appendix a: timeline of health care and hiv/aids in south africa

1913 – “Tropical workers” migrating bring in high prevalence of tuberculosis (Packard, 230)
1919 – Public Health Act places government control over mission health centers (Seedat, 63)
1930 – Mines experience shortage of workers (Packard, 229)
1934 – 2000 “tropical workers” brought into SA on experimental basis (Packard, 230)
1937 – The number of “tropical workers” increases dramatically after government ends ban on recruiting mine workers above 22nd parallel (Packard, 230)
1948 – National Party takes control and apartheid laws are enacted
Health budget is drastically cut (Seedat, 63)
Over 40,000 “tropical workers” are entering SA (Packard, 230)
1950 – Population Registration Act required S. Africans be segregated into three racial categories
Group Areas Act establishes separate residential areas for different racial groups, “forced removals” began of those living in the “wrong” area
1951 – Bantu Authorities Act established “homelands” (Bantustans) taking away SA citizenship and rights
Prevention of Illegal Squatting Act began destruction of basic health services developed by individuals in the “wrong” areas
1960 – Black townships became areas of concentrated population far from towns and city centers
*Sharpeville massacre kills 69, wounds 187 protesting the pass laws
1963-1964 – Rivonia Trials
1970 – South African Department of Health takes over control of all health services from ‘local’ governments, including mission and church hospitals (Seedat, 69)
1973 – Department of Bantu Administration and Development begins takeover of all mission hospitals in the Bantustans (Seedat, 69)
1976 – Soweto uprising kills 23, wounds 500 in protest of Bantu Education policies
1976-1981 – Four “homelands” (Bantustans) de-nationalize 9 million Black South Africans
1982 – First case of AIDS diagnosed in SA, increased charges in governmental health services (Seedat, 71)
1983 – Doctors in the Department of Medicine at Baragwanath describe overcrowding and shortage of staff as having reached a ‘breaking point’ (Seedat, 65)
1985-1989 – SA declares ‘state of emergency’
1986 – First AIDS Advisory Group established to aid the government’s response to the growing problem
1990-2003 – Most rapid increase in HIV prevalence rates
1990 – Mandela released from imprisonment
First antenatal survey estimates that between 74,000 and 120,000 people are living with HIV
1991 – Apartheid laws repealed
1992 – Referendum on de Klerk’s policy
Mandela addresses the newly formed National AIDS Convention of South Africa (NACOSA)
Free National AIDS Helpline established
1993-1999 – Internal labor migration increases significantly, specifically among women
1993 – National Health Department reported the number of HIV infections had increased by 60% in the previous two years and was expected to double over the year
1994 – First democratic elections held, Mandela wins
Minister of Health accepts the basis of the NACOSA strategy as the foundation for the government’s AIDS plan
1995 – International Conference for People Living with HIV and AIDS was held in South Africa, Deputy President Mbeki acknowledges the seriousness of epidemic
South African Ministry of Health announces that 850,000 people (2.1% of population) are believed to be HIV-positive
1998 – Treatment Action Campaign is launched
2000 – Department of Health outlines five-year plan to combat HIV/AIDS
International AIDS Conference in Durban, new SA President Mbeki denies HIV causes AIDS, cites poverty as cause
2002 – SA High Court orders government to make nevirapine available
Government remains hesitant to provide treatment to people living with HIV
2003 – Government approves plan to make antiretrovirals (ARVs) publicly available
2004 – ARV treatment program launches in Gauteng Province
2005 – One service point in each of the 53 districts established for AIDS related care and treatment
HIV prevalence reported at 30.2% – a steady increase since 1990
2006 – Former Deputy President Jacob Zuma claims taking a shower prevented HIV transmission after “having sex” with an HIV-positive woman
UN Special Envoy on HIV/AIDS, Stephen Lewis attacks SA government at International AIDS Conference in Toronto over ARV treatment access
2007 – Mbeki is forced to resign, interim president appoints Barbara Hogan as Health Minister, activists welcome the change and expect greater government commitment to HIV/AIDS
An estimated 1,400,000 orphans of HIV/AIDS in SA
2009 – Apology for Mbeki ARV policy
Development of health services/ access to health services is a major issue in 2009 elections

why there is no doctor: denial is the first step (7)

(photo: downtown Zonkizizwe, South Africa)

Since the early 1990s, Mbeki had turned his back on scientific evidence linking HIV as the cause of AIDS. Mbeki’s stance on the cause of AIDS is the largest contributing factor in the South African government’s failure to scale-up treatment. In 2000, Mbeki called together a group of scientists including a group of ‘dissident scientists’ to discuss the cause of AIDS (55). Later that year at the International AIDS Conference in Durban, he spoke publicly rejecting the accepted science that HIV causes AIDS and instead focused on the need to alleviate poverty in Africa as a way to combat AIDS (56). He said the cause was poverty, bad nourishment, and general ill health while also noting that more Western medicine was not what Africa needed (57).

