POLICY BRIEF:

SOUTH AFRICA AND THE HIV/AIDS QUESTION: WILL THE

GOVERNMENT EVER FIND A SOLUTION?

IPELENG BOSILONG
December 4, 2007

EXECUTIVE SUMMARY
 This paper will offer a proposed solution to the one issue that has been, and continues to

plague the African continent, with South Africa as the leader, and this issue is HIV/AIDS. For

many years, South Africa has unfortunately been at the forefront with regard to infection and

death rates, meanwhile not taking an active and leading role in coming up with a sustainable

solution which can benefit the South African and broader African people. As a part of this

solution, I propose for South Africa to abandon the Western pharmaceuticals and engage with

those from Brazil and India, which are at the forefront in terms of development of Anti-

Retroviral Drugs by developing nations. Not only will this have adverse effects for the South

African population and economy, it will also aid in fostering a sense of achievement and

independence in the developing nations, who for long have been under the yolk of Western

imperialism, or as it’s referred to nowadays, globalisation.

INTRODUCTION
 South Africa is one of the world’s leaders with regard to HIV/AIDS infection rates,

people living with and dying from AIDS. Currently, about 20% of the adult population is living

with AIDS, which is staggering considering that the population is at roughly 44 Million1. This

epidemic is of utmost importance not only for South Africa, its people and the economy, but also

for the rest of Africa as well since South Africa is a hub for immigration of different people

across the continent. AIDS is not only an issue for South Africa, as it is also prevalent in much of

Sub-Saharan Africa as well, therefore making it the sole most important issue for all African

nations to combat. I believe that South Africa, having one of the larger economies and resources,

along with political clout and influence, should be at the forefront in developing a sustained

policy which can eradicate the country and the continent of this deadly epidemic. In doing so, the

government and the country will benefit immensely from the reduced loss of lives, the increased

labour potential and the knock-off effects on the economy. The proposed policy will be loosely

based on that of Brazil’s, which suffered a similar epidemic and managed to substantially turn

things around through an effective government policy and commitment. Its main features will

focus on the continued education of all people, which would go a long way towards eradicating

the stigma that AIDS often faces, mostly in the rural areas. The policy would also suggest that

the government pursue ways of producing cheap drugs which currently are provided by foreign

pharmaceuticals which impose high prices. Correctly implementing this policy, I believe, will

effectively lower infection rates of people already with the virus and simultaneously provide care

for them, while also decreasing new infection rates.

BACKGROUND

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https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html#People
 The first recorded case of AIDS in South Africa was diagnosed in 19822. At this time, it

was not a large-scale pandemic and was concentrated in terms of the people it affected. As with

much of the world at the time, it was perceived that AIDS was only transmitted by and to those

that were homosexual, and with time this perception disintegrated as increasingly, heterosexuals

became affected as well. Throughout the mid 1980s, the Apartheid government began taking the

virus more seriously, evidenced by the establishment of the first AIDS Advisory Group in 1985.

As the transition towards democracy became a reality, there was more collaboration amongst the

government and the leaders of ‘homelands’- designated regions where Africans were permitted

to live- as people of all demographics were beginning to suffer from the virus. Even leading

political figures such as Nelson Mandela addressed the issue upon release from prison, realising

the potential severity of the issue if action was not taken by the government and the people.

Before the 1994 elections, the Apartheid government set up the National Aids Hotline in 1991 as

part of an initiative to provide “confidential, anonymous 24-hour toll-free telephone counselling,

information and referral service for those infected and affected by HIV and AIDS”3. Along with

the Hotline, the main role players in terms of tackling the pandemic are the Department of

Health, which administers the funding of various programs which aim to eradicate and provide

solutions to the growing problem. Also crucial have been interest groups such as Treatment

Action Campaign, which was established in 1998 with the purpose of highlighting the plight of

people living with HIV/AIDS and the attainment of instrumental anti-retroviral treatment for

them. The TAC’s highest point came in 2002, when the Constitutional Court awarded a ruling in

their favour which called for the government to “offer treatment to all pregnant women who

were HIV positive to prevent mother-to-child transmission”4 under the National Aids Plan.

