Policy, Politics and Transforming Practice 1.
Introduction
South Africa is one of the leading countries with the highest number of HIV cases amongst its population. Aim of this study is to provide detailed information on policy, politics, and transforming practices to control the spread of HIV in South Africa. South Africa has highest prevalence of HIV out of all the countries across the world. Government of South Africa has adopted various strategies as a preventive measure for controlling the widespread HIV infection in South Africa. Policies such as 90-90-90 policy, PrEP policy, and ART policy have been adopted by the government of South Africa in order to prevent prevalence of HIV in the country.
2. HIV scenario in South Africa
South Africa is said to have the highest prevalence of HIV around the world and is considered to be the highest HIV epidemic in the world. The country currently has more than 7.7. Million populations living with the immunodeficiency medical condition called HIV. Widespread infection among the population is high which accounts for more than 20% of the total population of the country. The prevalence of Human Immunodeficiency Virus is highest among adolescent women aged 15 to 24 years. As per the records of 2018, approximately 240000 new cases of HIV infection were found in the country and almost 71000 people have died due to the infection in South Africa (Avert.org, 2021).
It has been estimated that one out of 5 people in South Africa has been living with the deadly infection. One of the major reasons responsible for the prevalence of HIV infection in the country is considered to be direct contact of blood of an infected person or sexual secretion.
3. Three key policies for the prevention of HIV in the country
In 2018, approximately 140000 women were infected with the virus and have been suffering from its negative impact. As narrated by Satoh and Boyer, (2019), compared to this almost 15% of men population were observed to be infected with the deadliest virus. One of the major reasons for this phenomenon is considered to be having unprotected sex with an affected partner. In 2018, a serious number of 4.8 million women were living with HIV in South Africa. Gender-based violence and poverty such as low status of women in the country are considered to be another major factor for prevalence of the disease among the women population (Dellar et al. 2015).
PrEP policy
Prevalence of HIV among young women and adolescent girls is said to be almost four times greater than that of the young men population in the country. According to the reports of 2018, an estimated number of 540000 young women and adolescent girls were living with the deadly infection compared to 180000 young men (Ma et al. 2020). Widespread immunodeficiency disease has been a serious matter of concern in the country. Various majors were taken by the authorities of the country to prevent the prevalence of the infection.
South Africa has taken vital steps towards getting its population tested for HIV infection which has made significant improvement in recent years. As suggested by Popov et al. (2018), there are several policies adopted by the government of South Africa for the prevention of widespread infection in the country. South Africa is known for approving a fully PrEP programme which has been made available to people who have been at high risks of infection.
90-90-90 policy
The country has met its 90-90-90 target recently which has made 90% of people living with the infection aware of their status. This has been proven to be beneficial for proper treatment and improvement of the patients living with the deadly virus. The 90-90-90 treatment target is considered to be a key approach in assessing progress towards turning the tide of the HIV epidemic in South Africa. As argued by Mukandavire et al. (2018), this programme is a joint United Nations Programme on AIDS/HIV which has played a significant role in measuring progress towards controlling the prevalence of HIV in the country. As per the reports of UNAIDS, almost 75% of people around the world were aware of their HIV status by the end of 2017. Besides that, almost 79% of the population were aware that they were on ART (antiretroviral therapy).
ART policy
The country is said to have the world’s largest ART programme which has undergone specific changes involving test and treatment guidelines. Therefore, it can be stated in this context that the government of South Africa has been putting significant efforts into coming up with new HIV restriction programmes. HIV at a young age can have several negative impacts on young men and women; therefore, it needs to be prevented by the government. It is the responsibility of the government of South Africa to implement significant strategies and approaches within the country for preventing widespread HIV (Giabbanelli et al. 2018). The ART programme has been adopted by the government of South Africa in 2016 in order to provide antiretroviral disease in the country. It has been done to treat people with HIV infection irrespective of their CD4 cell count.
4. Critical evaluation of implemented methods in reducing the impact of infection among women
90-90-90 policy: The progress towards achievements of 90-90-90 targets in South Africa has been evaluated by random surveys in the country. The survey has revealed significant data regarding awareness of people living with HIV about their status. This has been proven to be beneficial for accurate as well as systematic treatment of every individual living with the infection. HIV infection can have negative impacts on the mental wellness of an individual which can affect their treatment process.
The 90-90-90 method analyzes the behavioural aspects of the population living with the infection to evaluate their mental health in order to motivate them for the treatment process. As per the reports of surveys conducted by famous scholars South Africa is the first country to be on track in order to achieve the first 90 indicators in 2020 (Dupont et al. 2020). This method has played a significant role in tracking and reducing the negative impacts of HIV amongst women and adolescent girls in the country. It has improved the targeted diagnosis, awareness as well as treatment programs for adolescent girls of 15 to 24 years of age. However, a more appropriate 90-90-90 is needed in the provinces of the country to analyze the gaps in provincial regions and also to inform interventions of provinces.
ART policy: South Africa has adopted the policy of providing antiretroviral treatment to every individual infected with the virus in 2016. This program has been adopted by conducting a survey to analyze the impact antiretroviral treatment can have on the patients. In the survey, data on HIV has been collected from the joint programme of the United Nation on HIV and AIDS from 1988 to 2013. As influenced by Wang and Su, (2019), data on tuberculosis from 1988 to 2013 has been collected from WHO to conduct the survey. Data on tuberculosis has been collected in order to fit a dynamic model of time and trends in the prevalence of HIV in South Africa. The data and the model have been used to analyze current trends and to project future patterns responsible for the prevalence of HIV in the country.
ETP strategy (Expanded Treatment and Prevention strategy) has been adopted by the government in 2016. This enables the government to increase its rates of testing and start treatment of an individual with HIV immediately. The findings of the survey suggest that South Africa is on the track of reducing its HIV cases and as well as mortality by the end of 2030.
