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PSCI 115F Final Essay
HIV/AIDS in South Africa and the United States: A Comparative Essay
By Allison Beers
Growth is biased, leaning more favorably to those institutions and countries with the most money, knowledge, and development. Using South Africa and the United States as examples, one can examine how governmental and societal response to emergencies changes as the countryâs state of development changes. Because of the sense of emergency HIV/AIDS created within South Africa, a series of developmental reforms were initiated, which were difficult to implement due to the draining effect of the disease on the countryâs resources. Yet it was the hostile social stigma associated with HIV/AIDS that prevented the United States government and people from responding appropriately to the disease, actively choosing ignorance instead. The United States was just as ineffective in containing HIV/AIDS at the start of the epidemic as South Africa was in terms of sympathizing with victims and forming policy; its only saving characteristic was its high amount of resources compared to that of South Africa.
Definition of Development
For the purposes of this paper, a developed country shall be one with the following characteristics: gender equality, accessible healthcare, and a responsive government with a concern for its people. These qualities are those that comprise a countryâs ability to provide a safe environment, especially in terms of containing diseases like HIV/AIDS. Quantifying these standards is difficult, yet the following measurements will suffice: HIV prevalence, doctor to patient ratios, availability of medicines, and the number of policies made by the government. These statistics provide insight into the effect that HIV/AIDS has on the countryâs state of development, and vice versa.
Definition of HIV/AIDS in South Africa and the United States
In order to understand the effects of HIV/AIDS on South Africa, it is important to note the lifestyle and history of the country before the virusâs unfortunate outbreak. In fact, South Africa has been plagued with diseases and health care problems since colonial times, yet the government was far more responsive to these outbreaks than they were to HIV/AIDS. In the 17th century during the Dutch colonialism period, small pox, malaria, famines, and other various health challenges emerged. These were followed by tuberculosis, syphilis, bubonic plague, yellow fever, parasites, and malnutrition during 19th century British colonialism (Coovadia et al. 2009). Consequently, various measures including the Public Health Act (1883; smallpox vaccines became required) and the Public Health Amendment Act (1897; separation of preventative and curative care) were put into effect.Â Doctors served the white population while practitioners of orthodox medicine became a staple for the rest of the population. During the period of segregation (1910-1948), there was only one doctor for every 3,600 people, but one doctor for every 308 white Cape Town residents (Coovadia et al. 2009). The problem of HIV/AIDS was not unique in its type but in its magnitude. South Africa had seen healthcare, health policy, and medical challenges in the past, but never on so large a scale. This scale is what created so much current tension between the HIV/AIDS situation and South African development. Contrastingly, the United States prides itself on being one of the most developed countries in the world. It maintains a standard of living incomparable to a majority of other countries; it has a functioning democratic system of government, and a strong army with bases all over the world. Yet, the United States is plagued by moments of corruption and weakness throughout history, including the failure to respond to those in need. America has been the host for cruelly fatal prejudices, especially during the height of the HIV/AIDS epidemic in the 1980s-1990s. Between 1992 and 1993, 78,948 cases of HIV/AIDS were diagnosed, 44,914 of which ended in death (Francis 2012). HIV/AIDS has been a crisis for both South Africa and the United States, crippling the health of each country.
Part 1: HIV/AIDS in South Africa
As a fatal virus, HIV/AIDS has been both the creator and receiver of immense social tension in South Africa by dramatically affecting gender roles. In South Africa, young women are the most affected by HIV/AIDS due to unprotected sex (the leading risk factor of morbidity, accounting for 30.9% of all total deaths) and rape or other forms of violence (second leading risk factor, at 8.4%) (Coovadia et al. 2009). In fact, according to a study by the Human Rights Watch, âwomen in South Africa are more likely to be raped than to learn how to readâ (EIU 2004).Â The South African government, although neglectful during the apartheid years, realized the importance of increasing womenâs protection when its new Constitution (1996) solidified gender equality. In addition, the Domestic Violence Act (1998) prohibited rape and abuse of women, and the Criminal Law for Sexual Matters and Related Offenses was altered in 2007 to give a broader definition of rape (Coovadia et al.Â 2009). In this way, gender inequality has a very circular relationship with HIV/AIDS. While HIV/AIDS is killing young women, its horrific presence is encouraging stricter laws and social reform, which benefits women long-term. It is sad that it has taken such an epidemic for the South African government to realize the necessity of illegalizing acts of violence, yet such is the case â HIV/AIDS spurred development in South Africa for gender equality.
