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Research papers on aids in south africa

Personal use only; commercial use is strictly prohibited for details see Privacy Policy and Legal Notice. The pandemic, and the political controversies it elicited, have come to define both local and global understandings of the post-apartheid nation. The history of HIV in South Africa begins in the 1980s during an era of heightened repression by the apartheid state, in which discriminatory laws and fearful public responses tapped into broader prejudices relating to race and sexuality.

During the 1990s, as South Africa transitioned to democracy and as rates of HIV reached pandemic levels, partnerships were built between civil society and state actors to confront the many challenges that the HIV epidemic presented.

A copious historiography on the HIV epidemic in South Africa maps the contemporary chronology and evolution of the disease, including a focus on changing public understandings and responses Keywords: This disease was causing them to become sick and die from infections that were generally rare, or unlikely to be fatal, among healthy adults. By March 1982, the CDC had posited a viral agent for its spread, and by August 1982, the disease was given the name by which we know it today: In the four decades since its emergence, science has made rapid advancements in understanding and treating HIV.

By 1983 the virus had been isolated, and its modes of transmission had been clearly established: Other challenges, such as the costs of transport to clinics, and the stigma associated with HIV as a marker of shame, make accessing and adhering to HIV medicines difficult for many.

The first, introduced by the minister of health, added AIDS to the official list of communicable diseases, giving state authorities the power to quarantine people whom they knew or suspected to be HIV-positive. This law was applied principally to migrant miners, some of whom were tested coercively and, if HIV-positive, forcibly repatriated.

HIV/AIDS in South Africa

Despite clinical guidelines that required the informed consent of patients prior to HIV testing, and that upheld the right of confidentiality regarding the results, violations of these rights were common in public-health facilities. However, these were located principally in metropolitan areas and had a limited public reach. Care and outreach programs were established, with a heavy reliance on volunteers, but state investment in these services—at the frontline of the national HIV response—remained scant.

At Baragwanath, the largest hospital in South Africa, HIV infection was first identified in 1985 — among a nine-year old haemophiliac boy.

But the racial divisions and inequalities carved out by the apartheid system also reverberated within the responses of different South African publics to the emergence of HIV in the 1980s. The AIDS epidemic tapped into more fundamental fears about the loss of control associated with the coming of democracy. Other ideas and understandings about HIV did not accord with the constructed racial delineations of apartheid, flourishing across diverse groups.

Some perceived AIDS as an apartheid plot to curb population growth and sexual enjoyment. The conspiracy theory that HIV was created as a biological weapon, engineered in Western laboratories to destroy the procreative futures of black South Africans, gained currency. One result was that patients questioned the veracity of HIV tests. Healthcare workers at Baragwanath Hospital, for instance, struggled to convince patients who had tested HIV-positive that they were truly infected, and that the disease was a medical reality, rather than a macabre scare tactic or artifact of political propaganda.

While sex across the color line became legal, sex between consenting adults of the same gender remained a crime until the Democratic Constitution of 1996 outlawed discrimination on the basis of sexual orientation. The first recorded deaths from AIDS in 1983 were among gay white men. Gay activists prominent in the anti-apartheid struggle, among them Simon Nkoli, had championed their own collective responses to AIDS in the late 1980s.

Nkoli died of AIDS in 1998. Decades of apartheid privation meant that many black South Africans lacked access to basic research papers on aids in south africa and social services.


The result was the Beyond Awareness Campaign, based on participatory communication and action-based research methods. Photo by Rebecca Hodes. The Beyond Awareness Campaign incorporated a vast array of media sources from small, community-based media to the national broadcast media. Plays, puppet shows, posters, and billboards sprung up across the country.

In the absence of public access to effective treatment for HIV, these initiatives focused largely on prevention. Both of these cases, recounted in detail in the national press and in academic accounts, exposed the misuse of public funds and political power by Health Minister Nkosazana Dlamini-Zuma, together with other senior political figures.

Research had shown that rolling out a program for the prevention of mother-to-child transmission would be cost saving for the state: In statements issued by the Department of Health, senior government officials research papers on aids in south africa that treatment was unaffordable and that poor South Africans would fail to adhere to complex antiretroviral regimens.

Health researchers and activists continued to collaborate to counter these claims, with a growing reliance on evidence from clinical trials, and through broad-based activist mobilization along similar lines to the anti-apartheid movement of the 1980s.

In those countries in which treatment was made available to the public, AIDS-related hospital admissions and deaths declined dramatically. From 1998 onward, the opposition of high-ranking political leaders to the public provision of ART became the greatest controversy to have emerged in the first decade of South African democracy. In the midst of ongoing controversies around public access to HIV treatment, social mobilization around HIV testing, disclosure, and treatment advocacy took on new imperatives.

Its successes were premised in part on its use of the courts to challenge the decisions of state actors, and on its building of broad-based partnerships.

To ensure that health departments fulfilled their mandate to provide HIV treatment, civil-society organizations and health researchers established the Joint Civil Society Monitoring Forum on Antiretrovirals. One purpose of these programs was to prove that poor patients could adhere well to treatment, despite its relative complexity. When published, the adherence rates of patients in the study were among the highest on record.

In response, MSF launched an antiretroviral clinic in a rural village of Lusikisiki in the Eastern Cape, to show that the lessons learned from the flagship clinic in Khayelitsha were replicable in rural areas with scarce clinical resources. Shortages of healthcare workers, haphazard systems of drugs supply, and weak financial oversight were among the key challenges confronting the public-health sector. A lack of standardization of treatment regimens and the late start of the ART program presented additional research papers on aids in south africa.

