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Allison Beers
Governmental and Social Responses to HIV/AIDS
Of all the factors that make up the human history, government and
society are the two most central and often the most influential. How these two
entities react to certain situations, especially emergencies, define their capabilities.
Can the government be trusted to take action for those in need? Will society be
compassionate towards victims? The short answer to both of these questions is no.
If one considers the case of HIV/AIDS in South Africa and the United States, it is
clear that there is a pattern showing a lack of immediate governmental action and
an understanding society during times of distress (even in two incredibly different
countries). Because HIV/AIDS was perceived as a disease for the sinful, the
governments and society of both the United States and South Africa failed to
overcome their prejudices at the expense of human lives. 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 and implementing policy; its only
saving characteristic is its high amount of resources compared to that of South
Africa.
Society in both the United States and South Africa adopted a hostile attitude
towards HIV/AIDS during the first epidemic; however, the United States’ society has
become increasingly more compassionate than that of South Africa’s due to its
developed judicial system. While South Africa is the only African country to legalize
homosexuality, it still 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 “a speed and breadth
reminiscent of the impact of the epidemic on gay men in New York, San Francisco
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and other North American and European cities in the 1980s” (Wakabi 2007). Yet the
“official hostility to gays” that characterized the United States HIV/AIDS epidemic
decades ago has since subsided, especially with the Supreme Court rulings on
California’s 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
from their community, forcing an unhealthy societal dynamic where “families 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]”
(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, “claims to have cured many
patients with prayer and sees the disease as a punishment of sin,” 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
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epidemic were ignorant of the true devastating power of the disease and blinded by
misguided prejudices. In the United States, “President Reagan presided over 5 years
of a burgeoning epidemic before he first uttered the word ‘AIDS’ in public” (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 “conservative calculation of the
number of HIV infections that could have been prevented ranged from 4394 (15 per
cent incidence reduction because of needle exchanges) to 9666 (33 per cent
incidence reduction)” (Drucker 2012). Clearly, the slow response of the United
States government to HIV/AIDS dramatically hurt the entire country’s 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, turned a blind eye
to HIV/AIDS and neglected to encourage his government to make any policy related
to the topic. In fact, “In the most striking example of poor stewardship, the national
HIV/AIDS epidemic was allowed to spread…the annual antenatal surveillance
prevalence rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005”
(Coovadia 2009). 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 this tragic time.
Upon realizing the horrifying magnitude of HIV/AIDS, both the United States
and South African governments enacted policy reform – only to find that each lacked
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the appropriate amount of resources to implement such policies. In the United
States, the most instrumental policy in containing HIV/AIDS has been the National
HIV/AIDS Strategy (NHAS). However, “HIV 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 NHAS” (Holtgrave, et al. 2012). The
government is at least funding some or most of the program – 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, “Just after it took power a decade ago, the African
National Congress government promised a comprehensive AIDS treatment policy. It
has taken 10 years to arrive” (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 the intense lack of
resources, South Africa has not seen such a promising trend as the U.S. has – the
deaths related to HIV/AIDS are not and show little to no signs of declining
(Treatment Action Campaign 2006). While both the American and South African
government 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 – it was innocent ignorance of the executives, not prejudice, that
perpetrated fatal silence. Diseases are not uncommon, so “President Mbeki…lumps
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AIDS in with other illnesses, such as tuberculosis and cholera, questioning why
people don’t make as much of a fuss about them” (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, yet other levels of government
acted accordingly. While the federal government silently neglected its citizens,
“state and locally funded programs offered…better access to HIV testing and
treatment, addiction care, and…general medical treatment” (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 – pride and prejudice.
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.
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Bibliography
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"The Health and Health System of South Africa: Historical Roots of Current
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September 2, 2013. Acorn.
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A Muted Response to AIDS; the Growing Epidemic is the Nation's no. 1 Killer,
but Many of the Sick are Shunned and Left to Rely on Prayer and Untested
Remedies. Series: Third in a Four-Part Series." Los Angeles Times, May 26, 0.
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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5021a2.htm.
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