90 targets to mitigate the adverse effects of HIV/AIDS (UNAIDS 2017). In line with the UN’s program, South Africa guarantees free and reliable access to anti-retroviral treatment (ART) (Hotez et al., 2029). At least 4.8 million people in the country are receiving HIV/AIDS treatment as a result of the free access to care and treatment policy (Masquillier et al., 2020). Studies reveal that more women than men are more likely to enroll for ART in South Africa and as a result, the mortality rate of men is twice that of women.

Just like in South Africa, there is free access to care and treatment policy for the people living with HIV/AIDS in the United States (Gona et al., 2020). Testing for HIV/AIDS in the United States has become widespread over time. However, more than half of the adult population are were yet to turn out for testing as at 2012 (Rizza et al., 2012). The number of people who turn in for these services in the United States is, however, lower when compared with that of South Africa (Zuma et al., 2017). This can be attributed to lack of awareness and misconceptions related to the HIV/AIDS virus in the United States.

Education and Awareness

The government of South Africa has made numerous efforts to educate the masses and create awareness of the HIV/AIDS pandemic (Gona et al., 2020). The government is determined to use the education policy to provide comprehensive sexuality education in both public and private schools. By the end of the year 2016, only 5% of the schools were offering sexuality education in South Africa (Zuma et al., 2017). The government is planning to introduce a system of education that will assist learners to prevent and report incidents of sexual violence.

In the United States, the status of sexual health education is insufficient in most areas (Amuche et al., 2017). There are claims that sexual education is not taken seriously and in some cases, it does not start early enough for the learners (Sweileh, 2018). The number of schools where students are supposed to get advice on HIV prevention keeps decreasing in the United States. Offering HIV/AIDS education and creating awareness has not been taken seriously in the United States. According to the Centers for Diseases Control and Prevention (2016), many Americans have become complacent about HIV/AIDS and at least a quarter of the patients are not aware of their statuses.

Legislation

Through legislation, the government of South Africa has managed to minimize cases of discrimination on an HIV status basis. Section 6(1) of the constitution requires the public especially those at the workplace to desist from any form of unfair discrimination based on a person’s HIV status (Hotez et al., 2019). The constitution bars employees from dismissing employees who turn out to be HIV positive. These laws aim to promote a non-discriminatory work environment and curb the stigmatization of HIV patients.

HIV/AIDS Pandemic issue in the Context of Social Divisions in South Africa

Apart from HIV/AIDS being a medical problem in South Africa, it is a social problem. This is demonstrated by the virus’s widespread, ineffectiveness and the inability of the medical department to control HIV expansion in the country. South Africa is one of the world’s countries that have experienced gross social inequalities(Gordon, Booysen and Mbonigaba, 2020). Such inequalities are mostly based on racial, class, and gender factors. Apartheid for instance has for a long time shaped the social profile and as a result, derailed the efforts to deal with the HIV/AIDS pandemic.

Social divisions and issues related to it have been the major setback in the fight against the virus. Whereas anyone regardless of their social status can get infected with HIV/AIDS, certain groups of people are at a higher risk of getting the infection (Sherr et al., 2018). These groups of people engage in high-risk behaviors while others experience stigma and discrimination. Stigma and discrimination are among the major hindrances for people to seek HIV testing and treatment. If the social issues are well understood and dealt with, the government and international organizations could effectively roll out prevention programs to the people at high risks (Sweileh, 2018).

Gender

Women in South African society have an unequal cultural, social, and economic status. This is largely a result of inequitable laws and harmful cultural practices that empower men and disempowering women (Sherr et al., 2018). Women are at a higher risk of contracting the virus as compared to men. By 2017, the percentage of women infected stood at 26% while that of men stood at 15% (Avert, 2020). Gender-based violence, poverty, and the low status of women in South Africa are largely to blame for the high disease prevalence among women. A third of women in the country have at one time experienced intimate partner violence.

A report by the world health organization indicated that the HIV prevalence among young women was much higher than that of young men in the year 2018 (Gona et al., 2020). Intergeneration relationships between older men and young women were understood to be the major force behind this disparity. Discriminative social attitude towards women makes it harder for them to access testing and treatment services.

Class

South Africa is among the countries with the highest unequal distribution of resources (Gordon, Booysen and Mbonigaba, 2020). The HIV/AIDS epidemic in the country has brought about huge demands for medical care in the public health sector. As a result, the disease is more prevalent among the middle class and lower class population.