South Africaâs development (in terms of healthcare) has allowed HIV/AIDS to spread, causing an epidemic that depletes medical resources even further. It is a constant struggle that has settled at an equilibrium point that benefits no one.Â Incredibly, the spending for the medical private sector was nine times as large as the spending for the public sector in 2005, meaning that one doctor served around 500 people in the private sector but 11,000 people in the public sector (Harris 2011). This suggests that the current healthcare system is too inadequate to handle such a serious epidemic as 73% of all doctors in South Africa practice for the private sector and health insurance is far too expensive for the majority of the population (EIU 2004). The HIV/AIDS epidemic has only worsened the situation because it has âincreased the price of occupational cover, and many insurers are considering stepping back from the mass cover marketâ (EIU 2004). For those who are not fortunate enough to have access to private health care, the state system must suffice.
The presence of HIV/AIDS created a sense of emergency throughout South Africa, and therefore catalyzed healthcare reform. The system of hospitals and health centers is supposedly undergoing reform (hiring health inspectors, enforcing higher standards, providing preventative medicines, etc.). However, there is serious doubt as to whether an appropriate amount of funds will be allocated, especially considering the systemâs past of being incredibly underfunded (EIU 2004). About 75% of the South African population turn to a traditional healer or take traditional remedies; the income from traditional medicines (R3.2bn/year) is almost half that of Western drugs (R7bn/year) (EIU 2004). Even under normal conditions, the healthcare systems are inadequate in serving a large majority of the population. When HIV/AIDS struck, South Africa was grossly unequipped and unprepared, which lead to devastating consequences. In the Kwa-Zulu-Natal province of South Africa alone, 36.5% of the population aged 15-49 in 2001 were infected with HIV (IHDI 2013).Â However, developmental reform is considered to be a result of this virus. The Medicines Amendment Act (1997) was passed (although it made ARV drugs highly priced) because the World Trade Organization ruled it acceptable because South Africa was in a state of emergency (2004). Due to the urgency of containing HIV/AIDS, the healthcare system in South Africa advanced and developed.
HIV/AIDS has created large amount of tension between the South African government and its people, resulting in resource depletion and political negligence.Â First, it took the South African government far too long to respond to the disease: âthe annual antenatal surveillance prevalence rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005â (Coovadia et al 2009). After it was established that HIV/AIDS was a national crisis, several new pieces of legislation emerged, including the case in which âThe Constitutional Courtâ¦ruled that an antiretroviral (ARV) drug, Nevirapine, must be made available to pregnant women with HIV/AIDS throughout South Africa to prevent mother-to-child transmission of the virusâ (EIU 2004). This was perhaps the most beneficial law passed as it focused on preventing the spread of AIDS as opposed to trying to cure it. Attempts to cure the disease were often overpromised and unfulfilled; for example, âthe implementation capacity of the government is proving to be a problem. As at March 2004 only 2,700 patients were receiving ARV drugs, against a planned level of 53,000â (EIU 2004). Barely 5% of those scheduled to receive the ARV drug actually received it, emphasizing HIV/AIDSâs depleting effect on the peopleâs trust in government and resources. Similarly, âhealth-care access for all is constitutionally enshrined; yet, considerable inequities remain, largely due to distortions in resource allocationâ (Harris 1). HIV/AIDS has encouraged governmental reform and development, but its costliness takes away the resources necessary for government to make such changes.
