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Brenna Marshall

Gligorije Rakocevic

Ahmed Alhashmi

Mohammed Al Khalifa

Saif Alhajr

South Africa: Weekly Report #7

Human immunodeficiency virus (HIV) in South Africa is currently the largest epidemic of HIV in the world (AVERT, 2019). Women are four times more likely than men to test positive for HIV and women who are between the ages of 15 and 24 years old made up 37% of newly diagnosed infections in 2016 (AVERT, 2019). There are many social determinants that lead to such a high rate of HIV in women in South Africa, some are education, violence/sexual abuse and access to care.

The lack of education about HIV can have devastating impacts on a population. In South Africa, women need to be better educated on prevention methods and treatments because it is a major disadvantage that leads to poor health (Maurice J., 2015). The argument that is made in an article from the Scandinavian Journal of Public Health says that although there is a high rate of school enrollment in South Africa, the rise in the amount of kids who drop out before 12th grade is at approximately 60% which suggests that prevention education programs need to be implemented at an earlier age (Ahmed, Flisher, Mathews, & Jansen, 2009). The lack of sex education that students received was also affected by the educators who felt uncomfortable with the topic and all it included (Ahmed et al., 2009).

Women in South Africa are often victims of rape and violence. According to the article written by Jamie Maurice, the normalization of male dominance and female submission increases the risk of HIV in women (Maurice J., 2015). In Maurice’s study, when women would ask their male partners to use a condom 51% of them would get angry, 30% of reported that their partners would break up with them and 28% said that their partners would become violent towards them (Maurice J., 2015). Overall, the amount of men who reported using violence against their female partners was 42%. The fear that women have to advocate for themselves plays a big role in their inability to have protection from HIV. Women being inferior to men often escalates to violence, sexual coercion and rape. In 2005, 1.6 million women in South Africa reported they were raped and 40% said they were sexually coerced (Maurice J., 2015). It is also reported that the victims have a 30-40% chance of testing positive for HIV, which is a significant number considering how high the prevalence is (Maurice, J., 2015).

A huge barrier among people in South Africa, particularly women, accessing health clinics to receive the care they need to HIV (prevention methods, treatments) is the stigma of HIV (Bogart et al., 2012). Patients who were studied said that the stigma was not in their control and felt that they would be discriminated if their boss/employer knew that they were going to clinics. The stigma affected those people who were more recently diagnosed to they typically did not treat their HIV, which could lead to the infection of other people (Bogart et al., 2012). Both external and internal stigma are barriers. People would blame themselves which was actually the primary reason they do not access the care they need (Bogart et al., 2012). They would blame themselves for bad life choice. Other reasons that South Africa may not be able to access care they need are the location of the clinic, lack of transportation, costs and communication barriers.

The high prevalence of HIV in women has many impacts. The main impact of HIV is stigma and “othering” (Cloete et al., 2010). There is a negative attitude towards people with HIV and especially women. According to Bruyn (2004), in a study done in South Africa, two out of eight respondents commented that women who are HIV positive should not or are not sexually active. This misconception also applies to women with HIV becoming pregnant. The respondents felt that women who are HIV positive are not supposed to become pregnant and if they do, that amounts to being irresponsible because of the risk of infecting the child or dying early and living behind orphans. Sometimes, when a woman living with HIV becomes pregnant, the pregnancy is termed as unwanted and may be forced to abort because of the stigma involved. Women with HIV are also likely to face stigma at their work (Bruyn, 2004). They are harassed and attacked and sometimes forced to resign from the positions.

Due to the fear of disclosing HIV positive status for fear of discrimination, women living with HIV fear to access health services for fear of being discriminated or being forced into sterilization or abortion. A study in Soweto in South Africa involving women between ages 18 and 24 revealed that they know where they can get sexual and reproductive health information and services, but they opt not to seek for these services because of the unsupportive attitudes towards women with HIV (Avert, 2018).

Apart from poor education and poverty being determinants of HIV, they are also impacts of HIV. HIV positive women fear to join a school for fear of being discriminated by their peers, so, they opt to stay at home (Avert, 2018). Lack of education makes women susceptible to HIV because they have no right information on how they can protect themselves. For instance, there is what is known as “dry sex” preference in South Africa where women insert antiseptic powders or detergents into their genital parts so as to make it “tight” and “dry” because they believe that highly lubricated vagina reduces sexual pleasure (Muula, 2008). Due to the lack of the right knowledge, they do not know that dry vaginal suffers lesions more than lubricated ones and increases the chances of HIV infection. HIV positive women are also at risk of poverty because they are discriminated from job opportunities. A lot of resources are also used in seeking health services for the disease, which further stresses their already limited resources.

The exposure of adolescents to the risk of pregnancy has gathered the attention of various researchers across the globe with an aim of understanding and addressing the problem. The use of contraceptives in South Africa has been limited to sexual involvement that is associated with marital commitment and relationships which are stable. However due to social changes, there has been an increase in premarital sexual activities and premarital births. Most of the births occur in the teenage years for women who are not emotionally or economically prepared to bear a child. The population growth rate in South Africa is 2.2% thus the government is very keen on population growth (Abaasa, 2018). A population policy developed in the country indicated that teenage pregnancy was one of the key factors that facilitated pupation growth.

The problem has further grown due to the contraceptive shortages that South Africa faced in 2018. The reproductive rights of women were undermined as supply shortages left most of the hospitals across the country without contraceptives. The National Department of Health (NDOH) confirmed that indeed, there was a shortage of contraceptives. NDOH did not provide a framework for hospitals to develop alternative methods despite many suppliers being unable to meet the demand for even several months. Dr. Indira Govender indicates that the shortage of contraceptives in many health care facilities increased the level of unwanted pregnancies which in turn increased the population growth despite the government key focus on how to reduce the population growth.

The products that experienced the shortage include various oral contraceptive doses such as Trigestrel and injectable contraceptives such as Nur-Isterate. The shortage affected the country for the entire year and many women returned from clinics without any contraceptives. The National and Provincial Departments of Health should have acted fast and identified where supplies were needed most and directed them there. The suppliers who experienced production problems should have solved them quickly and the manufacturers should have manufactured more contraceptives to ensure that there was extra stock available and make it available to the government and a reasonable price. The Stop Stock Outs Project (SSP) called for NDOH to immediately intervene and ensure that contraceptives are availed in all the medical facilities. It also instructed NDOH to evaluate all the shortages across the entire supply chain to ensure that the country does not experience such as a health crisis again (Nene, 2018).

To ensure this crisis never happen again, NDOH should provide a clear guidance on public health facilitates indicating the alternatives they can provide incase contraceptives are not available. Provincial departments should also ensure that all health facilities are ready to offer alternative contraceptive options such as implants and train various health professionals where necessary. The South Africa Health Products Regulatory Authority should rapidly approve applications that can enhance availability of contraceptive in the country. The SSP should continue working closely with NDOH to reduce the impact of lack of enough contraceptives and enhance the capability of health systems to identify and address supply problems as they arise (Moroole, 2019). This will not only reduce the level of unwanted pregnancies but also address the issue of population growth.

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