HIV/AIDS in South African townships

Last updated

A street shop in Dukatole, one of South Africa's Black townships. Aliwal North - Dukatole - 03.05 - Street Shop.jpg
A street shop in Dukatole, one of South Africa's Black townships.

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.

Contents

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

Provinces of South Africa. Map of South Africa with English labels.svg
Provinces of South Africa.

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. [1] 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. [2]

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. [1] 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. [1]

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." [1]

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. [3]

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. [4]

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. [3]

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. [5]

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. [6]

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." [7] 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. [8]

AIDS orphans are particularly vulnerable to poverty, malnutrition, stigma, exploitation, sickness, and sexual abuse, which lead to intense psychological trauma. [7] 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. [9]

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. [10] 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. [5]

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. [10]

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. [10]

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. [10]

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. [11]

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. [11]

HIV/AIDS prevention efforts such as school education, education in the workplace, and mass media campaigns have largely failed to significantly impact South African townships. For example, HIV voluntary counseling and testing programmes have improved HIV/AIDS awareness in Khayelitsha, but have for the most part failed to influence behavior. [12] On the other hand, specific HIV/AIDS prevention methods such as the Priorities for Local AIDS Control Efforts (PLACE) method have demonstrated a potential for success. [13]

A 2003 study used the PLACE method to determine where in townships people meet new sexual partners in order to strategically focus prevention efforts in these locations. These locations included bars, taverns, bottle stores, nightclubs, streets, hotels, and local shebeens. The vast majority of these locations did not provide condoms or information about the transmission of HIV/AIDS. Most patrons visit these sites daily or weekly; therefore, the PLACE method suggests that prevention efforts such as education and social support could be successfully focused on these popular venues. [13]

Churches in South African townships have largely failed to use their social and cultural influence to combat the HIV/AIDS epidemic. Many churches reject HIV-positive members because they are ignorant about the causes of AIDS, have traditional views on sexual morality, or believe that HIV/AIDS is well-deserved punishment for immoral behavior. In addition, many organizations such as the South African Church Leaders Association have only formally acknowledged the severity of the HIV/AIDS epidemic within the last decade. [11]

Despite these large-scale failures, some township churches have become actively engaged in preventing the spread of HIV/AIDS in their communities. Archbishop Desmond Tutu of the Anglican Church in the Western Cape founded the Desmond Tutu HIV Foundation and speaks openly and progressively about the role of education in battling HIV/AIDS. St. Michael's Church in Khayelitsha has supported the efforts of the Millennium Development Goals by founding an HIV/AIDS clinic and orphanage known as Fikelela; this movement has spread to dozens of other Anglican churches in the region. [11]

Attempts to address the epidemic

HIV/AIDS was largely considered a peripheral problem by the South African government and NGOs before the disintegration of apartheid in 1994. However, since then, efforts have been made to address the epidemic with varying levels of success. South Africa's government leaders largely failed to acknowledge the severity of the AIDS epidemic until 2009, which prevented the implementation of successful policy. However, many NGOs have succeeded in targeting South Africa's vulnerable township populations.

National government

The effectiveness of government-based anti-HIV/AIDS programmes in South African townships was severely reduced by the AIDS denialism of President Thabo Mbeki, who was in office from 14 June 1999 until 24 September 2008, and Manto Tshabalala-Msimang, who served as Health Minister from 25 September 2008 through 10 May 2009. These South African leaders brought the issue of AIDS denialism to the forefront of South African politics by rejecting scientific evidence demonstrating the connection between HIV and AIDS and declaring antiretroviral therapy ineffective. [14]

In 2000, President Mbeki invited nonconformist scientists such as Peter Duesberg and David Rasnick to a Presidential Advisory Panel on AIDS while excluding leading researchers from the convention. President Mbeki's denialism hindered progress in government HIV/AIDS policy by generating skepticism about HIV/AIDS among members of South Africa's Department of Health. This skepticism slowed the implementation of antiretroviral therapy programmes in many of South Africa's townships, particularly in Mpumalanga. [14]

Despite President Mbeki's denialism, the South African government did make efforts to combat the nation's HIV/AIDS crisis while Mbeki was in office. The National AIDS Convention of South Africa (NACOSA) first met in 1992 to design a national AIDS plan to fight the emerging epidemic, which was endorsed by Nkosazana Dlamini-Zuma, South Africa's incoming Minister of Health. However, the plan was largely ineffective because it failed to acknowledge the government's lack of economic resources. The development of the controversial AIDS drug Virodene in South Africa in 1996 reintroduced enthusiasm about HIV/AIDS into the political sphere and led to the successful implementation of several small-scale projects by the national government. [15]

The Khayelitsha District Management Team was established to focus on AIDS from an epidemiological angle and an AIDS programme coordinator was appointed to Khayelitsha to monitor the disease in the township. The government also financed a mother-to-child-transmission programme in Khayelitsha in 1999. However, stigmatization and the government's dismissal of new treatment options continued as Mbeki's denialism campaign intensified in the early 2000s. The government issued the HIV/AIDS/STD Strategic Plan for South Africa 2000-2005 at the urging of the United Nations, but the plan lacked concrete proposals and a timeline and largely neglected the potential of antiretroviral therapy. [15]