Preventing early deaths arising from HIV-related infections requires a household member to first identify the infection through testing, and enroll in the treatment program (Enoch and Piot, 2017). Though testing is free in South Africa, there are other related expenses such as transport fees. People of the lower class may have problems in financing such expenses. People of the lower social class report lower rates of HIV testing as compared to those of high social class (Gamarel et al., 2017).

Being of a lower social class in South Africa is associated with reduced or no food security, lack of food diversity, and increased chances of skipping meals. Poor women are forced to adopt behaviors that increase their risk of getting infected (Enoch and Piot, 2017). These behaviors include commercial sex and early marriages. HIV patients require a balanced diet to boost their immune response to opportunistic infections. In addition, Low-class people may have difficulties accessing protection equipment such as condoms due to their reduced financial capability (Gona et al., 2020).

Ethnicity

Globally, racial inequalities play a significant role in escalating the HIV/AIDS pandemic. Some ethnic groups are at a higher risk of acquiring and transmitting HIV when compared to other ethnic groups (Enoch and Piot, 2017). This is because, in some places such as South Africa, some population groups have higher rates of HIV/AIDS prevalence. The risk of acquiring the infection in these groups is high.

In South Africa, Black African males have high HIV/AIDS prevalence as compared to their counterparts from other races (Avert, 2020). The high prevalence among blacks is created by historical social injustices and unequal social and economic status. The apartheid particularly has contributed significantly to the HIV prevalence among the black community in South Africa (Hodes, 2018). In a country where blacks are the majority, apartheid perpetuated HIV through denial of health services and access to quality education to the black community. Apartheid policies mostly addressed the social and economic advances for the minority white communities at the expense of the black race. Up to date, the black community is yet to recover from the burden of high HIV prevalence which would otherwise not be there had it not for the apartheid system (Mokitimi et al., 2017).

Cultural Issues

The high prevalence of HIV/AIDS in South Africa has prompted speculations regarding risk factors that may be unique to the country. Some cultural practices increase the risk of HIV/AIDS in the region (Zuma et al., 2017). These factors include polygamy, early marriages, and virginity testing. All these vices characterize most South African societies.

Polygamy is not primarily a harmful practice that can directly lead to the spreading of HIV/AIDS. However, how people in polygamous marriages conduct themselves ends up facilitating the spread of the virus (Sweileh, 2018). Wives in a polygamous marriage have little or no control over the sexual behaviors of their husbands or co-wives. Infidelity for instance could be a catalyst for the spread if the cheating partner gets infected. In the KwaZulu-Natal community of South Africa, there has been a resurgence of virginity testing (Ngubane, 2020). The public identification of a young girl as a virgin increases her risk of sexual abuse.

Age and Family Status

By 2018, the number of HIV-infected children in South Africa stood at 260,000 and 63% of them were on treatment. These were children of age 0-14 (Avert, 2020). The rate of infection among young children is lower as compared to that of people aged 15 years and above. The decline in new infections among children is attributed to the government’s efforts in preventing mother-to-child HIV transmission. Children are however mostly affected by the HIV pandemic through the loss of their parents and guardians. HIV/AIDS pandemic has orphaned At least 1.2 million children in South Africa (Gona et al., 2020). This creates another problem as these children lose their providers. They become insecure and vulnerable to HIV due to economic and social insecurities. Such children become targets of sexual predators who force them to have sex in exchange for support.

The Role of International Organizations and Aid Agencies in Addressing the HIV/AIDS Issue

There are many international organizations involved in the fight against the spread ofthe HIV/AIDS pandemic. These organizations engage in a coordinated effort to stop new HIV infections and ensure that everyone living with the virus has unrestricted access to testing and quality treatment (Enoch and Piot, 2017). International Organizations such as the Joint United Program on HIV/AIDS (UNAIDS) are responsible for promoting human rights for the patients and producing data for decision making. Some of the prominent international organizations involved in this fight include The Global Fund, The World Health Organization (WHO), and UNAIDS. These organizations undertake the international role of policy formulation and legislation in matters concerning the HIV/AIDS pandemic (Sherr et al., 2018).

