South Africa's HIV/AIDS epidemic, which is among the most severe in the world, is concentrated in its townships, where many black South Africans live due to the lingering effects of the Group Areas Act.
False traditional beliefs about HIV/AIDS, which contribute to the spread of the disease, persist in townships due to the lack of education and awareness programmes in these regions. Sexual violence and local attitudes toward HIV/AIDS have also amplified the epidemic. Although some education efforts and treatment and prevention programmes have succeeded in spreading awareness about HIV/AIDS in townships, the impact of the disease remains severe.
Prevalence
In 2008, HIV/AIDS was most prevalent in the South African provinces of KwaZulu-Natal (15.8% HIV-positive), Mpumalanga (15.4% HIV-positive), Free State (12.6% HIV-positive), and North West (11.3% HIV-positive), while only 3.8% of the population was HIV-positive in Western Cape.
A survey conducted in 2010 indicated that HIV/AIDS infection among pregnant women is highest in KwaZulu-Natal (39.5%), Mpumalanga (35.1%), Free State (30.6%), and Gauteng (30.4%).
Traditional beliefs about HIV/AIDS
South Africans in townships are more likely to hold false beliefs about HIV transmission and prevention because they are less likely to have received a formal education or be employed. Many South Africans in townships are unaware of the primary modes of HIV/AIDS transmission: through unprotected sex with an HIV-positive individual, through contact with the blood of an HIV-positive individual, and through mother-to-child transmission from an HIV-positive mother to her baby during pregnancy."HIV/AIDS Information." Modes of HIV Transmission. Web. 8 Apr. 2012. <http://www.hivaidscare.com/hivtransmission.php?acode=na>.
Instead, the traditional beliefs of South Africans in townships have contributed to sexual violence in South Africa and stigmatized HIV-positive individuals, particularly women, thereby increasing the severity of the disease in the region.
Stigma
HIV/AIDS stigma is widespread in South Africa: a 2002 national survey revealed that 26% of respondents were unwilling to share a meal with a person living with AIDS, 18% were unwilling to sleep in the same room as with someone with AIDS, and 6% were unwilling to talk to a person with AIDS.S.C., Kalichman, and Simbayi L. "Traditional Beliefs about the Cause of AIDS and AIDS-related Stigma in South Africa." AIDS Care 16.5 (2004): 572-80. Print. AIDS-related stigma is most severe among township residents in South Africa because they lack access to reliable information about the disease. Many South Africans in townships wrongly believe that HIV is transmitted through proximity to HIV-positive individuals, which leads them to claim that people with AIDS should be socially ostracized.
In addition, many traditional groups believe that ancestral spirits and supernatural forces punish those who have failed to lead moral lives by infecting them with HIV. According to a study published in 2004, South Africans who attributed HIV/AIDS to spirits and the supernatural were more likely to claim that people with HIV/AIDS were "dirty," "repulsive," "cursed," and "foolish" and should "have restrictions on their freedom," "be isolated," and "feel guilty and ashamed."
Women are particularly vulnerable to HIV/AIDS infection and stigma because they are often economically dependent on men and frequently lack access to education. Men who have the disease may avoid testing and remain anonymous, but women who undergo pre-natal testing are less likely to escape a diagnosis. Because women are often identified as HIV-positive before men, they are branded as the spreaders of the disease and may subsequently face physical abuse and abandonment.
A study conducted in 2010 indicated that the majority of girls in a Cape Town township correlated thinness with disease – in particular, HIV/AIDS. Because of this, women who are slender or experience weight loss also face discrimination. This form of stigma affects women living in townships most severely because rates of malnourishment are higher in townships than in other parts of South Africa.Puoane, Thandi, Lungiswa Tsolekile, and Nelia Steyn. "Perceptions about Body Image and Sizes among Black African Girls Living in Cape Town." Ethnicity & Disease 20 (2010): 29-34. Print.
Spread of the disease
Multiple factors have contributed to the spread of HIV/AIDS in South African townships. Sexual violence in townships, which results partially from cultural norms regarding gender-based power dynamics and partially from psychological desperation, makes women particularly susceptible to HIV/AIDS. Female rates of HIV infection in South Africa are on average five times higher than male infection rates due to biological and social vulnerability."HIV and AIDS." UNICEF South Africa. UNICEF. Web. 30 Mar. 2012. <http://www.unicef.org/southafrica/hiv_aids_729.html >.
Sexual violence
Although many township inhabitants are knowledgeable about HIV/AIDS prevention methods, rates of condom use are still strikingly low. Studies suggest that fear of sexual abuse, which results from unequal power dynamics between men and women in South African townships, is the primary explanation for low condom use rates. Women in Khutsong reported that their relationship would deteriorate if they insisted that their partner use a condom because such a request demonstrates a lack of trust and respect.MacPhail, Catherine, and Catherine Campbell. "'I Think Condoms Are Good But, Aai, I Hate Those Things': Condom Use among Adolescents and Young People in a Southern African Township." Social Science & Medicine 52.11 (2001): 1613-627. Print.
