South African Aids Policy: It's Never Too Late To Be Ambitious

South Africa, the country with the highest number of HIV-positive people, has often been criticized for its hesitant government response to the disease. Recently, there seems to be hope that this is about to change.

The South African government is showing ambition in its 2006 National Strategic Plan on HIV/Aids. The Plan, issued by the South African National Aids Council (SANAC), aims to reduce the rate of new HIV infections by 50% and to expand access to treatment, care and support to 80% of all HIV-positive people by 2011. For a five-year period, CHF 6.5 to 7.3 billion are to be allocated for prevention and treatment of HIV/Aids.

Activist organizations as well as international media have previously criticized South Africa for its reluctant reaction to the HIV/Aids epidemic, especially during the 1990s.

The country's first significant response to the disease only came in 1992, ten years after the country's first Aids cases. Several councils and committees, such as the SANAC, were formed during the following years, although most of them remained inefficient.

Some African countries, such as Uganda, saw a drop of prevalence rates due to increased public awareness during the 1990s, however, South African HIV prevalence rates continuously increased. In Uganda, often cited as a success story, the prevalence rate began its downward slope in 1992, while South Africa's HIV figures only started to flatten out in 1998. Despite its relative wealth compared to other African countries, South Africa became one of the hardest hit countries in the world.

In 1999, the launch of the first large-scale prevention campaign, called loveLife, was a sign that the government's attitude might have changed.

However, high government officials had received criticism about their ambiguous stance on causes of Aids and their views on antiretroviral drugs (ARV) used in therapy for Aids. President Thabo Mbeki was reproached of denying that HIV is the cause of Aids. Instead he blamed poverty for the disease.

He had further ignored calls by international Aids experts to dismiss Manto Tshabalala-Msimang, Health Minister since 1999. She had raised controversy promoting vegetables such as garlic, lemons and African potatoes rather than ARV drugs as a treatment of Aids.

In 2002 however, a decision of the Constitutional Court forced her department to start providing ARV treatment to HIV-positive pregnant women. Under the pressure of the cabinet, the Department of Health also began supplying ARV to all HIV-positives in 2004. Antiretroviral therapy coverage skyrocketed thereupon, providing 32% of those in need in December 2006, compared to only 2.7% in 2003.

40% of the funds of the 2006 National Strategic Plan on HIV/Aids were earmarked for ARV medication.

Long-term success of South Africa's strategy will depend largely on how effectively it prevents new HIV infections. Awareness has risen in recent years. Since most people know at least somebody who has died of Aids, fear is likely to play its role in HIV prevention.

However, with 4.9 to 6.1 million South Africans being HIV-positive, there is still a long way to go.

Ivo Näpflin, GIMUNews, January 13, 2008