Formulation of Policies

One of the policies adopted by international organizations is the creation of awareness about HIV/AIDS. Kaiser Family Foundation for instance focuses on the provision of the latest data and information about the virus (Kaiser Family Foundation, 2016). The organization conducts research and data analysis on regular basis. In addition, Kaiser Family Foundation works with major news organizations across the world to enable easy access to information. Its information is provided free of charge.

International health organizations aim to build a better and healthier future for people living with HIV/AIDS across the world. These organizations advocate for equality and preservation of human rights regardless of their health status (Conmy, 2018). The World Health Organization particularly provides evidence-based technical support to countries across the world. The organization supports its members in the quest to scale up the treatment of the virus and slow down its spread. The mission of such organizations is to lead collective action on the global HIV response.

Legislation

The United Nations General Assembly fully recognizes human rights and freedoms. The organization has formulated a number of international regulations and guidelines meant to protect HIV patients across the world (Motikimi et al., 2017). Following a global outcry against the high cost of HIV treatment, the ministerial council in 2001 made a regulation prompting its members to take measures to protect public health (Patterson and London, 2002). The United Nations members were required to allow easier access to medications for people living with the virus.

International organizations have made numerous efforts to form and support national organizations. These national organizations comprise professionals and HIV/AIDS victims who are united in advocating for the rights of patients (Conmy, 2018). With the support of the United Nations Development Programme, many countries have been able to form law associations meant to oversee the implementation of the rights of patients. Organizations such as legal clinics promote laws and policies on human rights and freedom.

Comparison with US

President Donald J. Trump stated his administration's intention to end the HIV pandemic in the United States within ten years in his State of the Union Address on February 5, 2019. In the president's budget, Republicans and Democrats will be asked to make the necessary commitment to support a detailed strategy to achieve this goal (Fauci et al., 2019). While groundbreaking biomedical and scientific research advances have resulted in the development of many successful HIV treatment regimens, prevention strategies, and improved care for people living with HIV, the HIV pandemic continues to be a public health crisis in the United States and around the world.

More than 700,000 people have died in the United States as a result of HIV/AIDS since the disease was first recognized in 1981, and the Centers for Disease Control and Prevention (CDC) estimates that 1.1 million people are currently living with HIV, with approximately 15% of those people unaware of their HIV infection (Ransome et al., 2018). Approximately 23% of new infections are spread by people who are uninformed of their infection, and 69 percent of new infections are transmitted by people who have been diagnosed with HIV but are not receiving treatment (Fauci et al., 2019).

The US Department of Health and Human Services (HHS) has suggested a new strategy to address this ongoing public health epidemic, with the objective of first lowering incidence infections in the US by 75% within 5 years, and then by 90% within 10 years (Fauci et al., 2019). By coordinating the highly successful programs, resources, and infrastructure of the CDC, the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Indian Health Service, this initiative will leverage critical scientific advances in HIV prevention, diagnosis, treatment, and care (IHS) (Ransome et al., 2018).

Global Issues in the Fight against HIV/AIDS

The global economic crisis is a major hindrance to the international fight against HIV/AIDS. The UNAIDS faces a greater challenge in ensuring that UN agencies heed their call of supporting developing countries that are severely affected by the pandemic (Motikimi et al., 2017). Financing a sustainable response to the disease is a hard task especially for developing nations. With the emergence of other pandemics that require huge financing, international organizations face a challenge in financing the HIV/AIDS control measures.

The emergence of other infections has derailed the international fight against HIV/AIDS. Currently, the world is battling a new virus. The COVID-19 pandemic has a serious impact on the most vulnerable communities and impedes the progress of the fight against HIV/AIDS (Conmy, 2018). World resources are now redirected to the new virus. At the moment, there is no single country that is immune to the increasing economic cost of the new pandemic.

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Conclusion

The HIV/AIDS pandemic poses a significant health threat to South Africa. The complex nature of the disease makes it even harder for the government and other international organizations to develop a comprehensive approach to addressing it. The government and other organizations, however, have made numerous efforts to intensify testing, treatment, and provision of care to HIV patients. All these efforts have been derailed by other social factors such as class differences, gender inequalities, ethnicity, and cultural issues. In its efforts to slow the spread of the disease and mitigate its adverse effects, the government has enacted a number of policies. The policies include free access to HIV testing, education, and the creation of public awareness. International organizations have made numerous efforts to help South Africa and other developing nations in fighting the virus. These include financing the war against the disease and developing policies meant to address the HIV/AIDS issue.

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