The Political Management of HIV and AIDS in South Africa: One Burden Too Many?

258 Pages·2006·2.108 MB·English

by  Pieter Fourie (auth.)

The Political Management of HIV and AIDS
in South Africa
The Political Management
of HIV and AIDS in
South Africa
One Burden Too Many?
Pieter Fourie
Foreword by Alan Whiteside
© Pieter Fourie 2006
Foreword © Alan Whiteside 2006
Softcover reprint of the hardcover 1st edition 2006 978-0-230-00667-6
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First published in 2006 by
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ISBN 978-0-230-51696-0 ISBN 978-0-230-62722-2 (eBook)
DOI 10.1057/9780230627222
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managed and sustained forest sources.
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Fourie,Pieter,1972–
The political management of HIV and AIDS in South Africa :one
burden too many? / by Pieter Fourie ;foreword by Alan Whiteside.
p.cm.
Includes bibliographical references and index.
1.AIDS (Disease) – Government policy – South Africa.I.Title.
RA643.86.S6F68 2006
362.196(cid:2)979200968—dc22 2006043210
10 9 8 7 6 5 4 3 2 1
15 14 13 12 11 10 09 08 07 06
This book was inspired by and is dedicated to the memory of
baby Johanna, who died of AIDS in May 1999
Contents
List of Figures and Tables xi
Acknowledgements xii
List of Abbreviations and Acronyms xiii
Foreword xvi
Introduction 1
The South African epidemic 1
What have successive South African governments done? 3
The purpose of this book 5
The structure of the book 6
Finding our microscope: why words, models
and theories are important 7
A useful definition 8
The public policy-making process 10
Problem identification 10
Agenda-setting 12
Policy formulation 13
Policy adoption 14
Policy implementation 14
Policy evaluation 14
Theoretical frameworks 15
So where to from here? 22
1 AIDS, Poverty and Development in
Southern Africa 25
Introduction 25
Human security, development, and HIV and AIDS 26
Quantifying the fuss: HIV and AIDS in Africa 29
Labour migration 32
HIV and AIDS, the military, war and peacekeeping 33
Bad blood 34
Regional transport infrastructure 34
A free-riding disease 35
HIV and AIDS at the macroeconomic level 35
vii
viii The Political Management of HIV and AIDS in South Africa
HIV and AIDS and food security 38
HIV and AIDS and gender 42
Rape 42
Homophobia 43
Physiology 43
Gender roles and culture 44
HIV and AIDS and good governance 45
Income inequality 47
Conclusion 48
2 The HIV and AIDS Policy Environment in
Apartheid South Africa (1982–1994) 50
Introduction 50
Apartheid South Africa: an environment of risk 51
Risk profile 52
Biomedical factors 52
Economic factors 53
Sexual behaviour factors 53
Migration patterns 55
Political turmoil 55
The normative environment 57
Media reporting and popular culture 58
Religious-moralistic responses 60
Traditional societies 63
Conclusion 64
3 Biomedical and Workplace Responses in
Apartheid South Africa (1982–1994) 65
Introduction 65
The biomedical response 66
Contradictory messages 67
Absent and insufficient data 68
Blood transfusion services 70
Taking account of the social dimension of the problem 71
A policy/legal void 73
New institutions for an altered health care environment 75
The workplace response 77
The medical aid and insurance industry 77
The mining sector 80
Conclusion 85
Contents ix
4 Public Sector Responses to HIV and
AIDS in Apartheid South Africa (1982–1994) 86
Introduction 86
AIDS legislation as policy 86
AIDS-specific legislation 87
Criminal and case law 91
Redefining the policy problem: the move to a
human rights culture 94
Government 96
The ‘silent’ HIV phase: 1982–1988 97
Flux and re-conceptualisation: 1989–1992 99
The democratisation of AIDS policy-making: 1992–1994 100
Reflections on AIDS policy-making in 1982–1994 101
5 AIDS Policy-making during the
Mandela Administration (1994–1999) 105
Introduction 105
The National AIDS Plan of 1994 107
Idealism versus implementation 107
Explaining the failure of the NAP 112
A comedy of errors 120
Reflections on AIDS policy-making in 1994–1999 134
6 AIDS Policy-making during the First Mbeki
Administration (1999–2004) 139
Introduction 139
The institutional and legal context 142
‘The HIV and AIDS/STD Strategic Plan for
South Africa, 2000–2005’ 142
Legislation and case law 147
Denialism and obfuscation: Mbeki enters the fray 151
MTCT prevention, HAART and the monetarisation of the
policy problem 162
(Re)defining the problem, and implications for
policy-making: 1999–2004 168
Conclusion: Looking Back and Looking Forward 173
Looking back on the book 173
What have we found out? 174
The phase/stage approach to policy-making 174
x The Political Management of HIV and AIDS in South Africa
What does the theory tell us? And what does AIDS
teach the theory of policy-making? 179
What do we still need to find out? 182
Recent developments – and the road ahead 184
Appendix: AIDS Timeline (1982–2004) 189
Notes 197
Bibliography 215
Index 234
List of Figures and Tables
Figures
I.1 HIV and AIDS epidemic impact curves 3
I.2 Policy-making stages 11
I.3 Amended systems model of policy-making 16
1.1 The Jaipur Paradigm 32
Tables
1.1 HIV infection rates in various African countries
for the 15–49 years age group, 2003 30
1.2 Life expectancy and population growth, 2010 30
1.3 The sectoral impact of HIV and AIDS in South Africa 37
1.4 The impact of HIV and AIDS on the agricultural
labour force in the most infected African countries 39
5.1 The difference between a human rights approach
and a public health approach to HIV and AIDS 108
5.2 HIV seroprevalence in South Africa 109
6.1 Outline of the ‘HIV and AIDS/STD Strategic Plan
for South Africa’ 146
6.2 HIV and AIDS as a share of total budget 168
6.3 HIV and AIDS-specific spending in health sector as
share of total health expenditure 169
xi