South Africa

Introduction

Background

South Africa occupies the entire southern tip of Africa. The 25th-largest country in the world, South Africa borders Namibia, Botswana, Zimbabwe, Mozambique and Swaziland, and it surrounds the kingdom of Lesotho.

South Africa has a diverse population and a rich yet controversial history. It was first colonized by the Dutch; Great Britain took control in 1806. With the discovery of diamonds and gold in the late 19th century, European immigration to the territory greatly increased, as did subjugation of the indigenous peoples. Apartheid — an official policy of racial segregation — was born of this era and continued after South Africa gained independence from Great Britain in 1961. It was ended after the election of 1994 created a black-majority government.

During apartheid, the white minority held the political and economic power. Policies of apartheid South Africa were similar in some ways to the principle of “separate but equal” used during segregation in the United States; facilities and programs designated as “black only” were separate indeed, but rarely — if ever — equal.

Under apartheid, all citizens had to be registered as an ethnic group, e.g., white, black (African), colored (or mixed race), or Asian (mostly Indian). Mixing of the races was strictly forbidden, and ethnic groups were socially and sometimes geographically stratified. Myriad rules and statutes existed to create separate social spheres among the races and maintain white dominance.

Blacks were prohibited from residing in or even visiting all-white towns without special permission. Only blacks who worked in the cities were generally allowed to live in them, and even then, they often couldn’t have their immediate families with them, separating spouses from each other and parents from their children. About 13 percent of the country was divided into separate “homelands” for blacks, who comprised about 80 percent of the population.

The international community took strong action against South Africa. The U.N. placed binding sanctions on the country in 1977, and many celebrities and world leaders condemned the racist practices. Apartheid officially ended in 1994 with the election of Nelson Mandela, who had been imprisoned for 27 years for being a leader of the anti-apartheid movement.

Mandela’s successor is the current president, Thabo Mbeki, who was elected in 1999 and reelected in 2004. He has come under fire for comments he has made on the cause of HIV and its relationship to AIDS.

When apartheid ended, the country was divided into nine provinces that were further divided into 52 districts. South Africa has three capital cities — Tshwane (formerly Pretoria), the administrative capital; Cape Town, the legislative capital; and Bloemfontein, the judicial capital.

The face of HIV

South Africa has one of the highest rates of HIV in the world and the greatest number of people — 5.5 million — living with the virus. Of South Africa’s nine provinces, KwaZulu-Natal has the highest HIV prevalence rate.

According to a Demographic and Health Survey of South Africa, knowledge of AIDS among adults 15 to 49 years old is around 95 percent. The same survey revealed that knowledge of prevention methods is high as well.

A survey conducted by the South African Department of Health showed that 30 percent of pregnant women had HIV in 2005.

AIDS is most likely the contributing factor to the sharp increase in the death rate in South Africa between 1997 and 2004, The New York Times reported in September 2006.

Challenges to fighting the HIV epidemic

While South Africa is economically better off than most sub-Saharan nations, problems — many left over from the apartheid era — persist. Racial disparities are still evident. More than 90 percent of the country’s poor are black. Whites control 80 percent of the farmland. Unemployment and lack of economic empowerment, particularly among disadvantaged groups, remain a challenge.

Poverty is one of the biggest barriers to fighting HIV, as in the other “focus countries” receiving funding from PEPFAR, the President’s Emergency Plan for AIDS Relief, a five-year, $15 billion U.S. initiative to combat AIDS abroad. South Africa ranks 121 out of 177 on the United Nations’ Development Program’s Human Development Index, a comparative measure of factors affecting the quality of life in a given country. Just over 10 percent of the population lives on less than $1 a day.

South African government response

Before the end of apartheid, the South African government’s response to the HIV epidemic was limited and focused mostly around the distribution of condoms.

Now, like most countries heavily afflicted by HIV/AIDS, the South African government has launched multi-part plans to fight the epidemic. The five-year HIV/AIDS/STI [Sexually Transmitted Infections] Strategic Plan for South Africa, kicked off by the Department of Health in June 2000, provided a framework for response at all levels of society.

The plan’s two main goals were to reduce the number of HIV infections (especially among youth) and reduce the effect of HIV and AIDS on individuals, families and communities. In 2000, the South African Cabinet established the South African National AIDS Council to foster “greater cooperation between the government and all facets of civil society in the battle against the spread of HIV and AIDS.”

In April 2000, President Mbeki defended a group of scientists who claimed that AIDS was not caused by HIV. The South African Cabinet, which has the power to override the president, has declared HIV to be the cause of AIDS. In 2003, the public health system started to provide antiretroviral treatment, a program that President Mbeki had resisted. Antiretroviral drugs have largely transformed HIV/AIDS from a fatal condition to a manageable illness.

Mbeki has also described AIDS as a “disease of poverty” and called for efforts to relieve poverty in general rather than focusing on AIDS in particular. Further controversy has come in the form of statements made by the health minister, Manto Tshabalala-Msimang, who has promoted nutritional alternatives to antiretroviral drugs, saying that the drugs carry a risk of poisoning.

U.S. government response

South Africa is receiving the most funding of any PEPFAR country, with its allocation for 2006 topping $221.5 million.

According to the U.S. State Department’s Office of the Global AIDS Coordinator (OGAC), PEPFAR prevention programs — allocated $30.9 million, or 23.9 percent, of fiscal 2005 prevention, care and treatment funds — promoting abstinence and fidelity reached just under 4 million people while programs promoting condom use and related prevention services reached just over 4 million. OGAC reported that $7.6 million was spent on condoms and related activities.

Additionally, 28.8 percent, or $37.3 million, was reserved for care activities; and 47.3 percent, or $61.3 million, for treatment activities.

According to the 2005 PEPFAR South Africa Annual Report, two-thirds of all PEPFAR funding for 2006 will go to the South African government and local private organizations, with the remaining one-third going to international organizations and their local partners.