Not available / text

D.Litt et Phil. / According to the Joint United Nations Programme on HIV/AIDS, more than 5.3 million South Africans were HIV-positive at the end of 2003; AIDS is killing the population at a rate of around 1,000 people each day; and about 2,000 South Africans are becoming HIV-positive daily. This study is an enquiry into the public policy response to the South African epidemic. Since AIDS first appeared in the country in 1982 there have been numerous good policy documents written by successive South African governments—yet the epidemic shows little sign of abating. The study provides an overview of the main theories on public policy making, and applies these by combining a meso-level of analysis with a phase/stage approach to the policy process. It demonstrates that successive South African governments have defined the policy problem in different ways: moving from a moralistic to a biomedical approach, the most recent public policy response has been to (discursively at least) view the epidemic as a developmental and human rights-based problem. However, despite the drafting of broadly inclusive and well-conceptualised policies, previous as well as the current South African government suffers from a ‘crisis of implementation’. The study finds that this crisis of implementation is the result of a failure on the part of South African governments to consistently and correctly define the public policy problem itself. This has resulted in a contested policy environment, particularly in terms of the appropriate policy responses required. As a consequence, the initial close relationship between the new South African government and AIDS civil society has been badly eroded. The latter policy actor has turned to a strategy of bypassing the national government altogether, by appealing to the courts in an effort to ensure the implementation of AIDS policies. The study concludes that, unless public policy makers address the structural causes of the AIDS epidemic (race relations, sexual violence and cultural factors), the country will continue to suffer the ravages of the epidemic, nullifying some recent successes of lower levels of government (provinces and local governments) in demonstrating some implementation capacity. The study suggests that the public sector take greater cognisance of the tenets of different theories on public policy making in an effort to ameliorate the mistakes of the past. / Prof. Yolanda Sadie

A RESEARCH REPORT SUBMITTED TO THE WITS SCHOOL OF GOVERNANCE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR A MASTER OF MANAGEMENT DEGREE IN PUBLIC AND DEVELOPMENT MANAGEMENT / HIV and AIDS impact severely on the capacity of the state, its skills base and the efficient use of public funds to render high quality services to the broad populace. Public sector institutions are under immense pressure to implement policies and programmes to mitigate the impact of HIV and AIDS in the workplace (Public Service Commission, 2006). In this context, the purpose of this research is to assess the implementation of HIV and AIDS policy in the Gauteng Department of Roads and Transport to determine if employees are benefiting from this policy. To accomplish this goal, the study employed qualitative interviews and observations to obtain the necessary data from DRT managers, programme officials and employees in June 2014. An examination of the data confirmed that efforts had been made to implement the HIV/AIDS policy in the DRT, although the scope and intensity of these initiatives varied across occupational levels. It was found that an internal policy on HIV and AIDS has been developed; some employees had been informed about the risks of HIV and AIDS; some line managers had been trained on HIV/AIDS management; health screening including HIV counseling and testing takes place regularly; employees have access to 24 hour counseling services; and some units had been supplied with educative messages including pamphlets and brochures. However, the findings also revealed gaps in the current implementation strategy, including limited communications, poor participation in campaigns, lack of leadership commitment, lack of resources and time constraints. In light of this, it was concluded that the current HIV/AIDS management strategy suffers from lack of capacity and coordination

The 2003 UNESCO report indicated that the HIV/AIDS pandemic contributes to rapid breakdowns of existing structures that traditionally took care of the development of young children. There must be strategies to provide support, care and guidance to young children, families, parents and care givers that are directly or indirectly affected by HIV/AIDS. This is classified as interventions at the local level. There must be a conducive policy environment that allows safety nets and strategic interventions to take place, to grow and be inclusive (UNESCO, 2003:18). The death of parents and other family members leave children in a vulnerable state, some of whom enter the school system and are at the mercy of others. School based HiV/AIDS policies and programmes are necessary to protect these children. A two phase research design incorporating quantitative and qualitative methods was utilized in this study. The first part of this study was quantitative (audit of HIV/AIDS policies in 23 schools) and the second was qualitative, which comprised 2 focus group interviews. Findings from the quantitative audit from phase one of the study indicated that while primary schools attempted to comply with the National Schools policy on HIV/AIDS (DoE 1999), policy formulation, policy involvement, policy implementation (action plan) and policy review have not been conducted as per policy directives. Four major themes and various sub-themes emerged from the phase two qualitative focus group interviews with participants from two primary schools. Process of policy formulation and implementation, school based HIV/AIDS action plans, support mechanisms and challenges emerged as the factors associated with the formulation and implementation of school based HIV/AIDS policies in the Umgeni North Ward. Much of the phase one data is triangulated with data from phase two, hence the triangulated methodology. This study confirmed that in some schools, a fragmented relationship between the important stakeholders exists. This leads to the needs of those infected and or affected by the epidemic being treated in a vacuum. Hence, other intervention strategies are necessary. Institutional resources (educator support teams, funding, human resource and school nurse) as well as working closely with other departments are support mechanisms that can assist schools where children are infected and affected by the epidemic. In light of this, HIV/AIDS related problems pose a dilemma for educators to handle. Educators feel insecure as a result of lack of training, lack of support, poor policy directives and a lack of support mechanisms in the school environment to deal with HIV/AIDS related problems in the school context. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2008.