Jacob Zuma, South Africa's president as of 9 May 2009, has expanded the national government's HIV/AIDS outreach programmes in an attempt to serve marginalized township populations and the country as a whole. On World AIDS Day on 1 December 2009, President Zuma announced his intention to reverse South Africa's health trends by increasing HIV treatment nationwide. He insisted that HIV-positive children under age one and pregnant women would receive increased attention and treatment in accordance with World Health Organization treatment guidelines. [16] However, the national government remains hindered by the high cost of medication and the nation's unpredictable funding, poor health systems, and widespread stigma, leaving many townships unaided. [17]

NGOs

NGOs have played a significant role in combating and raising awareness about the HIV/AIDS epidemic in South African townships.

Treatment Action Campaign

The Treatment Action Campaign (TAC) was launched in 1998 to "campaign for greater access to treatment for all South Africans, by raising public awareness and understanding about issues surrounding the availability, affordability and use of HIV treatments." [21] The TAC's goals are to "ensure access to affordable and quality treatment for people with HIV/AIDS, prevent and eliminate new HIV infections, improve the affordability and quality of healthcare access for all, and campaign against the view that AIDS is a death sentence." [21]

The TAC has focused its efforts on urban populations in Gauteng and Western Cape, but is continuing to extend its reach to townships and rural areas in South Africa such as Lusikisiki. [21] The TAC is well-established in Mpumalanga and has contributed substantially to the HIV/AIDS campaign in KwaZulu-Natal, which was among the first provinces to provide antiretroviral drugs to HIV-positive pregnant women. [22] In August 2002, the TAC campaigned to have the local clinic in Nyanga open for five days per week rather than two. [23] The TAC distributes over 500,000 condoms in Khayelitsha every month, which helped reduce the incidence of sexually transmitted diseases in the township by 50% between 2004 and 2007. [24] Mortality statistics in Khayelitsha have also improved in recent years, which may be partially due to the TAC's outreach efforts. [25]

See also

Related Research Articles

<span class="mw-page-title-main">HIV/AIDS in Africa</span>

HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates varies significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.

<span class="mw-page-title-main">Treatment Action Campaign</span> South African HIV/AIDS activist organization

The Treatment Action Campaign (TAC) is a South African HIV/AIDS activist organisation which was co-founded by the HIV-positive activist Zackie Achmat in 1998. TAC is rooted in the experiences, direct action tactics and anti-apartheid background of its founder. TAC has been credited with forcing the reluctant government of former South African President Thabo Mbeki to begin making antiretroviral drugs available to South Africans.

HIV/AIDS has been a public health concern for Latin America due to a remaining prevalence of the disease. In 2018 an estimated 2.2 million people had HIV in Latin America and the Caribbean, making the HIV prevalence rate approximately 0.4% in Latin America.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

<span class="mw-page-title-main">HIV/AIDS in South Africa</span> Health concern in South Africa

HIV/AIDS is one of the most serious health concerns in South Africa. The country has the highest number of people afflicted with HIV of any country, and the fourth-highest adult HIV prevalence rate, according to the 2019 United Nations statistics.

The very high rate of human immunodeficiency virus infection experienced in Uganda during the 1980s and early 1990s created an urgent need for people to know their HIV status. The only option available to them was offered by the National Blood Transfusion Service, which carries out routine HIV tests on all the blood that is donated for transfusion purposes. The great need for testing and counseling resulted in a group of local non-governmental organizations such as The AIDS Support Organisation, Uganda Red Cross, Nsambya Home Care, the National Blood Bank, the Uganda Virus Research Institute together with the Ministry of Health establishing the AIDS Information Centre in 1990. This organization worked to provide HIV testing and counseling services with the knowledge and consent of the client involved.

Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.

HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).

<span class="mw-page-title-main">HIV/AIDS in Malawi</span> Impact of the immunodeficiency virus in the African nation

As of 2012, approximately 1,100,000 people in Malawi are HIV-positive, which represents 10.8% of the country's population. Because the Malawian government was initially slow to respond to the epidemic under the leadership of Hastings Banda (1966–1994), the prevalence of HIV/AIDS increased drastically between 1985, when the disease was first identified in Malawi, and 1993, when HIV prevalence rates were estimated to be as high as 30% among pregnant women. The Malawian food crisis in 2002 resulted, at least in part, from a loss of agricultural productivity due to the prevalence of HIV/AIDS. Various degrees of government involvement under the leadership of Bakili Muluzi (1994–2004) and Bingu wa Mutharika (2004–2012) resulted in a gradual decline in HIV prevalence, and, in 2003, many people living in Malawi gained access to antiretroviral therapy. Condoms have become more widely available to the public through non-governmental organizations, and more Malawians are taking advantage of HIV testing services.

<span class="mw-page-title-main">HIV/AIDS in Mozambique</span>

Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.