Part 2: HIV/AIDS in the United States
The consequences of the stigma associated with HIV/AIDS extend far beyond those of societal disgrace; in fact, it even extended to Washington, where the Reagan administration was almost completely inept in handling the crisis. President Reagan and his administration made many decisions that benefitted America; their response to HIV/AIDS, however, was definitely not one of them. Donald Francis, a former employee of the Center for Disease Control during the time of the HIV/AIDS crisis, recalls his frustration at the governmentâs refusal to fund HIV/AIDS treatment and research efforts. The plan the CDC proposed to the White House for curbing HIV/AIDS (which Francis helped to draft) was rejected with the commentary, âLook pretty and do as little as you canâ (Francis 2012). It was not ignorance of the effect of HIV/AIDS that prevented the Reagan administration from taking action against the disease but a genuine disinterest, which may or may not have been heightened by homophobia. In some cases, the prejudice is clear; for example, Patrick Buchanan, the White House Director of Communications at the time, was an outspoken homophobe who claimed that homosexuals were victims to HIV/AIDS because they âdeclared war on nature and now nature is exacting an awful retributionâ (Francis 2012). Buchananâs statement is extreme. Not all members of the White House shared the same sentiments, and even if they did, it is likely that they would not express it to such a shocking degree. However, it was this prejudice that won out over the others in the end. At a time when the government was trying to cut back on spending, a disease such as HIV/AIDS that carried such a negative stigma was unlikely to receive any special attention until absolutely necessary. When it was necessary, it was too late â HIV/AIDS epidemic was quickly escalating into a pandemic, affecting parts of Africa and Europe, and there were over 10,000 cases reported in the United States (Francis 2012).Â Due to misguided priorities, the United States government failed to respond appropriately to the HIV/AIDS crisis.
Once the overwhelming amount of patients infected by HIV/AIDS pushed discrimination into the background, the United States government began enacting policies to combat its prevalence, only to find that its resource advantage had been dramatically damaged by the programsâ late start. In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act (to be managed by the U.S. Health Resources and Services Administration (HRSA)). Perhaps the most important provision of this act was that it provided $220.5 million in federal funds for HIV-related programs (HRSA 2011). The most recent attempt to control HIV/AIDS was the inception the U.S. National HIV/AIDS strategy (NHAS), which was gathered under President Obama. However, âHIV programs have generally been flat funded or received small percentage increases which are not at levels estimated to be necessary for full implementation of the NHASâ (Holtgrave et al 2012). While HIV/AIDS prevalence has certainly decreased since the 1980s-1990s, the United States is still experiencing the same implementation problems it did in the past, but on a smaller scale. Had the government taken steps earlier in the process, it could have saved valuable resources and money by not having to treat as many patients because not as many people would be affected today.
Even though the United States may possess and distribute antiretroviral drugs, the drugs are useless if the patients do not use them correctly, which is often the case due the diseaseâs stigma, transmittance, and a long incubation period.Â The presence of antiretroviral drugs has no doubt allowed for the prevention of HIV/AIDS and a slower increase in its spread; however, âproblems with adherence have prevented many from realizing the full benefits of treatmentâ (Leeman et al. 2010). This unfortunate lack of cooperation stems from several qualities of HIV/AIDS. First of all, the disease has a long incubation period of around ten years; that is, victims and potential victims do not see the immediate consequence of the diseaseâs presence. This leads to the second problem: there is no cure, and in order to keep it contained, a person needs to change their daily habits and behaviors. Illegal drug users who are used to sharing needles will either have to stop using drugs (unrealistic for most addicts) or find clean needles. The most effective preventative method for homosexual men â abstinence â is also not a likely lifetime behavioral change. It has also been a problem for patients with HIV/AIDS to seek help and treatment, although it seems that if the patient develops a strong, personal relationship with his doctor that cooperation is more effective (Leeman et al 2010). Because of the characteristics of this disease, HIV/AIDS has had a nulling effect on the resources made available by the United States government, increasing its prominence in the community.
Part 3: Governmental and Social Responses to HIV/AIDS
Society in both the United States and South Africa adopted a hostile attitude towards HIV/AIDS during the first epidemic; however, the United Statesâ society has become increasingly more compassionate than that of South Africaâs due to its developed judicial system. While South Africa is the only African country to legalize homosexuality, it remains a large problem. Cary Johnson of the International Gay and Lesbian Human Rights Commission commented that the rate at which gay, lesbian, and transgender people in Africa were dying had âa speed and breadth reminiscent of the impact of the epidemic on gay men in New York, San Francisco and other North American and European cities in the 1980sâ (Wakabi 2007). Yet the âofficial hostility to gaysâ that characterized the United States HIV/AIDS epidemic decades ago has since subsided, especially with the Supreme Court rulings on Californiaâs Proposition 8 and the elimination of the Defense of Marriage Act (Drucker 2012). While homophobia may be prevalent in the U.S. still, the government is taking much larger strides to equalize gay rights. Meanwhile, in South Africa, no such progress is seen. Individuals with HIV/AIDS are often ostracized in their communities, forcing an unhealthy social dynamic where âfamilies often reject patients, children taunt their sick parents and spouses conceal their HIV status from each other, according to health workers in [towns of South Africa]â (Dixon 2004). The lack of trust between community members in this society breeds HIV/AIDS at an alarming rate, causing many people to seek traditional healers due to the high cost and low availability of doctors. Flora Mogano, a traditional healer in South Africa interviewed by the Los Angeles Times, âclaims to have cured many patients with prayer and sees the disease as a punishment of sin,â a view that many South Africans seem to take (Dixon 2004). This is a view common in South African society, placing the blame on the victim of HIV/AIDS. Unfortunately, this view makes it difficult for patients to seek treatment for fear of losing respect in the community. Progressive views have yet to emerge. Because of the nature of the disease, HIV/AIDS catalyzed hostile societies in both the U.S. and South Africa, yet the development of the U.S. allowed its society to reform, while the South African stigma remains stagnant.