Since his public statements, Mbeki and the South African government have been hit by a backlash of criticism from the international community and Mbeki has remained silent on the topic. The year 2000 was the same year that the Department of Health launched a five-year plan to combat HIV/AIDS. However, Mbeki’s statement and the lack of strong governmental support led to much “foot-dragging” (58). Mbeki had turned down grants, funding, and free medicines to scale-up the treatment program as a result of his denial. Now a recent Harvard study has placed impact numbers with Mbeki’s denial claims. The authors of the study estimate that more than 330,000 people died unnecessarily in South Africa and that 35,000 babies could have been protected from HIV-infection as a direct result of Mbeki’s HIV/AIDS policy and denial (59).

In 2002, with international pressure growing, the South African High Court ordered that nevirapine, which combats the spread of HIV from mother-to-child, be made available (60). Sadly despite offers of free and cheap antiretrovirals (ARVs), the South African government was hesitant to offer the medicines and only distributed in two test sites. In 2003, the government approved a plan to make antiretrovirals publicly available and by 2005 there was at least one service location for AIDS-related illness in each of the 53 districts (61). However the program did not reach enough people and the HIV prevalence rate among pregnant women was recorded at 30.2%, a steady increase since 1990 (62). The treatment program was beyond inadequate.

The case for HIV/AIDS treatment and prevention suffered another blow at the hands of South African government leadership in 2006. Former Deputy President Jacob Zuma went on trial for the rape of an HIV positive woman and claimed that having taken a shower afterwards protected him from HIV transmission (63). This only heightened international outrage and pressure on South Africa’s HIV treatment programs. At the 2006 International AIDS Conference in Toronto, UN Special Envoy on HIV/AIDS Stephen Lewis, called the South African government “obtuse and negligent” (64). By the end of the year the government had announced that it was drafting a framework to tackle AIDS and pledged to increase public access to antiretrovirals (65).

Mbeki was ousted from his ANC leadership position in September of 2008 and the interim president appointed Barbara Hogan as the Health Minister. Many saw this as a major turning point in South Africa’s HIV/AIDS policy, especially as the government is working to get antiretrovirals to as many people as possible. Unfortunately, Zuma is set to win the upcoming presidential election and has not made any apology for his false statement on HIV prevention.

55. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
56. Boseley, Sarah. “Mbeki Aids denial ‘caused 300,000 deaths.” Guardian News UK. 26 November 2008.
57. Ibid.
58. Ibid.
59. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
60. Ibid.
61. Ibid.
62. Ibid.
63. Ibid.
64. Ibid.
65. Ibid.

Coming next: What happened to Reconstruction and Development?

Access all entries in this series: Index

what are we to do when our children are dying?

Yesterday the headlines in South Africa’s Times newspaper read, “Our children are dying.” In South Africa 75,000 children die before they turn 5 each year. As one of 12 countries, South Africa has a rising child mortality rate. Of these 12 countries the top causes of a rise in child mortality is war and HIV/AIDS (and the UN Security Council disregarded HIV/AIDS as not important enough). The statistics come from a report released two days ago by the national health department, the Medical Research Council and the University of Pretoria.

South Africa is experiencing one of the most severe HIV/AIDS epidemics in the world. It is said that one in five people in South Africa has HIV/AIDS. The Avert organization cites sources that say more South Africans spend time at funerals than they do “shopping or having barbecues” and “twice as many people have been to funerals in the past month than have been to a wedding.” In 1992, Nelson Mandela took the first big steps to deal with the HIV/AIDS crisis when he addressed the National AIDS Convention of South Africa (NACOSA) to develop a national strategy. In six years (1996-2001) the HIV prevalence rate among pregnant women doubled and since 2002 has steadily increased. In 2003, South Africa announced a plan to provide antiretroviral treatment to the public. Following in 2004, the South African government’s treatment program began in Gauteng Province and soon included other Provinces. In 2005 the prevalence rate was at a high of over 30% in pregnant mothers.

