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 organisations.
Policy Overview: HIV/AIDS policy in South Africa. Working Paper No. 4, Bradford Centre for International Development, University of Bradford, UK, v + 19 pp.