PrEP policy: PrEP policy is considered to play a significant role in controlling the widespread of HIV amongst the South African masses. There is a high demand for pre-exposure prophylaxis among people who are at high risk of HIV (van Heerden et al. 2017). However, the facility is not yet available in many regions of South Africa which has been restricting the prevention programme of the country. Prescribing prophylaxis by oneself can result in inappropriate and inadequate follow-up with improper linkage of health service support. Moreover, it can increase the risk of using substandard products and can also decrease the effect of an overall treatment.
South Africa is the first country to have adopted and approved the use of antiretroviral treatment to protect its men and women from the deadly spread of HIV infection. The PrEP model for prevention of HIV in South Africa is based on both needs and rights of people suffering from HIV. As argued by Fomundam et al. (2017), a model was initially intended for sex workers in South Africa as the number of HIV cases among the sex workers was highest amongst them. However, this policy is now used for the entire population of South Africa living with the infection; it is especially dedicated to young women and adolescent girls of the country who have been suffering the most in recent times.
5. Challenges of HIV in South Africa
There are several challenges that have been imposed while applying the policies for the prevention of HIV in South Africa. Some of the major challenges of imposing the policies in the country are as discussed below:
Social challenge
A social challenge can be considered to be the primary challenge in imposing the policies for the prevention of HIV in South Africa. Majority of the population of the country is least interested in making the lives of people more sustainable in the country (Bunyasi and Coetzee, 2017). The people of South Africa are not very implicative and adaptive to new changes due to which the majority of them are unable to adapt to the policies for the prevention of HIV prevalence in South Africa. Most people do not participate in the awareness programmes arranged for the people in order to spread awareness of the infection. This ignorance of the South African population, especially the tribal caste is making it difficult for the government to impose the policies and make proper use of them.
A major portion of African population treats awareness programs as well as other approaches for preventing HIV with less care which has made it difficult to implement various policies of controlling HIV (Mwagomba et al. 2018). Policies such as the PrEP model, ART programme, and 90-90-90 method are used for making the lives of people in South Africa more sustainable. However, less involvement of the population has made the process less effective and time-consuming.
Inadequate suppliers
Imposition of policies for the prevention of HIV in the country requires a large number of resources as the country has millions of people infected by HIV (Cluver et al. 2018). This has forced South Africa to use medical equipment supplied from other countries which have made the policy imposition process more complex and expensive. Process of collecting resources from external sources has affected the efficiency of the policy implementation process which has made it difficult for South Africa to impose policies for prevention of HIV. Gathering resources from internal sources can help to make the process cost-effective and efficient. However, lack of adequate suppliers has made it difficult for South Africa to impose the policies.
Managing adequate medical resources can be attained by adequate funds which can be managed by business industries operating in South Africa (Rahyani, 2018). The country has faced several issues in managing its industries and corporate sector properly due to which it has been unable to collect adequate funds. Therefore, it can be stated in this context that, inadequate amount of funds has been a major reason for improper management and imposition of policies in South Africa.
6. Recommendation
HIV is a contaminated and infected disease and is mostly spreading among women between the age group of 15-24. NSP (National Strategic plan) and STIs (Sexually Transmitted Infections) is one of the initiatives taken by the government for setting goals to influence the management of HIV infection (Biggs and Spooner, 2018). Some of the solutions which can help in reducing the infection of HIV among adolescent girls and women are described below:
Inclusivity to be addressed: The foremost thing to be initiated in reducing the HIV infection is to care for the most unsafe population that is the Sex workers and the people who are drug-addicted. Neglecting people of the society, intolerance and discrimination are resulting in keeping the groups out of the clinics and research. As opined by Biggs and Spooner (2018), people are not allowed in the clinics where the treatment of the infection is available. Some of the national programs like the HIV plan for the sex workers nationally and the LGBTQ HIV framework of the National AIDS Council of South Africa is still not available. The creation of such programs for addressing the awareness and needs of the abused population is the foremost stage towards minimizing HIV in South Africa.
Women to be supported: Globally, more than 35 million women and girls among people are suffering from HIV disease. Women and adolescent girls must be provided with medical awareness and the methods of Safety birth controls. In South Africa, the number is even worse, which shows that the prevalence of HIV in women is more than 4 times higher than in men of the same age. The higher numbers consequently lead to violence of gender bias. Poverty and generation gap marriage and mostly found within the age group 15-24 (Fomundamet al. 2017). The deployed resource such as the She Conqueror Campaign helps to give several interventions socially which can reduce gender-bias violence and teenage pregnancy. The women and adolescent girls within the age group of 15-24 can get business opportunities and mainly educational support.
Treatment of Tuberculosis to be done: One of the major reasons for the increase of death in South Africa is Tuberculosis (TB). The immune system of the victims of HIV suppresses which leads to multiple severe infections in the body of women. The most difficult disease to be handled is TB and it can be killing for the person without treatment (Fomundamet al. 2017). It is seen in a survey that almost two-third of HIV-positive people have TB. Tuberculosis reduction disease has been incorporated by the NSP of South Africa which helps in the reduction of fatalities in the country.
7. Conclusion
It can be concluded from the above study that HIV disease has a severe impact on the women and adolescent girls within the age group of 15-24 of South Africa. The infectious disease is often spread through the infected blood which badly affects the immune system of the women. A decrease in immunity power in the body leads to capturing of other multiple infections. The implementation method of reducing the impact of HIV among women and adolescent girls is critically evaluated. Several challenges are faced when imposing the key policies for preventing HIV in the country is described in the study. In the study, the recommendations that should be initiated for the prevention of HIV among young women and girls and creates awareness among the people of the society are provided.
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