Beers 1
Allison Beers
HIV/AIDS in South Africa
For every solved mystery in the world, there are thousands upon thousands
of others that are unsolved. Such is the case with all fields of humanity, but
particularly in medicine – discoveries are recognized and then expanded upon. Of
course, the playing field is not level. Time is biased, leaning more favorably to those
institutions and countries with the most money, knowledge, and 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. Quantifying these standards is difficult, yet the
following measurements will suffice: HIV prevalence, doctor to patient ratios,
percent, and income from medicines. However, there is no cut-off for determining
whether or not a country is developed using these measurements, so further
analysis is required. Using the case of South Africa, one may explore the reciprocal
effect of health challenges on development, and vice versa. Because HIV/AIDS
created a sense of emergency within South Africa, it initiated a series of
developmental reforms, simultaneously depleting the resources of the country and
making it exponentially more difficult to implement these reforms.
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 virus’s
unfortunate discovery. 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
Beers 2
during the Dutch colonialism period, small pox, malaria, famines, and more health
challenges emerged, followed by tuberculosis, syphilis, bubonic plague, yellow fever,
parasites, and malnutrition during 19th century British colonialism (Coovadia 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. Doctors were prominent
because they were serving the white population, and practitioners of orthodox
medicine became a staple for the rest of the population. During the period of
segregation (1910-1948), there was one doctor for 3,600 people total, but one
doctor for 308 white Cape Town residents (Coovadia 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
dangerous a scale. This scale is what creates so much current tension between
HIV/AIDS and South African development.
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, accounting for 31.9% of morbidity) and rape or other forms of
violence (second leading risk factor, at 8.4%) (Coovadia 2009). In fact, according to
a study by the Human Rights Watch, “women in South Africa are more likely to be
raped than to learn how to read” (EIU 2004). The South African government,
although neglectful during the apartheid years, realized the importance of
increasing women’s protection when its new Constitution (1996) solidified gender
Beers 3
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 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 – HIV/AIDS spurred development in South Africa for gender
equality.
South Africa’s 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.
Incredibly, “In 2005, spending per private medical scheme member was nine fold
higher than public sector expenditure, and one specialist doctor served fewer than
500 people in the private sector but around 11,000 in the public sector” (Harris
2011). First of all, the current healthcare system is largely inadequate to handle
such a serious epidemic because 73% of all doctors in South Africa are practicing for
the private sector, insurance that is far too expensive for a majority of the
population (EIU 2004). The HIV/AIDS epidemic has only worsened the situation
because it has “increased the price of occupational cover, and many insurers are
considering stepping back from the mass cover market” (EIU 2004). For those who
are not fortunate enough to have access to private health care, the state system must
suffice.
Beers 4
The presence of HIV/AIDS has created a sense of emergency throughout
South Africa, and it has 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.),
there is serious doubt as to whether an appropriate amount of funds will be
allocated, especially considering the system’s 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 for serving a large majority of the
population. When HIV/AIDS struck, South Africa was grossly unequipped and
unprepared, leading 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). However, developmental reform is seen as 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 progressed.
The South African government has created and received extreme tension
over HIV/AIDS, resulting in a series of overwhelming factors such as resource
depletion and political negligence. First of all, it took the South African government
far too long to respond to the disease; “the annual antenatal surveillance prevalence
rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005” (Coovadia
Beers 5
2009). After it was established that HIV/AIDS was a national crisis, several new
pieces of legislation emerged, including the case in which “The Constitutional
Court…ruled that an antiretroviral (ARV) drug, Nevirapine, must be made available
to pregnant women with HIV/AIDS throughout South Africa to prevent mother-tochild transmission of the virus” (EIU 2004). This was perhaps the most beneficial
law passed because it focused on preventing the spread of AIDS as opposed to trying
to cure it. Such attempts often were overpromised and went unfulfilled; for example,
“the 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 53,000” (EIU 2004). Barely 5% of those scheduled to receive the ARV drug
actually received it, emphasizing HIV/AIDS’s depleting effect on trust in government
and resources. Similarly, “health-care access for all is constitutionally enshrined; yet,
considerable inequities remain, largely due to distortions in resource allocation”
(Harris 1). HIV/AIDS has encouraged governmental reform and development, but its
costliness takes away the resources necessary for government to make such
changes.
Very often in history, serious changes in government or development are
time-consuming processes that do not happen over short periods of time. However,
national emergencies create a sense of urgency that need to be solved right away or
will continue to spread and wreak havoc. Such is the case with HIV/AIDS and South
Africa. 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.
Beers 6
Bibliography
Coovadia, Hoosen, Rachel Jewkes, Peter Barron, David Sanders, and Diane McIntyre. "The
Health and Health System of South Africa: Historical Roots of Current Public Health
Challenges." Lancet 374 (September 5, 2009): 817-34. Accessed September 2, 2013.
Acorn.
Harris, Bronwyn, Jane Goudge, John E. Ataguba, Diane McIntyre, Nonhlanhla Nxumalo,
Siyabonga Jikwana, and Matthew Chersich. "Inequities in Access to Health Care in South
Africa." Journal of Public Health Policy, 2011. Accessed September 2, 2013. ProQuest.
"International Human Development Indicators - United Nations Development Programme."
International Human Development Indicators. Accessed September 04, 2013.
http://hdrstats.undp.org/en/countries/profiles/ZAF.html.
South Africa. Report. London: Economist Intelligence Unit, 2004. Accessed September 04, 2013.
http://portal.eiu.com/FileHandler.ashx?issue_id=227847822.