South Africa has the fifth highest prevalence of HIV in the world, with
29.5% of the population estimated to be infected. A combination of
factors seem to be responsible for this, including: poverty and social
instability; high levels of sexually transmitted infections; the low
status of women; sexual violence; high mobility (particularly migrant
labour); and lack of coherent policies. The government was also slow to
react to the epidemic. The government has a relatively solid policy
framework to tackle AIDS, but the implementation encounters multiple
political, infrastructural, and organisational problems.
As a result, major activities in prevention, palliative and medical
care, and research are carried out by nongovernmental agents, including
a strong emphasis on the deployment of community-based organisations for
the provision of home-based care.
Voluntary community and non-governmental responses to HIV/AIDS are
diverse, such as self-help groups that respond to a particular need
within their locality (community). Increasingly, such Community Care
Workers (CCWs) or Volunteers are institutionalised through establishing
policy guidelines for those involved in HBC. While many CCWs work
largely on a voluntary basis, some CCWs receive the Departments of
Health and Social Development stipend of R500 per month. However, there
are no clear policy guidelines for the future career prospects for these
CCWs. There is however a recent move toward harmonising the work of CCWs
and the Department of Health has developed a Framework on Community Care
Workers CCWs. The involvement of People Living with HIV/AIDS (PLWA) in
the formulation and implementation of services is encouraged. The
involvement of beneficiaries of such services can strengthen and improve
provider's attitude and understanding of issues affecting people living
with HIV/AIDS. Wider benefits from involving PLWAs and OVCs include
improved psychological and physical health, reduced isolation, better
access to care and increased knowledge of HIV/AIDS.
A further policy consideration is that of care-givers. The government
hopes that the newly installed system of Community Development Workers
(see Working Paper 3) can support care-givers and signal problems.
Considering the inefficiency and contradictory nature of the
government's AIDS policy and practice, HIV/AIDS activist organisations
operating both on local and national level are crucial. However, the
lack of government support and coordination has fed into conflicts over
access to resources, conflicts of representational issues, and
accusations of racism among both white and black groups within AIDS
Policy Overview: HIV/AIDS policy in South Africa. Working Paper No. 4, Bradford Centre for International Development, University of Bradford, UK, v + 19 pp.
Policy Overview: HIV/AIDS policy in South Africa. Working Paper No. 4.