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Introduction: Research Problematique and Methodology

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Introduction: Research Problematique and Methodology INTRODUCTION: RESEARCH PROBLEMATIQUE AND METHODOLOGY 1. Background In 1982 HIV/AIDS claimed its first two victims in South Africa. At the 15th International HIV/AIDS conference held in Bangkok in mid-2004, the Joint United Nations (UN) Programme on AIDS (UNAIDS) released their most recent statistics for South Africa. The figures indicated a disturbing increase in the 22 years since the disease first appeared in this country—by December 2003 (out of an official population of just over 43 million): • 5.3 million South Africans were HIV-positive; • 5.1 million of whom were economically active (between the ages of 15 and 49 years), representing 21.5 percent of the adult (sexually active) population; • 370,000 AIDS-related deaths had occurred in South Africa in 2003 alone—more than 1,000 deaths a day, and • the country had 1.1 million orphans due to AIDS (UNAIDS 2004:190-93). According to a report published by UNAIDS in 1998, by 2010 life expectancy in South Africa was projected to fall from 68.2 years to 48.0 years as a result of AIDS. The population growth rate is expected to drop from 1.4% to 0.4% annually (UNAIDS 1998:66). One of the most comprehensive studies into the effect of HIV/AIDS on South Africa was published by ING Barings in April 2000. The report focuses mainly on the impact of the disease on the domestic economy, pointing out the following: • HIV infection rates in South Africa will peak at almost 17% by 2006 for the population as a whole. AIDS-related deaths will peak about five years later at 256 AIDS deaths per 100 normal deaths; • The economically active population will be the worst affected, with infection rates forecast to reach 26%. South Africa is already battling with a skills shortage, which will be further exacerbated by the AIDS epidemic, raising remuneration and replacements costs for companies; 2 • South Africa will have a smaller labour force, lower labour productivity, higher cost pressures for companies, lower labour income, and increased demand for health services from the private and the public sectors. The report found that the public sector currently spends between R3,000 and R4,000 per AIDS patient per year. This would result in annual increases in health spending in excess of R4 billion by 2008 (ING Barings 2000: 16); • Gross Domestic Product (GDP) trend growth is forecast to be on average 0.3 to 0.4 percentage points per year lower than in a no-AIDS baseline. • South African domestic savings will plummet, and • The lower growth and higher risk profile for South Africa will not bode well for financial markets and may well deter foreign investors. In addition to the negative economic impact of the disease, South Africa stands to suffer on the socio-political and developmental levels as well (Loewenson & Whiteside 1998: 13). One effect of the disease will be a sharp rise in the number of families without adult bread winners. The result will be that the elderly and very young children will have to be looked after by either the state (putting great strain on the fiscus), or by older children. AIDS impacts on the lives of people around the sufferers of the disease, leading analysts to talk of people infected as well as affected by AIDS. The expected increase in the number of AIDS orphans in South Africa, for example, has lead some commentators to point out that the country is on the verge of experiencing another ‘lost generation’—a generation of orphans who will have to fend for themselves. This could give rise to further increases in national crime rates (Schönteich 1999). As the disease rips through society, everyone will become the victims of HIV/AIDS in one sense or another—all South Africans are affected by AIDS. 3 2. What have successive South African governments done? Two facts emerge from the above: firstly, South Africa has a horrifying and growing HIV/AIDS problem; and secondly, the country has failed to address the issue effectively. Whatever the public or private policies that might have been introduced to combat HIV/AIDS in South Africa since the 1980s, the statistics mentioned above and the continuous, exponential rise in HIV infections in this country through the 1990s up to today demonstrate that the policy response in South Africa has been a dismal failure. In addition to this, the current government in general, and President Mbeki early in his Presidency in particular, seemed to be less busy with serious policy formulation and implementation in the battle against AIDS than with nightly Internet searches, flirting with controversial and minority views regarding the causal links between HIV and AIDS, and allowing his Ministry of Health to prevaricate on the issue of rollout of anti-retroviral therapies (ARVs). This not only affects the legitimacy of policies emanating from the top echelons of power; it is also purported to