The National Strategic Plan of South Africa: what are the prospects of success after the repeated failure of previous AIDS policy?

Abstract

Hitherto, the story of HIV/AIDS in South Africa is, to a large extent, one of lost opportunities. Whereas the country has one of the worst epidemics in the world, consecutive national AIDS strategies have been repeatedly marked by failure over almost three decades. Understandably, South Africa's most recent HIV/AIDS policy, the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP), has been greeted with general acclaim. However, what are its real prospects of success against the backdrop of the repeated failures of the past? The first objective of this review is to systematically identify the core reasons for past policy failures. Using a comprehensive analytical framework, this article presents a systematic review of the literature on postapartheid AIDS policy in South Africa. The analysis demonstrates that a complex interplay among the content, context, actors and process of AIDS policy created a gap between policy making and policy implementation, which rendered near-ideal AIDS policies ineffective. Secondly, we evaluate the chances of success of the current NSP by examining both the policy-making phase and the resulting policy document in light of the reasons for past policy failures. Our analysis shows that the NSP contains dynamic and comprehensive policy content, sensitive to the socio-economic and cultural dimensions of HIV/AIDS. However, many of the political actors that hampered treatment implementation in the past, and who deepened the gap between government and civil society, are still in office. Monetary and human resource shortages also create a policy context that is infertile for the implementation of a comprehensive HIV/AIDS strategy, as envisaged in the NSP. Finally, these health system restrictions have a clear negative impact on the process of policy implementation. Without the mobilization of people living with HIV/AIDS and their communities, the NSP will be ineffective in bridging the gap between policy intentions and policy implementation. The strength of this article lies in its systematic analysis of previous policy responses, as a basis for appraising current AIDS policy. Although such an approach tends to simplify the complexities of the actual policy environment, it nonetheless draws to the attention of policy participants the importance of and the complex interrelationships among the different dimensions of AIDS policy.

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

“…The HIV/AIDS and STI National Strategic Plan for South Africa 2000–2005 reiterated the key principles of cooperation and inclusion that were included in the original NAP (1994–1999), with a focus on establishing a national multi-sectoral coordinating structure, called the South African National AIDS Council (SANAC), to drive programme implementation [23]. SANAC is made up of government, civil society and the private sector (see Figure 1 for the structure of SANAC).…”

“…The concept ‘MSA’ was formally referred to and incorporated in the plan, which called for ‘a comprehensive national multi-sectoral response to HIV and AIDS’ [28,p.7,9,19). All government departments and sectors of civil society were required to use the NSP as the basis to develop their own HIV and AIDS strategic and operational plans in order to achieve a focused, coherent, country-wide response to HIV and AIDS [23]. For the first time, provinces, districts and local government were given the critical role of acting as implementing agencies of the NSP.…”

The new epidemic of non-communicable disease in people living with the human immunodeficiency virus [Perspective]

“…In South Africa, the country with the highest number of people globally on ART, the South African strategic plan on HIV has adopted a broad 20-year vision that at least 80% of eligible patients will be initiated on ART within this period. 1 In 2007, the WHO estimated that 5.7 million people in South Africa were living with HIV. By the end of that year, only 27% of those eligible to receive ART had been commenced on antiretrovirals.…”

Using People to Cope with the Hunger: Social Networks and Food Transfers Amongst HIV/AIDS Afflicted Households in KwaZulu-Natal, South Africa

“…It is now generally accepted that efforts to build on local community support networks should be an integral part of any HIV/AIDS response [1,2]. In South Africa, the focus of this paper, the most recent National HIV and AIDS Strategy for 2007-2011 [3] has met with general acclaim for its emphasis on utilizing local networks that support and enable effective care for those affected by HIV/AIDS [2].…”

“…In South Africa, the focus of this paper, the most recent National HIV and AIDS Strategy for 2007-2011 [3] has met with general acclaim for its emphasis on utilizing local networks that support and enable effective care for those affected by HIV/AIDS [2]. Mainstreaming this policy into multiple sector strategies has become a major focus of HIV/AIDS programming.…”