Thesis (MPA)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: The implementation of national policies is a key function of government through its various departments. This is very crucial in the health sector where lives of individuals are involved. The implementation of the national HIV/AIDS policy is very important in dealing with the epidemic. This study combined both quantitative and qualitative methods to analyse the implementation of the South African government’s national HIV/AIDS policy in the Vhembe District of the Limpopo Province. The quantitative phase involved the stratified sampling process, resulting in identifying 2 health workers from each of the 25 health units in the district comprising of 22 community clinics, the infection control unit, the counselling unit at the hospital and 2 from among the doctors. A total of fifty respondents were selected from a workforce of about 500. The staff profile indicates that 76 % of the health workers interviewed were below 40 years of age and 28% of them were chief professional nurses. Of the health workers, 78 % had been in the current position for between 1 and 5 years, 6 % for 6 to 10 years, 6 % for 16 or more years and 10 % for less than one year. All of them had a diploma as a minimum qualification, 8 % had 2 diplomas, 2 % had 3 or more diplomas, 2% had degrees and 2 % had a degree plus diplomas. In terms of HIV/AIDS policy implementation, 100% of all the facilities provided HIV prevention information to clients, 60% of these facilities worked with other organisations in HIV prevention, but only 4% had voluntary counselling and testing (VCT) services. In these health units only 28% had had staff trained regarding HIV/AIDS issues. In addition 96 % of the health units had the male condom stocked at any one time and only 12 % stocked the female condom. In terms of sexually transmitted diseases (STD) control, all clinics were using the syndromic approach in management of STDs and also claimed to have youth-friendly services. On the other hand only 80 % of the facilities had had staff trained in STD management using the syndromic approach. In the area of prevention of mother-to-child transmission of HIV, (PMTCT) none of the clinics had VCT services for pregnant women and only 8% of them had PMTCT counsellors. Because of the lack of VCT services only 4% of the clinics had known HIV positive mothers attending the antenatal care services. On the issue of post-exposure prophylaxis (P.E.P.) all clinics had protocols for this and 88% of them had antiretroviral drugs (ARVs) stocked for post-exposure treatment for health workers. However, only 8% of these clinics had a betadine douche as the only post-exposure intervention for raped women. In the area of treatment care and support for patients none of these clinics offered ARVs, 24 % had protocols for prevention and management of opportunistic infections, 4% were involved in any form of home-based care, 4% had HIV/AIDS dedicated services and 24% collaborated with community non-governmental organisations (NGOs) in HIV/AIDS care. The qualitative phase of the study highlighted what health workers perceived as prominent features of the national HIV/AIDS policy and these included prevention of HIV by use of condoms, faithfulness and pre-test counselling. The respondents also interpreted the social response by government to include provision of home-based care, care of orphans, food provision and safe guarding rights of victims. Other issues that were perceived to be part of the national HIV/AIDS policy were STD management, health education, provision of training to health workers in HIV/AIDS issues, provision of home-based care and occupational health and safety for health workers. The government was also perceived to have a negative attitude towards AIDS NGOs, not providing adequate numbers of the female condom and denying patients antiretroviral drugs (ARVs). The recommendations made on the basis of the study therefore include strengthening the training of health workers in HIV/AIDS care and management, improved provision of VCT services, wider distribution of the female condom, provision of prevention of mother-to-child transmission of HIV (PMTCT) services and the linking of research and care to provide evidence-based practice. Other recommendations are that there should be support programmes for health workers with HIV, addressing gender issues in implementation and provision of ARVs especially where it is already known that they help. / AFRIKAANSE OPSOMMING: Die implementering van nasionale beleid is ‘n sleutelfunksie van die regering, verrig deur sy onderskeie departemente. Dit is veral deurslaggewend in die gesondheidsektor waar die lewens van individue op die spel is en die implementering van die nasionale MIV/VIGS- beleid is baie belangrik in die hantering van die epidemie. In hierdie studie is beide