damage South Africa’s standing in the international policy community. This situation has prompted more than a few AIDS commentators to label the South African HIV/AIDS policy environment a failure.1 In an address to diplomats in Pretoria, the Director of the Centre for the Study of AIDS at the University of Pretoria noted that the country’s HIV/AIDS policy makers seem to her to be ‘currently roaming the [policy] landscape like packs of leaderless dogs’ (Crewe 2000: public address). She also said that—in relation to policy making— ’this is the most difficult time in South Africa’s AIDS epidemic’. Not that the country can boast with great success with regards to HIV/AIDS policy making in the past: as far back as 1992, Sadie and Schoeman noted what a struggle it was to get HIV/AIDS on the policy agenda—and even to get political scientists to write about AIDS in South Africa. Sadie and Schoeman (1992:85-99) reviewed the National Party (NP) government’s handling of the emerging HIV/AIDS polemic, and pointed out that the 1 For examples of such views, see Sidley (2000: 2), Mail & Guardian (12-18 May 2000), Sunday Independent (2 April 2000), Schneider (2002: 35), Nattrass (2004: 66) and Van der Vliet (2004b: 57). 4 previous government’s policies had failed to address it appropriately. Reasons for this include homophobic and racist assumptions regarding disease vectors, an exclusivist manner of policy consultation, resultant inappropriate policy formulations, misplaced actions, ineffective implementation, and a general lack of legitimacy, which compounded the whole problem. Reviewing the African National Congress (ANC) government’s handling of the epidemic during the Mandela administration (1994-1999), Marais (2000:1-68) notes that—although legitimacy became less of a problem for HIV/AIDS policy formulation since 1994—structural impediments within state structures, and dissonance and a clear lack of capacity between different spheres of government (notably national- provincial government levels) led to the failure of the government to effectively implement its policies. The irony, according to Crewe (2000), is that the government did have a good, inclusive and multi-faceted AIDS strategy at its disposal in 1994. However, the mentioned structural impediments and the fact that the South African society was in the midst of a fundamental social constitutional change distracted policy implementers from adequately addressing this issue.2 These problems were compounded by a government which became increasingly belligerent and defensive in light of criticism. Marais (2000:28) points out how— particularly in the aftermath of the Sarafina II debacle in 1996—the government started to close itself off from constructive criticism: ‘… these scandals, in fact, showed that politicians were already under pressure to act on AIDS and [were] searching for short-term solution. In that reading, they betrayed misapplied or miscalculated political will’. The government’s response to AIDS became an opera of blunders, embarrassments, and scandals: Sarafina II (1996); Virodene (1997); the mystery of the azidothymidine (AZT) decision (1998); mixed messages on notifiability (1999-2001); the courting of scientific dissidents (2000-2004), and prevarication on treatment rollout (2003-2004). 2 Bernstein (1999: 20) notes that it is possible to identify a few critical flaws in the government’s policy making since 1994, including (1) confusion of policy advocacy with policy analysis, (2) ignorance concerning the key components of policy analysis, (3) a lack of appreciation for the system of government, (4) a tendency to govern by legislation rather than sound administration, and (5) the assumption that good intentions will automatically result in good policies. 5 Referring to former President Mandela’s record on HIV/AIDS, Marais (2000:47) sardonically notes that, ‘…measured minute-by-minute, during his Presidency Mandela probably spent more time with the Spice Girls and Michael Jackson than he did raising the AIDS issue with the South African public’. Fundamental to the current as well as previous South African governments’ failure to make effective policy with regards to HIV/AIDS, is the framing of AIDS as an individual health issue. Marais (2000:47) and Crewe (2000) insist that AIDS should, instead, be conceptualised as a public issue which encompasses more than only health: in South Africa HIV/AIDS is a social, developmental issue and policy responses should not be limited to medical searches for the so-called quick-fix, ‘holy grail’ or ‘magic bullet’. One positive development would be, for example, to move public policy making on this issue out of the National Department of Health, and into a special unit within the Presidency.3 Marais (2000:48) notes that the Mbeki government’s obsession with finding a vaccine or quick solution to the HIV/AIDS situation might have been brought about by the public’s perception of him as ‘Mr Delivery’—he needs to perform, and quickly.
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