HIV/AIDS and Society in South Africa / Mandisa Mbali

Global Public Health, Vol. 5 No. 5, September 2010, pp. 558-560

South Africa has the world's largest HIV epidemic (UNAIDS 2008, p. 40). Its former president Thabo Mbeki's bizarre stance on the issue and his administrations' clashes with AIDS activists have also been widely discussed in the world's media and global health circles. Mercifully, this historical chapter now appears to be closed. But the country's epidemic has multiple social causes and it has shaped South African society in ways which will have important policy ramifications for decades to come, as Alan Whiteside points out in this new volume.

The book uses the concept of 'human security' to examine the social drivers and impact of the epidemic and policy responses to them in South Africa and globally (pp. 1-2). It deals with a diverse array of social aspects of AIDS in the country including, for instance, chapters on the Treatment Action Campaign's (TAC's) activism and the impact of the epidemic in prisons, the military and schools.

Nana Poku and Bjorg Sandkjaer usefully point out that while human security has gained currency in global academic and policy circles, it 'has yet to become a robust analytical and policy tool' (p. 17). Indeed, I would argue that the socio-economic rights to access to health care services enshrined in South Africa's Constitution have been far more compelling, domestic conceptual levers for AIDS activists' campaigns. But the concept certainly enjoys currency at the United Nations, as discussed in chapters by the editors and Peter Fourie.

Some of the richest chapters in the volume deal with social aspects of South Africa's epidemic which relate to the country's history, laws, politics, institutions and cultures. One such chapter is that where Shula Marks questions the South African relevance of Iliffe's (2006) contention that sub-Saharan Africa's pandemic is the world's worst because it experienced it first. Indeed, the countries of southern Africa are 'Johnnies come lately in the grim story of the African epidemic' (p. 38). This is indicated by the fact that as late as 1990, South Africa's national antenatal clinic survey indicated an HIV prevalence of less than 1%. She goes on to argue that the country could not have escaped AIDS in toto, especially given its long history of socio-economic inequality, migrant labour and the more recent trend of the rapid urbanisation of young women. Instead, Marks holds that 'the extent of the spread of the virus was far from inevitable; with vision and determination it would have been possible to contain the epidemic in its early stages' (p. 53).

Edwin Cameron and Marlise Richter's chapter focuses on the TAC's prevention of mother-to-child transmission (PMTCT) litigation to make a case for human rights as an effective tool to promote human security. A moving quote from the affidavit of Global Public Health a deponent in the case is used to show the psychological trauma and deadly threat posed by inadequate provision of health care (pp. 73-74).

South Africa is also a country with high rates of intimate partner violence and sexual assault, the former of which has been shown to make affected women more vulnerable to HIV infection (Dunkle et al. 2004). Dean Peacock, Thokozile Budaza and Alan Grieg critique the perception that the TAC has failed to examine the gendered aspects of AIDS. Instead, they highlight the movement's successful campaign for justice in the wake of the 2003 murder of activist Lorna Mlofana in Khayelitsha township in Cape Town. The campaign ensured a thorough prosecution, the conviction of the perpetrators and the establishment of a comprehensive rape crisis centre in the township.

Women make up the majority of the TAC's membership and now hold many of its prominent leadership positions. But it was not always thus — before 2005 the TAC's most visible spokespersons were mostly male and the organisation's feminist programmes emerged as a result of gender activism within it. Moreover, as Peacock and colleagues discuss, some male members have not been particularly supportive of more recent efforts to empower women within the organisation. Unsurprisingly, given the persistence and prevalence of sexist attitudes within wider South African society, they conclude that there is still a need for 'more structured opportunities for men and women in the organization to discuss gender equality' (p. 98).

Razaan Bailey's chapter on AIDS in prisons discusses how some of their managements' fears of being seen as 'condoning' sex between offenders operates as an impediment to consistent condom provision, as mandated by a 2002 policy. Moreover, in 2006, the TAC initiated court action against the Department of Correctional Services to ensure antiretroviral drug provision to inmates at Westville Prison in Durban.

An outstanding question for me after reading the volume was exactly how, and whether, the 'securitisation' narrative has actually meaningfully shaped South African AIDS-related domestic policy-making or diplomacy. A closer reading of relevant South African policies in some of the chapters may have shed some more light on this question. The most obvious area where this may have been the case is the military sector where, as Angela Ndinga-Muvumba argues, the human insecurity of soldiers affects the security of the state in a more conventional sense. Instead, it seemed to me that a concept which has been widely used in an international context was applied to the South African case, without much of a sense of whether it had had a great impact within the country's national context.

As Alan Whiteside argues, the global AIDS pandemic is a long-wave event whose effects will be experienced decades from now. While the concept of human security has doubtlessly played a critical role in getting the pandemic onto intergovernmental organisations' agendas, in South Africa, AIDS activists have found that the constitutionally enshrined socio-economic rights — to access to healthcare — have been far more effective in generating political will for appropriate governmental action on the issue. Nevertheless, this volume constitutes an important addition to the literature on the social aspects of AIDS in South Africa, especially its chapters dealing with the epidemic's history, impact on various state institutions and the TAC's human rights-based activism.

References

Dunkle, K.L., Jewkes, R.L., Brown, H.C., Gray, G.E., McIntyre, J.A., and Harlow, S.D., 2004. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet, 363, 1415-1421.
Iliffe, J., 2006. The African AIDS epidemic. Athens, OH: Ohio University Press.
UNAIDS, 2008. Report on the Global AIDS epidemic. Available at http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp [Accessed 16 April 2010].

Mandisa Mbali
Yale University
New Haven, CT, USA
©2010, Mandisa Mbali

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