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http://www.aidshelpline.org.za/default.aspx?link=site_home
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 In previous governments, the response to the AIDS pandemic has been somewhat

stagnant, epitomised by Pres. Mbeki’s infamous questioning of whether there is a relation

between the HIV virus and AIDS. These thoughts and statements have brought much criticism

towards the government, whose population leads the world in number of infection rates per

capita, from governments, interest groups and global institutions, all of which believe that South

Africa should be taking more decisive action to combat the epidemic. This criticism came to a

boiling point in 2006 at the International Aids Conference in Toronto, where South Africa’s

response and actions with regard to the pandemic was labelled as ‘negligent’.

There is a general consensus that South Africa should be doing more to tackle this issue.

Global institutions, such as the WHO and the UNAIDS, have provided data which indicates that

the country’s infection rates are still on the rise, even though the pandemic has been

acknowledged as critical by the government. Since 2000, the first Mbeki administration initiated

a proposal structured and loosely based on an internationally-used plan which was referred to as

the HIV/AIDS and Sexually Transmitted Infections Strategic Plan5. A main component of the

plan was to significantly increase the budget in order to finance the areas of concern under which

the plan would focus on: preventing further HIV infection, providing treatment, care and support

for those infected and affected by HIV, researching an AIDS vaccine and conducting other

research and monitoring, asserting the human and legal rights of all affected by the disease6.

Although this initiative has been partially successful in that it has conformed South Africa’s

AIDS strategy to one which is similarly implemented in many other countries, the results have

been somewhat dismal, as evidenced by the increasing infection rates. Therefore, it is apparent

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that either a more decisive strategy is needed, or reforms have to be implemented within the

government in order for the plan to be a success, as it has been in other hard-hit nations, with

Brazil being a good comparison.

POLICY SOLUTIONS

The South African government has been faced with many possible solutions since it came

into power in 1994. The most prominent of those has been the decision faced by Mbeki during

the early stages of his first presidential term to adopt either a strategy which featured the pursuit

of the medical option or one more socially-inclined. The medical option focused on providing

public funding and easier access to anti-retroviral drugs (ARV), seen as essential in the

prevention of the spread of the virus between mother and child, and a more cohesive effort by all

sectors to combat the epidemic, led by the political leadership. The more socially-inclined option

“focused on sexually transmitted infections (STI) treatment, behaviour change, condom

marketing, a mass communications strategy, and life-skills education”7. As it turned out, the

government chose to pursue a strategy which leaned more on the side of the socially-inclined

option, as there were concerns raised about the funding of such programs recommended by the

first option which was to provide expensive ARVs, something the government felt it would not

be able to fully commit to. There were also issues with the political leadership, as famously

illustrated by Pres. Mbeki, which related to the questioning of the links between the HIV virus

and AIDS. This slowed down the process tremendously, as the government sought more medical

testing and results to clarify something that the rest of the world had already known. Recently,

the government has switched its stance and choice of option, deciding to pursue the first option

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of providing ARVs more publicly, while also attempting to continue the process of establishing

cohesion between government, medical and advocacy interest groups. This option, however, is

also proving to be quite unsuccessful, even though it was widely called for by various groups.

There are several reasons behind this: the first of which is that the wide distribution of ARVs is

proving to be a strain on the government and the taxpayers; also, there is still many in the nation

and government who believe that there should be more emphasis placed on nutrition and

traditional medicine8 as opposed to expensive foreign medicine; yet another reason is that many

of the hospitals and clinics which stand to benefit from government policies to provide ARVs are

understaffed and ill-equipped to facilitate and efficiently provide care for infected patients.

Therefore, in order for such an option to be successful, the government would first have to look

at redeveloping the infrastructure, committing more funds to the drugs and training of staff who

would be able to man the hospitals and clinics. On a side note, the government would also have

to make a conscious effort to retain the brain drain that is occurring due to lack of employment

and sufficient wages for such occupations as nursing and doctors, who are increasingly seeking

improved situations abroad. It is imperative for the government to provide this labour force with

the necessary resources and compensation for their work in order for the country to be able to

fully combat the epidemic whole-heartedly.