Despite expanding terms of ART availability, in line with global evidence about the health benefits of earlier initiation to the treatment, vast numbers of patients continued to initiate ART within the public sector at an advanced stage of HIV illness. For the first time in years, government officials and activists mutually accepted a unified policy position on the prevention and treatment of HIV. In the cabinet reshuffle that ensued, Barbara Hogan was appointed as the health minister, replacing Tshabalala-Msimang.

Ten years of financial mismanagement, the erosion of transparency and accountability within the Health Department, and the failure to integrate health programs at national and provincial levels had weakened the health sector significantly.

In 2008, there were fewer public-health workers including nurses than a decade prior. The moratorium lasted for over four months, during which no additional patients were initiated to treatment.

At this time, only about 25 percent of patients in immediate need of ART were able to gain public access in the Free State. Then I did my viral load test, and results showed that the virus was getting strong in my body… My doctor explained that when you take your ARVs correctly, it might take longer for the virus to change form, but it can happen eventually.

My clinic changed me to an effective second-line ARV regimen. Under the rubric of the National Strategic Plan, activists, policy makers, and health officials pursued new collaborations, seeking to bridge the divide that had opened up during the Mbeki era.

  • Other ideas and understandings about HIV did not accord with the constructed racial delineations of apartheid, flourishing across diverse groups;
  • The ART rollout is often utilized as a means of asserting the political successes of Zuma;
  • Thus, populations that are currently underserved would benefit from large scale HIV testing, knowledge of HIV status, expediting early access to and adherence to treatment, mitigate stigma and discrimination and realization of prevention benefits from early treatment initiation [ 97 , 103 - 107 ];
  • A lack of standardization of treatment regimens and the late start of the ART program presented additional difficulties;
  • The potential for ARV based vaginal microbicides, PrEP and passive immunity offer hope for young women but are several years away.

Zuma was acquitted, but in the course of the trial research papers on aids in south africa a number of comments that fueled public confusion about HIV transmission. He testified, for instance, that while Khwezi was HIV-positive, he had chosen not to use a condom during sex, but had showered soon afterward. Corruption and cronyism have impacted disastrously on the delivery of public healthcare in present-day South Africa. The ART rollout is often utilized as a means of asserting the political successes of Zuma.

In 2015, Zuma recommended that teenage parents should be separated from their children and sent to Robben Island, revealing a deep disregard for reproductive rights.

In 2012, black women between twenty and thirty-four had the highest incidence of HIV infection. One study found that 9 percent of women on ART had become pregnant since commencing treatment. From 2010 onward, the Health Department has substantially increased the provision of HIV testing in public facilities.

The HCT campaign was one of the means by which the government has sought to improve the national HIV response, research papers on aids in south africa the expansion of the national ART program has been its principal priority. Side effects are relatively common, and range from the mild to the severe. In the struggle for public access to treatment, the attention of healthcare workers and activists has been focused in the past on ensuring that drugs were available, and starting patients on HIV treatment.

Discussion of the Literature South Africa has been a hub for clinical, operational, social-sciences, and humanities research about HIV. In the first texts, scholars grappled with the medical and social meanings of a new epidemic, emerging from a context of 1980s fiscal conservatism, the resurgence of the moral right, and the assertion of sexual equality by the feminist and gay-rights movements.

Scholars honed in on the crisis of AIDS denialism among the highest echelons of ANC leadership, and marked the emergence of new forms of advocacy for access to HIV treatment and support.

A number of ethnographic studies were also published. By the end of 2016, an estimated 3. Through in-depth, interdisciplinary academic inquiry, these researchers have explored how HIV and its diagnosis and treatment have been imbricated in the intimate lives of South Africans. As in the global domain of HIV research, the body of literature in South Africa has stoked a disciplinary debate about the best means of understanding and responding to the HIV epidemic.

In these writings, scholars grapple with the challenges of adherence to antiretroviral treatment—the use of medical regimens, previously classified as tertiary care, as the clinical crux of an ever-expanding primary-health program. Interventions with an avowedly social dimension—condom use, HIV testing, and indeed antiretroviral treatment—have been recast as medical.

Much of the literature on HIV in South Africa challenges traditional taxonomies of knowledge through incorporating elements of history, anthropology, the life sciences, bioethics, sociology, and other forms of academic inquiry. Authors have combined qualitative and quantitative research to triangulate their findings, and include different modes of understanding and analysis in their research. This fusion of sociology, epidemiology, geography, political economy, and participatory research has become a hallmark of HIV social sciences in South Africa.

The associations, intersections, and cross-overs among social experiences, the lived realities of the global south, and their influence on HIV epidemiology are central concerns of this literature on HIV. Between 1994 and 2009, life expectancy in South Africa was reduced by almost twenty years, largely because of the rise in HIV-related mortality.

HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

In particular, I thank Chris Saunders and two anonymous reviewers for their comments on an earlier version of this chapter, and am grateful to William Beinart, Lucie Cluver, Robert Morrell and Nicoli Nattrass for their critical insights. The South African Medical Journalfor instance, provides an extensive archive of clinical and epidemiological histories of the epidemic, including research studies conducted by doctors and public-health officials, and commentaries by activists, civil-society organizations, and journalists.

The University of Cape Town hosts a visual archive of the HIV epidemic—including copious collections of video and photography. Cambridge University Press, 2010.