Why has South Africa faced such a difficult and severe epidemic? Why has it taken so long to get a government response prepared? During the time period of the 1990s into 2003 South Africa was in the midst of major political and social turmoil. While HIV/AIDS was a growing problem, the political issues were at the forefront. Responses to and a recognition of the epidemic was glancing at best. The fall of apartheid allowed leaders to focus on dealing with the epidemic and Mandela led the charge. However the leaders that followed were far from Mandela’s original plan. In 2000, President Mbeki denied, in front of the UN Assembly, that HIV caused AIDS. He had put together a committee of AIDS deniers to advise his HIV/AIDS response plan. Mbeki denied that HIV caused AIDS and instead focused on the idea that poverty was to blame. While the official position of the government has been stated as “HIV causes AIDS” (2002), Mbeki continues to question such a strong correlation. In other headlines that spread across the globe, former Deputy-President, Jacob Zuma went on trial for the rape of an HIV positive woman. In the court questioning he told the court that, “he thought the risk from HIV was small, and that he had taken a shower immediately after the sexual intercourse on the night in question, because – he believed – it was one thing that might reduce the chances of contracting HIV.”

As with many health and development topics there is no clear cut issue to focus on and so if you want to talk comprehensively about HIV/AIDS in South Africa you have to talk about the effectiveness of treatment programs, the stigma of the disease, the rape and sexual abuse of women from gender inequality, the inadequacy of school systems, the responses of government, HIV testing programs, and the effects of HIV/AIDS on children. This last issue I will focus more.

Today I am flying to South Africa to work for the next three months at a care center in a remote (urban) informal settlement called Zonkizizwe. Zonkiziwe is in the Ekurhuleni township in Gauteng Province. The center assists children affected by HIV/AIDS and as you can guess that is every child. With the statistic that one in five people are infected there is no way that each child is not potentially already infected, has lost a parent, or knows someone who is affected. Many women who are HIV positive do not receive the drugs that they need and so the disease is passed on to their babies – thus creating one of highest child infection rates. In a Department of Health survey (2006), it was found that 260,000 children under age 15 were living with HIV in South Africa. In Zonkizizwe this prevalence rate coupled with a poor schooling system is contributing to a ‘hopeless’ outlook for the future. Life in a township is difficult with poverty and inadequate schooling, but when HIV/AIDS is added into the equation there are lost parents, children missing school to work, and children infected without testing or treatment available. On being hopeless, Justice Cameron said, “We don’t accept ‘sad realities’ in South Africa. If we accepted sad realities, we would still have a racist oligarchy here.”

The center, VumundzukuBya Vana “Our Children’s Future” (VVOCF), seeks to be a place where children can actualize their potential through educational programs, learning about health and nutrition, self expression, and life skills development. VVOCF has a feeding program, a school uniform fund, and a number of smaller projects to help the children of Zonkizizwe advance. VVOCF was started through a partnership fostered by Dr. Jeanne Gazel through her research of the impacts of HIV/AIDS. With her connection to VVOCF she was able to bring Zonkizizwe closer to the MSU community as a Professor and Director of MRULE (Multi-Racial Unity Living Experience) by way of a pen-pal program. I first learned of the center and got involved through the pen-pal program. This summer I am looking forward to meeting my pen-pal as well as contribute to the development of the VVOCF center. Over the three months I spend in Zonkizizwe I will be helping to develop after school programs that can continue, staff development, English instruction, possibly a book club, and setting up the internship program for other students in future years. I am excited to see Johannesburg and the surrounding area and hope to travel to see Soweto, Durban, Lesotho, and visit a friend in Mozambique.

This summer brings another new and exciting view of the African continent and I cannot wait to learn about the people and culture where I will be living. As with all my experiences I enter with an open mind and an unburdened quest to learn. While in Zonkizizwe, South Africa the majority of my time will be spent learning. Even though I am going as an intern to work there is no way that I will be the only one providing education. I am excited to learn Zulu, hone my soccer (football) skills, and learn of life in Zonkizizwe from my pen pal and all the children that I will meet.

Read the VVOCF Blog.

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