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The Scattered Response to HIV & AIDS in South Africa

9th December 2010

By: Creamer Media Reporter

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History does inform the honest. Thirty-one years after the first diagnosis of HIV in South Africa and despite numerous interventions, an honest assessment would reveal that these interventions are failing. While South Africa glimmers with a multitude of brilliant HIV & AIDS responses in the NGO, government, corporate, faith-based, and educational sectors, the overall response is like looking at shattered glass rather than a beautiful stained-glass window. This CAI discussion paper reflects on the reasons for the lack of integration in the South African HIV & AIDS effort and suggests ways to address this problem. These reflections are based on formal and informal conversations with local and foreign doctors, nurses, counsellors, educators, policy makers, managers, government officials, funders, people living with HIV & AIDS, administrators, and consultants over the last twenty-two years.


Respond rather than reflect

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This refers to a strength and weakness in the South African response. South Africans are known to get on with things; we do not require years of planning to respond to a problem. Just mention it and people will respond. This is naturally an asset, but a crisis sets in when the next problem presents itself before the first one has been resolved. The original issue is then abandoned in favour of addressing the newest one. This leads to a lack of carry-through and reflection, and is evident in the NGO response to the epidemic:


NGOs are responsible for much of the excellent work in the areas of HIV & AIDS education, counselling, and support, yet few NGOs are able to provide a summary of what has or has not worked over the last twenty years. Granted, the pandemic has required swift responses and NGOs rely on funding from local and foreign funders who demand sudden changes in direction, but a significant part of NGO work remains undocumented. One cannot understate the importance of historical racial segregation on this form of response in South Africa.

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The corporate sector is another example of innovative and unique responses to HIV & AIDS. The voluntary counselling and testing (VCT) response by certain retailers in Cape Town shows creativity, effectiveness, and responsibility, yet few other retailers, never mind other sectors, even know about the project. Many successful responses remain locked within the delivery organisation. This is another example of the lack of integration in South Africa’s response to HIV & AIDS.


In the last five years, monitoring and evaluation (M&E) of programmes has improved, principally because of the pressure for M&E by foreign funders. M&E is an important step in the right direction, but further programme analyses and reflections are needed. South Africa lacks critical analyses of short- and long-term responses in order to bridge the gap between its response to and reflection of the HIV & AIDS pandemic, and to better integrate the two actions into an effective onslaught against the disease.


Negative over positive


Flowing from our lack of documentation and critical analyses, we South Africans have tended to focus on the negative aspects of HIV & AIDS responses. We clearly have had much to criticise – for example, Virodene, stigma and discrimination, lack of accountability of NGOs, Mbeki’s ‘dissident debate,’ gender discrimination, and the suggested curative powers of garlic and olive oil. But, we also have much about which to be positive. To name but a few things: antiretroviral (ARV) treatment, HIV & AIDS education and counselling, adherence programs, support groups, HIV-in-th-workplace programmes, and training, as well as measures to counter discrimination. Yet, the general public is largely unaware of the areas in which South Africa is often a world leader in the response to HIV & AIDS.


Conclusion


Dr Rieux resolved to compile this chronicle so that he should not be one of those who hold his peace but should bear witness in favour of plague-stricken people; so that some memorial of the injustice and outrage done them might endure; and to state quite simply what we learn in time of pestilence: that there are more things to admire in men than to despise.(2)


The words we use to describe HIV & AIDS are important. The American literary theorist and political activist, Susan Sontag, illustrated the importance of using the correct metaphors in describing HIV & AIDS. Media and lay descriptions fall short. We require ongoing documentation – through processes like monitoring and evaluation - and critical analyses of the management of HIV & AIDS if we are to properly reflect the chronology, continuity, and change of the pandemic. This documentation needs to take place in the academic, medical, psychosocial, pharmaceutical, and public realms. Without the critical ability to assess different forms of material, interpretations and responses, we remain locked in negative perceptions, victims of our past mistakes.

NOTES:

(1) Contact S.V. Houten through Consultancy Africa Intelligence’s HIV & AIDS Unit (hiv.aids@consultancyafrica.com).
(2) Albert Cambus (1947). The Plague. Penguin Modern Classics.

Written By: S. V. Houten (1)

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