My proposed solution to this crisis takes on a completely different outlook, as I plan to

focus on the aspect that many leading developing nations such as India and Brazil have

advocated for, which is for international pharmaceuticals to release patents on their anti-

retroviral drugs. In doing so, nations such as South Africa, India and Brazil would be allowed to

produce cheaper versions of the drugs that these pharmaceuticals sell to nations, thereby being

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able to make the drugs more easily-accessible to the public without having to worry about

stretching the national budget. The process of achieving this would involve imposing tough

licensing restrictions on pharmaceuticals that intend to sell their drugs in South Africa, which

would hopefully have an adverse effect of the companies lowering their prices or even releasing

their patents altogether. Another aspect of this process could be to use threats of not doing

business with these pharmaceuticals unless they release their patents. Several years ago this

would not have been an option, but with the recent success of nations such as India and Brazil

who have both successfully managed to produce their own cheaper versions of ARVs, nations

such as South Africa are thereby able to negotiate with pharmaceuticals, threatening to otherwise

do business with these cheaper-producing nations. South Africa should also take initiative and

establish a medical program which could be capable of producing local ARVs, instead of always

importing the drugs, even if they are from cheaper markets like Brazil. In order for patents to be

released in South Africa, the government and the “Medicines Control Council (MCC), the

national pharmaceutical regulatory authority”9 would have to issue licenses to these

pharmaceuticals, thereby allowing for local production to occur without legal repercussion.

POLICY ANALYSIS

I would imagine that the main challenge to this proposed policy would come from the

international pharmaceuticals, which would have the most to lose if this policy was adopted.

Pharmaceutical companies make billions of Dollars from the sale of their patented ARVs and

giving up their patents for the good of mankind, although seems like the right thing to do, is not

what companies are focused on as it would take away from the ‘bottom line’. Most of these

companies have their bases in either the United States or Europe, and therefore would probably

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generate much support from their governments and therefore international institutions if such

measures were taken by South Africa. This was seen during South Africa’s early years of

democracy, when Pres. Mandela and his government passes laws which were aimed at reducing

drug prices, primary of which were coming from U.S pharmaceuticals. Accordingly, the U.S

government took action by applying “powerful pressure points to repeal a clause allowing

potential importation of generic substitutes and imposition of compulsory licensing. At stake

were not only local interpretations of patent law and World Trade Organization rules on Trade in

Intellectual Property, but international power relations between developing countries and the

pharmaceutical industry”10. This indicates that the U.S, and the West as whole, aimed at

maintaining the status quo relationship shared between developing and developed countries

through pharmaceutical companies, and were willing to do whatever was necessary, even if it

meant repealing part of a signed treaty which had previously allowed for developing nations such

as South Africa to impose compulsory licenses on western pharmaceuticals.

Naturally, as the pharmaceuticals would be the biggest challenge to the government if it

planned to pursue this policy, the multinational companies would also be the biggest losers as

well. South Africa currently spends upwards of 2 Billion Rand annually as part of the HIV/AIDS

and STI Strategy Plan and much of this sum goes to the acquisition of ARVs from foreign

companies. Was the government to produce its own version of the ARV drugs, or even import

the drugs more cheaply from nations such as India and Brazil, the western pharmaceuticals

would stand to lose large amounts of money, and through it influence in the region. The

beneficiaries on the other hand, would be the millions of South African people currently living

and suffering with the HIV virus. This new policy would allow them to have ready access to

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cheap and perhaps even free treatment, which could potentially be life-saving in terms of

mother-to-child transmission and also life-prolonging for those already with the virus. The rest of

the country would also benefit from such a policy as the result of a decreased death rate would

mean more people in the labour force, and more importantly, less people dying that make up the

potential labour force. There would also be positive effects on the economy as more investment

and consumer and foreign confidence in the nation would increase, whereas now it is declining

due to foreign investors turned off at the prospect of suffering costs due to providing health care

for HIV positive workers.

If for no other reason, this solution is worth investing in because it will save many lives.

Apart from all the talk of financial and political effects in terms of going against western nations

and their pharmaceuticals, obtaining cheap drugs will provide treatment for many people who

would otherwise never have access to any drugs, let alone the expensive pharmaceutical ARVs.

