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Does South Africa deserve its bad rep on tackling HIV?

September 24th, 2008

Dr Petra

Over the past few years South Africa has gained a reputation for being very poor at tackling the HIV issue. Nelson Mandela, while adored by his country, admitted he could have spoken out earlier and more forcefully on AIDS – although at least Madiba was prepared to discuss the issue. His successor Thabo Mbeki presented an approach to HIV that (depending on who you listen to) ranged from denying its existence through to seeing it as a Western conspiracy or suggesting it might be ‘cured’ through herbal alternatives. A view that has proved costly to both the citizens of South Africa and one of the leading proponents of the herbal treatment for HIV.

Meanwhile one of Mbeki’s strongest critics, Jacob Zuma, was aquitted of the charge of rape, but not before he’d admitted to not using a condom but claimed he’d taken a shower as a means of protecting himself from HIV. Not, perhaps, the best role model in a country ravaged by AIDS.

But does South Africa truly deserve its bad reputation? Research just published in the Journal of Public Health by Nicoli Nattrass suggests that it does – although there are a number of other countries who are also not doing their bit in the fight against HIV and AIDS.

Nattrass used a cross-country regression analysis to assess how different countries were performing on HAART coverage (provision of antiretroviral treatment) and tackling mother to child transmission (MTCTP). Analysis suggested that countries with strong leadership on HIV such as Brazil, Cambodia, Thailand and Uganda, Costa Rica, Mali and Namibia did well in their treatment programmes. South Africa did perform well below expectations, as did countries like Trinidad, China and Russia.

Interestingly not all countries that performed badly did so across the board. Russia did provide treatment programmes around mother to child transmission, but were not good at HAART provision – perhaps because within the country the view is those with HIV are stigmatised (and stereotyped) as injecting drug users. Interestingly, other countries like Botswana who do have a good reputation in their tackling HIV did well in providing universal HAART coverage but were not so strong on their programmes around mother to child transmission.

South Africa’s poor performance can be tracked to poor leadership since the country does have the resources and capacity to provide high level of HAART and MTCTP coverage – suggesting ideological views of those within the government has limited the use of antiretrovirals – not, as perhaps as sometimes been suggested, institutional or economic problems.

The whole paper is well worth a read, although does contain some complex analysis. I’d recommend it to anyone working in the area of HIV education, treatment or prevention (or hopefully all three). It does allow a cross country reflection on an area that is full of political and personal issues – but where people’s lives are quite literally at stake.

South Africa isn’t the only country where there are problems, and even in the countries that are seemingly tackling HIV well there is always room for improvement. However, we can at least see that the situation in South Africa has not happened by accident, but by design. And that’s a very grim message we all should heed.

By now, most of us have heard that Thabo Mbeki, former president of South Africa, has resigned. It’s not over HIV, but through a wider range of issues. There are many who feel he has done much for his country, and many who feel he could do a lot more. The future of South Africa now hangs in the balance and many of us working in healthcare will be waiting anxiously to see what happens next for the health minister and the public.

At this time we need to remember the high prevalence of HIV in South Africa (in some regions at nearly 30% of the population), the people who need treatment, but also the greater need to provide preventative approaches. Mismatched education campaigns that have been haphazardly delivered and often give conflicting messages (ranging from abstinence only to condom use) have left healthcare practitioners, politicians and the public equally confused. Moving forward we need to think about prevention messages being as strongly made as treatment programmes. And we should take this time to thank the countless HIV counsellors working across South Africa, many on very low incomes themselves, who work tirelessly to educate and support their communities in the face of poverty, ignorance and fear.

Here is Mbeki’s resignation speech. Some feel this is one of his finest moments and have expressed regret it should come at the end of his period in office. Others feel it is right that he goes. Whatever you think, try and see if you can spot any mention of HIV in the following address…

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