It is all too easy to criticise governments. However, there is an example where the government is due credit, mainly because it shows how things can be done. This is the successful implementation of a nationwide HIV/AIDS treatment and prevention programme that has come to light most recently at the 19th International AIDS Conference held in Washington DC.
There are four key lessons that can be learnt from this successful public health initiative in SA.
First, it does not necessarily take that long to turn things around. More than half of the post-democratic era was characterised by an inhumane HIV/AIDS policy. Yet, over the course of less than a decade, access to treatment has improved. The number of people receiving antiretroviral treatment increased more than tenfold between 2005 and 2010, from 101,000 to 1.1-million. The country is now close to reaching it target for reducing mother-to-child transmission, with the proportion of babies born HIV-positive having fallen from 8% in 2008 to 2.7% this year, against a target of 2% by 2014.
Second, civil society can make a difference. The pressure of nongovernmental organisations played a significant role in shaming the government into changing its policy on antiretroviral treatment.
Civil society organisations, big and small, have also played a role in implementing parts of the programme, both in the absence of better government policy, and later in conjunction with the new policy. Nongovernmental organisations have contributed to the nationwide testing and prevention campaign, using community engagement and national media campaigns to get the message across. As a result, the use of condoms has increased significantly. The latest National HIV Communication Survey shows that the proportion of people who use condoms the first time they have sex with a new partner has increased from 18% in 1992 to 66% this year. The same survey found that more than 17-million South Africans had been tested for HIV, 10-million of whom had been tested in the last 12 months.
Nongovernmental organisations also play a significant role in administering treatment and support for those who need to adhere to the strict drug and nutrition regime required by antiretroviral treatment. This may partly explain the fact that the proportion of all deaths accounted for by HIV/AIDS has dropped from a high of 40% in 2005 to 31% last year.
The third lesson is that political will goes a long way. This has required, among other things, changing policy boldly, and in doing so, acknowledging the failure of past policies. It has also involved the effective use of public funds. Success is not determined by how much is spent, but by how effectively the money is used.
Fourth, the progress made in the treatment and prevention campaign in SA and other countries in the region shows that Africa is not always trailing behind. According to the World Health Organisation, people living in sub-Saharan Africa are twice as likely to receive antiretroviral treatment as people living in eastern Europe and central Asia. SA now has one of the largest treatment programmes in the world.
There are still more new infections every year in sub-Saharan Africa than in any other region, but unlike eastern Europe and central Asia, the numbers are dropping. Admittedly Africa has received a lot of international funding and assistance for HIV/AIDS treatment and prevention, but nevertheless, its progress is significant, considering that average gross domestic product per capita in the region is about a sixth of what it is in Eastern Europe.
HIV/AIDS denialism in SA is said to have caused more than 300,000 unnecessary deaths, leading some to have labelled it as a genocide. Along the way life expectancy has dropped from 66 in 1995 to 51 in 2010, bucking the global trend. Thanks to better prevention and treatment, the local trend is now upward and the number of new infections each year is half what it was in 1999.
Much as was the case with HIV/AIDS at the height of denialism, the state of public education is cause for despair as we witness a whole generation miss out on the chance to realise their true potential. While education is arguably a much more complex problem to fix, the HIV/AIDS story shows that it need not be another generation before things start to get better, with the right combination of civil society involvement and political will. The former seems to be growing in momentum, the latter is sadly lacking.
- Lucy Holborn (Research Manager at the South African Institute of Race Relations)
This article was first published in Business Day on 10th August 2012.
