South Africa's Wealth/Health Paradox
South Africa, where approximately 1 in 9 people are afflicted with AIDS, has a paradoxical economic development profile. It is considered an upper middle income country based on its healthy Gross Domestic Product (GDP). The World Bank ranked South Africa's GDP 27th of 177 countries in 2005, putting it in about the 85th percentile for GDP. The International Marketing Council of South Africa, with the slogan "South Africa, Alive With Possibility", describes the country as the "economic powerhouse of Africa".
Yet about 800 people a day die from AIDS in this country. Life expectancy in South Africa has decreased by four years and deaths from AIDS continue to decimate populations of young women under age 35 and men in their 30's and 40's, people who are in their prime and who -- from an economic perspective -- are in the most productive years of their life.
Now more bad news. An alarming study from Statistics South Africa's shows yet another dramatic increase in deaths from AIDS in South Africa. The report analyzed death rates from unnatural and natural causes and found that the death rate from communicable diseases of South African women aged 30-45 had increased by about three times, from 500 per 100,000, to 1500 per 100,000 between 1997 and 2004. Male deaths from communicable diseases had also increased and had even doubled in some areas. Some of this bad news was predicted. Since there is a lag between infection and full blown AIDS, it was assumed that the death rates would not decrease until 2008. However the figures are still stunning - as they were last year, and the year before...
The expectations of economists and politicians was that post-apartheid Africa would rebound and that the health of South Africans would improve. Indeed according to economic measures Africa is doing better and foreign investment has skyrocketed. But even compared to Russia, where life expectancy decreased as a result of political upheaval and economic downturn, the current patterns in South Africa indicate a dire state of affairs. For scientists and doctors, the increases in deaths are distressing since there are few signs that action is being taken to stem the epidemic.
South Africa AIDS Policies
With full knowledge of the toll of South Africa's AIDS policies, international public health officials, scientists and doctors are taking South Africa to task and rightly so. Historically, the government has denied that the HIV virus caused AIDS, and it has been slow to implement treatment programs for AIDS afflicted patients. Despite pleading from world leaders, South Africa's AIDS policy remains one of obfuscation and denial. Health minister Dr. Tshabalala-Msimang often insists that nutrition will beat AIDS, and regularly pushes garlic, beets and lemon, and African potatoes as effective cures. Since patient treatment via antiretrovirals now costs less that $130 dollars a year. South Africa's health policies are out of step with the modernity and prosperity that it claims.
The country was condemned at the AIDS conference in Montreal this year for displaying a basket of this produce in its booth, initially without antiretroviral drugs. Earlier this year the country banned two non-governmental organizations (NGO's) from a UN AIDS conference because they were particularly critical of Mbeki's policies.
In the most recent international public plea for policy change, a group of 81 doctors wrote a letter to President Mbeki asking the president to replace the ineffectual health minister, Dr Tshabalala-Msimang. In response to the recent letter, the health minister complained that the international community was undermining the country's efforts. She has long defended her nutrition advice as "the truth", and allegedly doesn't mind her moniker- Dr. Beetroot".
In response to the outcry against him, the president has assigned a new committee to oversee the AIDS program, according to an associated press article (South Africa Scales Back Health Minister's AIDS Role). But the health minister denies that she has been demoted, and in typical sidestepping form, a government spokesperson, Themba Maseko, said: we need to shift the focus from saying the problem is the Minister of Health".
Effective AIDS Policies
AIDS programs succeed in countries because of many deliberate actions by leaders. It is imperative that there is strong leadership to combat AIDS at the very, very top levels of a government. So in South Africa's case, if the problem is not with the minister of health then it is with the president.
People have said that effective AIDS policies will be pushed to the fore by governments who realize that deaths impede economic progress. It's hard to imagine that South Africa, where 1 in 9 people on average are affected by the deadly disease and only a small fraction receive drugs, has not come to terms with this economic reality. Any government which claims that beetroot is as effective as antiretrovirals is, as Stephen Lewis put it: "obtuse, dilatory and negligent."
Once it seemed intuitive that a higher GDP could be linked to greater general welfare of a country's citizens. Economists now recognize that GDP doesn't always correlate with overall broader measures of prosperity. South Africa is a telling example of this phenomenon. The United Nations' Human Development Index (HDI) rates quality of life factors such as education, the status of women, morbidity, and mortality. South Africa's comes in at 121sh out of 178 countries. This puts it in about the 33rd percentile of all countries, in the company of many countries who have far fewer resources. Therefore in terms of HDI, as opposed to GDP, South Africa's is in the same band of countries that its pro-business groups lord over with their "economic powerhouse" status.
In this "post-apartheid" era, we would not expect this chasm between the HDI (where it lies in the 33rd percentile) and GDP (where it is the 85th percentile). We would not expect the travesty of preventable AIDS deaths. We only wish that such a sorry state of affairs would convince those at the top levels of the government that only an active AIDS program will assure that South Africa truly is, as its marketing campaign says: "alive with possibility".
Acronym Required previously wrote about AIDS in Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?" - in response to a David Brooks column and optimistic prognosis for the AIDS epidemic in South Africa. We also wrote about AIDS in Zimbawe, in Burma, as well as in other articles.