Denial to make policies regarding HIV/AIDS by both the American government and the South African government have drastically increased the impact of the epidemic on each country. The Presidents during the HIV/AIDS epidemic were ignorant of the true devastating power of the disease and blinded by misguided prejudices. In the United States, âPresident Reagan presided over 5 years of a burgeoning epidemic before he first uttered the word âAIDSâ in publicâ (Drucker 2012). President Reagan not only failed to push for HIV/AIDS treatment; he failed to address it altogether. This denial of attention allowed for HIV/AIDS to spread much quicker and easier than it should have. In a study to quantify the effect of government ignorance during the epidemic, the âconservative calculation of the number of HIV infections that could have been prevented ranged from 4394 (15 percent incidence reduction because of needle exchanges) to 9666 (33 per cent incidence reduction)â (Drucker 2012). Clearly, the slow response of the United States government to HIV/AIDS dramatically hurt the entire countryâs public health and contributed to one of the most fatal epidemics of all time. Similarly, Thabo Mbeki, the President of South Africa at the height of the epidemic, refused to even associate HIV with AIDS and neglected to encourage his government to make any policy related to the topic (Coovadia, et al. 2009). In fact, âIn the most striking example of poor stewardship, the national HIV/AIDS epidemic was allowed to spreadâ¦the annual antenatal surveillance prevalence rate increased from 0.7% in 1990, to 8% in 1994, and to 30% in 2005â (Coovadia, et al. 2009).Â Parallel to the negligence from the American government, the South African government failed to respond appropriately to HIV/AIDS, giving the disease full power to overwhelm the country with its horrible fatality rates. In this way, both the South African government and the American government gave HIV/AIDS full reign over the health of the nation, denying its citizens sympathy and help during the spread.
Upon realizing the horrifying magnitude of HIV/AIDS, both the United States and South African governments enacted policy reform â only to find that each lacked the appropriate amount of resources to implement such policies.Â In the United States, the most instrumental policy in containing HIV/AIDS has been the National HIV/AIDS Strategy (NHAS). As discussed previously, this policy is underfunded (Holtgrave, et al. 2012). The government is at least funding some or most of the program â enough to make prevalence decrease. According to the Center for Disease Control, HIV/AIDS related deaths and incidences reached a peak in the early 1990s and has been declining ever since (CDC 2001). South Africa, on the other hand, has had a very difficult time implementing policy at all. In fact, âJust after it took power a decade ago, the African National Congress government promised a comprehensive AIDS treatment policy. It has taken 10 years to arriveâ (Dixon 2004). The arrival of the policy does not even guarantee full implementation of the policy, which has proven to be a bigger problem, since the percentage of people who were promised ARV drugs but are actually receiving them is at about 5% (EIU 2004). Due to its intense lack of resources, South Africa has not seen such a promising trend as the U.S. has â the deaths related to HIV/AIDS show little to no signs of declining (Treatment Action Campaign 2006). While both the American and South African governments are unable to entirely fulfill their promises to treat HIV/AIDS, the United States is at an obvious advantage due to its development, therefore containing the disease more effectively.
