There are a whole host of South African political events and movements that have had unique effects on the development of the HIV epidemic, from apartheid to the Treatment Action Campaign but instead of addressing a specific event or movement I would like to spend some time talking about social embeddedness in South Africa. Social embeddedness is the degree to which the government is listening and acting on the demands of the people and the lack of it in South Africa today is a crucial issue that has affected not only the development of HIV but many other issues as well.Following the fall of the apartheid regime, South Africans received enormous political and legal gains through the newly created Bill of Rights and Constitution, however despite these gains the socioeconomic landscape remained and still remains very similar to the days before 1994. Just like in the US, after the abolishment of slavery, there has been a failure to redistribute wealth leading to poverty that mostly carries a black face. Except here, in South Africa, that face is the majority of the population. The plan to redistribute following apartheid was largely built upon macroeconomic policy dependent on foreign investment with the hopes that international wealth would somehow trickle down. The issue with this is that many initiatives to benefit the people were ignored for the sake of creating a welcoming environment for investors. One of the most important of these for the HIV epidemic was the rollout of ART’s. Along with Mbeki’s denialism the cost and fear of scaring off investors played a secondary role in denying treatment.
The focus on investor oriented economic policy and the failure to redistribute have stunted the progress of public health and more specifically HIV treatment through the massive disparity that exists among the people. This has shown itself in the disparity amongst public and private health care but in more subtle ways has also affected the development of social movements. The disparity in resources has meant that most movements are organized and managed by the middle class and this further distances the poor from politics. This has meant that many social determinants of health, such as sanitation and education, have been largely ignored. A problem has to become big enough or visible enough to garner the attention of those with skills to maneuver the political system and these people are rarely found amongst the poor. Here, an analogy of a boiling kettle seems widely applicable to many movements where those closest to the bottom, the poor, are affected most. This is where the boiling begins. The bubbles rise and begin to affect the water above it until it finally reaches the top where pressure builds and eventually either forces the government to action or the lid is blown off and the result is a revolution.
This is a shame because the modern government of South Africa from it’s genesis has been good at creating policy, but it has failed in the implementation and enforcement. What makes this worse is that the ANC has controlled the government almost effortlessly and without the threat of the power of the vote there is no reason for them to not just simply follow the money. A government for the people, by the people, and of the people is an American myth that applies to democracies the world over. It is the power of the vote that primarily ties people to the government and if that vote becomes guaranteed the government falls into complacency. Goodwill can only take an initiative so far and ultimately self interest must be wrangled into the equation for meaningful results to be attained. The complacency that the government now carries has played a major role in slowing the rollout of ARV treatment and in transitioning to a clinic focused health model. For each issue it has taken a highly focused and organized group of people to force the government into action and that allowed the HIV epidemic to become as large as it has.