HIV/AIDS in Namibia is a critical public health issue. HIV has been the leading cause of death in Namibia since 1996, but its prevalence has dropped by over 70 percent in the years from 2006 to 2015. While the disease has declined in prevalence, Namibia still has some of the highest rates of HIV of any country in the world. In 2016, 13.8 percent of the adult population between the ages of 15 and 49 are infected with HIV. Namibia had been able to recover slightly from the peak of the AIDS epidemic in 2002. At the heart of the epidemic, AIDS caused the country's live expectancy to decline from 61 years in 1991 to 49 years in 2001. Since then, the life expectancy has rebounded with men living an average of 60 years and women living an average of 69 years

<span class="mw-page-title-main">HIV/AIDS in Zimbabwe</span> Major public health issue

HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.

Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

Undetectable = Untransmittable (U=U) is a message used in HIV campaigns. It means that if someone has an undetectable viral load, they cannot sexually transmit HIV to others. U=U is supported by numerous health groups and organisations worldwide, including the World Health Organization (WHO). The validity of U=U has been proven through many clinical trials involving thousands of couples. U=U is also used as an HIV prevention strategy: if someone is undetectable, they cannot pass it further and hence, prevent the virus from spreading. This is known as Treatment as Prevention (TasP).

References

  1. 1 2 3 4 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.
  2. "HIV/AIDS Information." Modes of HIV Transmission. Web. 8 Apr. 2012. <http://www.hivaidscare.com/hivtransmission.php?acode=na>.
  3. 1 2 "HIV and AIDS." UNICEF South Africa. UNICEF. Web. 30 Mar. 2012. <http://www.unicef.org/southafrica/hiv_aids_729.html Archived 14 October 2016 at the Wayback Machine >.
  4. 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.
  5. 1 2 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.
  6. 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.
  7. 1 2 Van Rooyen, Dalena, Sharron Frood, and Esmeralda Ricks. "The Experiences of AIDS Orphans Living in a Township." Health SA Gesondheid 17.1 (2012). Print.
  8. 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.
  9. 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.
  10. 1 2 3 4 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.
  11. 1 2 3 4 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.
  12. Venkatesh, Kartik K., Precious Madiba, Guy De Bruyn, Mark N. Lurie, Thomas J. Coates, and Glenda E. Gray. "Who Gets Tested for HIV in a South African Urban Township? Implications for Test and Treat and Gender-based Prevention Interventions." JAIDS: Journal of Acquired Immune Deficiency Syndromes 56.2 (2011): 151-65. Print.
  13. 1 2 3 Weir, Sharon, Charmaine Pailman, Xoli Mahlalela, Nicol Coetzee, Farshid Meidany, and Ties Boerma. "From People to Places: Focusing AIDS Prevention Efforts Where It Matters Most." Epidemiology & Social 17.6 (2003): 895-903. Print.
  14. 1 2 Daniel, John, Adam Habib, and Roger Southall. State of the Nation: South Africa, 2003-2004. Cape Town, South Africa: HSRC, 2003. Print.
  15. 1 2 Butler, A. "South Africa's HIV/AIDS Policy, 1994-2004: How Can It Be Explained?" African Affairs 104.417 (2005): 591-614. Print.
  16. Dugger, Celia W. (1 December 2009). "Breaking With Past, South Africa Issues Broad AIDS Policy". The New York Times. ISSN   0362-4331 . Retrieved 3 March 2023.
  17. Fleshman, Michael. "At Last, Signs of Progress on AIDS." UN News Center. United Nations. Web. 14 Apr. 2012. <http://www.un.org/en/africarenewal/vol23no4/progress-on-aids.html>.
  18. "Township AIDS Project (TAP)." Peacebuilding Portal. Web. 13 Apr. 2012. <http://www.peacebuildingportal.org/index.asp?pgid=9%5B%5D>.
  19. "South Africa." Médecins Sans Frontières. Web. 14 Apr. 2012. <>.
  20. "PSI." South Africa. Web. 14 Apr. 2012. <http://www.psi.org/south-africa>.
  21. 1 2 3 Friedman, S. "A Rewarding Engagement? The Treatment Action Campaign and the Politics of HIV/AIDS." Politics & Society 33.4 (2005): 511-65. Print.
  22. Mosoetsa, Sarah. "The Legacies of Apartheid and Implications of Economic Liberalisation: A Post-Apartheid Township." Crisis States Programme (2004): 1-16. Print.
  23. Robins, Steven, and Bettina Von Lieres. "Remaking Citizenship, Unmaking Marginalization: The Treatment Action Campaign in Post-Apartheid South Africa." Canadian Journal of African Studies 38.3 (2004): 575-86. Print.
  24. "Pope’s Comments on Condoms Are Wrong and Irresponsible." Pambazuka News. Web. 8 Apr. 2012. <http://www.pambazuka.org/en/category/comment/54977>.
  25. "Key HIV Statistics." Treatment Action Campaign. Web. 8 Apr. 2012. <http://www.tac.org.za/community/keystatistics Archived 7 August 2022 at the Wayback Machine >.