Investing in this solution also allows for a developing nation to do something for itself, as

opposed to continually relying on the West for handouts and aid. If the world is as serious as it

states in the development of Africa, then a policy such as this would be a great way to initiate

that development, and work towards its sustainability.

Brazil is a nation which has applied similar policies and methods to its HIV/AIDS

pandemic, with much heralded success. Like South Africa, Brazil is a larger developing nation

which has taken the lead in the challenging of pharmaceutical companies over their patents on

anti-retroviral drugs. Brazil, however, has taken it a step further by deciding to push ahead with

the production of cheaper generic drugs that are without patents, all the while imposing licenses

on those that do have them in Brazil, thereby making the drugs imported much cheaper than

would usually be. In doing so, the pharmaceuticals have been led to a realisation that their
options with Brazil are essentially that they either continue to fight the issue of releasing patents,

thereby potentially losing a market, or comply with the Brazilian government and lower its costs

of drugs in order for them to be made accessible to the people. Actions such as this should be

inspiring to South Africa, which itself should be attempting to twist the arm of the

pharmaceutical companies by threatening to close its markets to them if they do not comply and

show some humanitarian spirit in tackling such a worldwide pandemic. Another action which

should be inspirational for the South African government should be Brazil’s efforts to offer

improved and cheaper health care for all citizens as part of its health reforms. Using this model,

South Africa should emulate this and aim to use the AIDS reform platform as a measure to

reform the whole health sector as well. This would go a long way towards benefitting not only

those with HIV, but the whole population as well.

CONCLUSION

South Africa’s HIV/AIDS crisis has over the years developed into an unnecessary epidemic, and

one that could be easily combated, as evidenced by Brazil which, like South Africa, previously

had a high rate of infections and death due to the virus, yet took concerted action to reverse the

effects of the HIV virus, even with opposition from the West. As with most policies, there is no

guarantee that this proposed solution will be one hundred per cent effective, yet to a country and

people who continue to see family members die on a daily basis, some percentage of

effectiveness is better than none. Alternatively, the South African government could implement a

policy of solely purchasing its ARVs from nations such as Brazil and India, which in itself would

be much cheaper than purchasing the drugs from the Western multinationals. My proposed

solution, therefore, is more preferable as it promotes self-sufficiency and taking care of oneself,

all the while generating local economy and developing local medicinal technologies and
capabilities. I believe that this solution could be achieved through partnerships between states

such as Brazil and South Africa, as evidenced by a current project in Khayelitsha, Cape Town,

where a South African clinic provides treatment with Brazilian ARVs imported by the TAC

unilaterally. Partnerships such as these are beneficial for South Africa as they not only provide

life-saving treatment at affordable prices, but they also provide South African medical experts

the opportunity to learn from their Brazilian counterparts in the production of generic ARVs,

which eventually could lead to South Africa producing them themselves. Either way, changing

direction and working with other developing nations is something that the government should be

looking towards, as the developing world attempts to close the bridge between itself and the

developed world. An issue such as this, with two regional powers having the opportunity to work

together, would be a great start toward that goal.

BIBLIOGRAPHY
• http://baywood.metapress.com/app/home/contribution.asp?
referrer=parent&backto=issue,6,17;journal,33,148;linkingpublicationresults,1:300313,1

• https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html#People

• http://www.avert.org/aidssouthafrica.htm

• http://www.aidshelpline.org.za/default.aspx?link=site_home

• http://afraf.oxfordjournals.org/cgi/reprint/103/410/109.pdf

• http://afraf.oxfordjournals.org/cgi/content/full/104/417/591?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=aids&searchid=1&FIRSTINDEX=0&re
sourcetype=HWCIT

• http://www.southafrica.info/ess_info/sa_glance/health/aids.htm

• http://afraf.oxfordjournals.org/cgi/content/full/104/417/591?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=aids&searchid=1&FIRSTINDEX=0&re
sourcetype=HWCIT#SEC2

• http://www.aids.org.za/hiv.htm

• http://www.accessmed-msf.org/prod/publications.asp?scntid=29120021037154&contenttype=PARA