Ubuntu, an African philosophy that promotes a spirit of brotherhood between and among community members, explains why township adolescents knowingly spread the disease – they believe that the entire community should share their burden. As a result of this philosophy, HIV-positive fathers will sometimes rape their daughters to guarantee their loyalty and care when their parent's health begins to deteriorate. It is likely that the sense of peer group affiliation that developed among township adolescents during apartheid has contributed to the desire to share the frustration and hopelessness that accompany the disease.Leclerc‐Madlala, Suzanne. "Infect One, Infect All: Zulu Youth Response to the Aids Epidemic in South Africa." Medical Anthropology 17.4 (1997): 363-80. Print.
AIDS orphans
An AIDS orphan is defined as "any child under the age of 18 years who had lost one or both parents through an HIV-related illness."Van Rooyen, Dalena, Sharron Frood, and Esmeralda Ricks. "The Experiences of AIDS Orphans Living in a Township." Health SA Gesondheid 17.1 (2012). Print. Orphanhood is a severe consequence of the AIDS epidemic in South African townships: a 2006 study stated that there were 2.2 million AIDS-orphaned children in South Africa alone. AIDS orphans in an urban Cape Town township have been shown to have significant rates of depression, anxiety, post-traumatic stress, peer relationship difficulties, suicidal urges, delinquency, and homelessness. These rates are higher than those of both non-AIDS orphans and non-orphans in South African townships.Cluver, Lucie, Frances Gardner, and Don Operario. "Psychological Distress amongst AIDS-orphaned Children in Urban South Africa." Journal of Child Psychology and Psychiatry 48.8 (2007): 755-63. Print.
AIDS orphans are particularly vulnerable to poverty, malnutrition, stigma, exploitation, sickness, and sexual abuse, which lead to intense psychological trauma. AIDS orphans are also less likely than non-AIDS orphans and non-orphans to attend and remain enrolled in school due to stigma and an increase in adult responsibilities such as care work and formal or informal employment.Cluver, Lucie, Frances Gardner, and Don Operario. "Poverty and Psychological Health among AIDS-orphaned Children in Cape Town, South Africa." AIDS Care 21.6 (2009): 732-41. Print.
Education
There is currently no law requiring AIDS education in South African schools and government attempts to raise AIDS awareness have largely failed to reach South Africa's underserved townships, where the quality of education is poor.Kuhn, L., M. Steinberg, and C. Mathews. "Participation of the School Community in AIDS Education: An Evaluation of a High School Programme in South Africa." AIDS Care 6.2 (1994): 161-71. Print. However, there is a clear need for education programmes in South African townships – a survey in Khutsong demonstrated that 70% of the community's young men believed they were not vulnerable to infection.
A 1994 pilot study in an urban Cape Town township demonstrated the potential, but also the limitations, of AIDS education. The study compared AIDS knowledge in two schools, one of which underwent an intensive AIDS awareness programme and one of which did not. Before the programme, students in both schools were misinformed about HIV transmission – many wrongly believed that drinking from an unwashed cup and touching somebody with the disease could transmit the virus.
Few students knew that using condoms, having only one sexual partner, and attending clinics for information and tests can all help prevent HIV/AIDS. Before the implementation of the educational programme, students in both schools also expressed hostility toward HIV-positive individuals – very few indicated that they would welcome an HIV-positive student into their class. They were also likely to underestimate the prevalence and severity of the disease.
Following the completion of the AIDS awareness programme, the students who had participated were more knowledgeable about HIV transmission, prevention, and the course of the disease. However, hostility toward HIV-positive individuals decreased only slightly among the students after the programme and the students did not demonstrate any intention to increase their use of condoms.
Treatment and prevention
Most of South Africa's current anti-HIV/AIDS efforts involve treatment rather than prevention. Although prevention programmes are considered more cost effective, the pervasiveness of the disease has made treatment facilities increasingly important. A 2005 study determined that the introduction of antiretroviral medication, mother-to-child transmission prevention programmes, and Médecins Sans Frontières, or Doctors Without Borders, clinics to Khayelitsha played a role in reducing the impact of the disease.Levy, N. C. "From Treatment to Prevention: The Interplay Between HIV/AIDS Treatment Availability and HIV/AIDS Prevention Programming in Khayelitsha, South Africa." Journal of Urban Health 82.3 (2005): 498-509. Print.
These programmes have started to confront the HIV/AIDS epidemic in Khayelitsha by making treatment more widely available and providing incentives for HIV testing. Despite these specific successes, treatment has played a limited role in South African townships due to their lack of infrastructure and trained professionals and the high cost of antiretroviral drugs.