LIMPOPO, South Africa — “I first knew of my HIV status when I went for cancer chemotherapy. There, I had to do some tests, and an HIV test was one of them. It was back in 2007 when I knew that I was HIV-positive,” says Pontso Tsotetsi, a young single mother from rural Limpopo.
Amid a host of problems that democratic South Africa inherited from apartheid, such as high levels of violence, racism and social inequalities, the prevalence of HIV/AIDS has been the most devastating, unpredictable and difficult to contain.
But even since the abolishment of the Apartheid, South Africa’s approach to HIV and AIDS in the early years is perhaps the most controversial of any country. The problems ranged from government vacillation, unfounded scientific claims and lukewarm strategies from HIV and AIDS organizations. During a period of denial, it is believed that approximately 300,000 people died, and in 2005, at the peak of the crisis, there was an average of 900 deaths per day.
Sub-Saharan Africa has the highest HIV/AIDS rate in the world, most of which is concentrated in the member states of the South Africa Development Community. By delaying an approach to deal with HIV/AIDS, democratic South Africa paid an enormous price, as many died and the suffering of those infected escalated. Castigation from all fronts followed: nationally, regionally and internationally. However, having realized its error, the country changed its approach.
Solution both expansive and expensive
“South Africa has the biggest HIV/AIDS antiretroviral [ARV] drugs rollout in the world,” says professor Norman Nyazema, a former member of the Nestlé Nutrition Africa Scientific Board and affiliate of the Nestlé Nutrition Institute. “The country has over 6 million HIV infections and only 2 million infected [are] on antiretroviral drugs. The youth are the most sexually active people, and when coming to HIV, you will expect the youth, who fall in the prevalence rate of 19.1 percent on adults aged 15 to 49, to be leading the numbers [of the infected].”
With such a high number of people infected, on HIV/AIDS. This includes public and private sector contributions. The initiative has not just been government-led; humanitarian organizations and commercial companies, both nationally and internationally, have also chipped in. This is the biggest investment by any low- or middle-income country within this same period.
Development and delivery of primary health care services to a population of about 5.2 million people in a predominantly rural province, such as Limpopo, is especially challenging, due to the topography of the province, poor road infrastructure, poverty and cultural factors. Yet, even in difficult conditions, South Africa has strived to ensure that ARVs are made available to these patients. A Limpopo Provincial AIDS Spending Assessment Brief, published in 2013, said government spending on HIV/AIDS, excluding other discretionary and hidden spending, in the province had increased significantly over the years to reach 915 million Rand in the 2012/13 budget.
The role of education
Today, most South Africans have enough information about HIV/AIDS, including prevention, medication and patient care. The mushrooming of HIV/AIDS information centers in the country that mostly target young people has also facilitated this.
“The health ministry has taken a decision to bring the HIV/AIDS information and knowledge to mostly students. For instance, we stationed on campuses of universities,” says Selina Maunatlala, a health promoter and coordinator at the University of Limpopo’s health center. She adds that youths are finally appreciating the need to get HIV testing and find out their results, and massive numbers of young people come voluntarily to the testing centers. The current response to HIV/AIDS from a political, economic and social viewpoint has been aggressive, intense and more successful, compared with the early, turbulent years of indecision in democratic South Africa.
Change in wind
Speaking this year to The Lancet, Minister of Health Aaron Motsoaledi said, “We [South Africans] no longer fear the disease as we did.” It was not just government policy that resulted in the poor approach to dealing with HIV/AIDS in the early years; South African society was also unaccommodating. Discrimination toward those affected by the disease was rife during the denial era. Due to a lack of understanding and knowledge, those suffering from HIV/AIDS were treated as outcasts.
An appropriate environment to accommodate those infected with HIV/AIDS, as now championed by the South African government, calls for a change throughout society. Before acceptance and accommodation by the government, the entire country declined to act. Now, the entire country has become more open-minded. This is true in rural areas such as Limpopo, where HIV-positive young people such as Tsotetsi can manage their illness and live normal lives.
A future led by youth
Today’s public infrastructure in rural areas of South Africa allows for young people to continue the country’s ongoing fight against the disease. Tsotetsi says, “I think the government is doing more now than in the past. I started my treatment in the public sector at clinics, and later I got employed as a health adviser on HIV/AIDS.”
Although the first cases of HIV/AIDS in South Africa were recorded in the late ’80s and early ’90s, it turned into a full-blown problem only after South Africa became a democracy. Thus any analysis and judgmentregarding how the country dealt with HIV/AIDS must be put in proper historical context. Democratic South Africa made a U-turn from one approach to another not in reaction to the apartheid regime but in reaction to itself.
“One thing that is important in living with the HIV infection is to have a positive attitude towards that situation,” Tsotetsi says. “When I knew of my status, I immediately started being on the treatment, and so far it has done me right. I started to find out more information about this infection to educate myself. Like any other infected person, the side effects of the medication started to show, but I managed to come above them. I needed to rise above my circumstances and survive because I have a daughter and she was still young then, and I could not afford to abandon her alone on this earth.”
She continues, “It took me about five years before I could tell her of my status. All along, my daughter did not know anything, although she saw me taking the medicine a couple of times. I am sure she thought it was for my cancer treatment. I needed to take good care of myself before breaking the news. I did eventually tell her when the side effects were no longer that much visible. I waited long so that I can be on track health-wise, to be the person she knows, before telling my daughter the news. I wanted my daughter to be at a matured age for her to know of my status, not to devastate her.
“After I had told my daughter, I went to tell the whole family, and most of them thought I was only joking because I was not any different from them appearance-wise. I help each of my family members to have full information about any type of illness. What is needed is a supportive family in this situation, and mine really is.”
Tsotetsi accepts being HIV-positive. “I am a living testimony that you can live with the HIV infection and still look good.”
Featured image source: flickr / exfordy under Creative Commons