An argument that is often put forth about the delay in governmental response to HIV/AIDS is that no one could have predicted how widespread it would become â it was innocent ignorance of the executives, not prejudice, that perpetrated fatal silence. Diseases are not uncommon, so âPresident Mbekiâ¦lumps AIDS in with other illnesses, such as tuberculosis and cholera, questioning why people donât make as much of a fuss about themâ (Dixon 2004). What President Mbeki clearly refuses to realize is that death certificates in South Africa often list these other such diseases as causes of death, but the victims caught those other diseases as a result of their immune deficiency (Dixon 2004). It is not the case that Mbeki had not been informed of the gravity of HIV/AIDS; he simply refuses to acknowledge it. Likewise, in the United States, President Ronald Reagan went five years without formally giving a speech on HIV/AIDS, while other levels of government acted accordingly. While the federal government silently neglected its citizens, âstate and locally funded programs offeredâ¦better access to HIV testing and treatment, addiction care, andâ¦general medical treatmentâ (Drucker 2012). Obviously, there is communication between state governments and federal governments; therefore, it cannot be the case that the federal government (executive branch in particular) was innocently unaware of the full scope of HIV/AIDS when the state governments clearly were. There are undoubtedly other factors at hand besides ignorance of the scope of the disease; factors that caused the executives to purposely fall into the shadows of negligence â pride and prejudice.
It can be said that HIV/AIDS has done more harm than good in terms of the lives it has taken, yet it catalyzed long-term policies that are on track to improve the quality of life compared to before HIV/AIDS. If only it did not take a crisis to necessitate progress in equality (in terms of gender, healthcare, etc.), governments worldwide would be far more responsible. Even though they are drastically different, the United States and South Africa handled the same crisis in a nearly identical way, until the resources and development of the United States overwhelmed the prevailing sense of prejudice and negligence towards HIV/AIDS. Extrapolating on this idea, it is most likely that if South Africa had the resources that the United States did, treating HIV/AIDS would be a much smaller problem, as the politics of the disease would fade into the background. Dr. James Mason, the Director of the CDC during the HIV/AIDS crisis, stated, âthere are certain areas which, when the goals of science collide with moral and ethical judgment, science has to take a time outâ (Francis 2012). Although this is a discouraging claim, especially from the head of one of the most important science departments in the world, it proved to be true. It is a testament to the prejudice of the society at the time that saving lives and preventing the spread of disease would be considered immoral simply because of the nature of the lives being saved. Choice, not ignorance, was the main factor at play in the HIV/AIDS crisis.
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Conclusion is the final part that summarizes your main points. You should not face any difficulties in this part, especially if you have clear understanding of your thesis all way through. If you experience some difficulties in summing up your main points, then apparently you have not developed your thesis.
Your final part, conclusion, should correspond to your first part - introduction. The main idea should be restated again (it should not be repeated or paraphrased in the same words). Conclusion should emphasize the issue of your discourse. Pay close attention to the main idea presented in the introduction of essay writing. If the main idea has been changed or modified during the process of writing the essay, you should reformulate your thesis in the introduction.
You may open your summary by reminding your thesis to the reader. First, you must look trough the different components of your essay and emphasize your thesis to convince the reader that you have made true and right assertions. In the introduction after you have acquainted the reader with your idea, you should restate it throughout the text and since the last paragraph is conclusive you should present your thesis in its conclusive and most compelling form.
One of the best ways to present the effective conclusion for your essay is to explain how people can apply your solution to the bigger picture. The conclusion imbedded with platitudes and generalities may weaken the final part of your essay.
This conclusion of the essay "The Efficiency of the US Aid to AIDS in Africa" is an example how the thesis can be improved:
"Rather than use the AIDS epidemic as an opportunity to redress the under financing of African health services, USAID would seem to be pursuing its long-desired program goal of population control. The agency is insisting on the nature of AIDS as an STD, the heterosexual transmission of AIDS in Africa, and the importance of condom use to prevent HIV transmission. Of course condoms also prevent conception. Although USAID projects a 30 to 50 percent increase in child mortality as a result of the epidemic, it expects the population growth rate to decline by only I percent, because total fertility is so high in Africa (Harris 1990). USAID concludes, "Not only is this not the time to diminish family planning efforts, but instead such efforts could be redoubled . . ." (Merritt, Lyerly, and Thomas 1988: 127)"
The broadening of your conclusion does not mean that you should present new facts and materials you have not mentioned before. Your conclusion is your last say. So, develop a strong conclusion to make a lasting impression on the reader with your essay writing.