kwalitatiewe en kwantitatiewe metodes gekombineer om implementering van die Suid-Afrikaanse regering se nasionale MIV/VIGS -beleid in die Vhembe-distrik van die Limpopo-provinsie te analiseer. Die kwantitatiewe fase het ‘n gestratifiseerde steekproefproses behels, wat gelei het tot die identifisering van 2 gesondheidswerkers uit elk van die 25 gesondheidseenhede in die distrik, bestaande uit 22 gemeenskapsklinieke, die infeksie-beheereenheid, die beradingseenheid by die hospitaal en die geledere van die dokters. So is ‘n totaal van 50 respondente geselekteer uit ‘n arbeidmag van ongeveer 500. Die personeelprofiel dui aan dat 76% van die gesondheidswerkers wat ondervra is jonger as 40 jaar was en dat 28% van hulle hoof professionele verpleegsters was. Van die gesondheidswerkers was 78% vir 1 tot 5 jaar in hul bestaande posisie , 6% vir 6 tot 10 jaar, 6% vir 16 of meer jare en 10% vir minder as 1 jaar. Almal van hulle het ‘n diploma as ‘n minimum kwalifikasie gehad, 8% het 2 diplomas, 2% het 3 of meer diplomas, 2% het grade en 2% het ‘n graad plus diplomas gehad. In terme van die MIV/VIGS beleidsimplementering het 100% van die fasiliteite MIV- voorkomingsinligting aan kliënte verskaf, 60% van hierdie fasiliteite in samewerking met ander organisasies , terwyl slegs 4% vrywillige berading en toetsdienste verskaf het. Slegs 28% van die gesondheidseenhede het oor personeel beskik met opleiding in MIV/VIGSkwessies. Verder het 96% van die gesondheidseenhede die manlike kondoom in voorraad gehad teenoor slegs 12% eenhede die vroulike kondoom. In terme van die seksueel-oordraagbare siektebeheer, het al die klinieke die sindroom-benadering in die bestuur van seksueel- oordraagbare siektes toegepas en het beweer dat hulle dienste jeugvriendelik is. Daarteenoor het slegs 80% van die fasiliteite beskik oor personeel wat opgelei was in seksueel- oordraagbare siektebestuur met toepassing van die sindroombenadering. Op die terrein van voorkoming van moeder- na- kind- oordraging van HIV het geen van die klinieke oor vrywillige berading en toetsdienste vir swanger vroue beskik nie en slegs 8% van hulle het wel moeder-na-kind– oordragingsberaders gehad. As gevolg van die gebrek aan vrywillige berading en toetsdienste het slegs 4% van die klinieke kennis gedra van HIV- positiewe moeders wat voorgeboortelike sorgdienste bygewoon het. Wat na-blootstellingsvoorbehoeding aanbetref, het alle klinieke protokolle gehad en 88% het antiretrovirale medisyne in voorraad gehad vir nablootstellingsbehandeling van gesondheidswerkers. Slegs 8% van hierdie klinieke het egter ‘n betadine-spoeling(“douche”) as die enigste nablootstelling intervensie vir verkragte vroue gehad. Op die gebied van die behandeling van en ondersteuning aan pasiënte het geen van hierdie klinieke die antiretrovirale medisyne aangebied nie, 24% het protokolle vir die voorkoming en bestuur van geleentheidsinfeksies gehad, 4% was betrokke in enige vorm van tuisgebaseerde sorg, 4% het oor MIV/VIGS -gerigte dienste beskik en 24% het met gemeenskapsvrywilligerorganisasies saamgewerk in die voorsiening van MIV/VIGS-sorg. Die kwalitatiewe fase van die studie fokus op wat gesondheidswerkers beskou as prominente kenmerke van die nasionale MIV/VIGS- beleid en wat insluit die voorkoming van HIV deur die gebruik van kondome, getrouheid en voortoets- berading. Die respondente vertolk die regering se sosiale reaksie as insluitend die verskaffing van tuisgebaseerde sorg, die versorging van weeskinders, voedselvoorsiening en die beveiliging van slagoffers se regte. Ander kwessies wat ook gesien word as deel van die nasionale MIV/VIGS beleid is seksueel- oordraagbare siektebeheer, gesondheidopvoeding, die verskaffing van opleiding aan gesondheidswerkers in MIV/VIGS-probleme, die voorsiening van tuisgebaseerde sorg en beroepsgesondheid en veiligheid vir gesondheids werkers. Die regering se houding teenoor VIGS vrywilligerorganisasies is ook as negatief vertolk deur onvoldoende hoeveelhede van die vroulike kondoom te verskaf en antiretrovirale medisyne te weerhou van pasiënte. Die aanbevelings wat op grond van die studie gemaak is, sluit in die verbeterde opleiding van gesonheidswerkers in MIV/VIGS-sorg en -bestuur, verbeterde verskaffing van vrywillige berading en toetsdienste, wyer verspreiding van die vroulike kondoom, verskaffing van MIV-dienste vir die voorkoming van moeder-na-kind-oordraging en die konnektering van navorsing en sorg om ‘n inligtingsbaseerde praktyk te skep. Ander aanbevelings is dat daar ondersteuningsprogramme vir gesondheidswerkers met MIV behoort te wees wat geslagskwessies aanspreek in die implementering en verskaffing van antiretrovirale medisyne waar dit reeds bekend is dat dit wel help.

This study was concerned with the social construction of HIV/AIDS at the policy level in contemporary South Africa, and how such constructions shape the manner in which the epidemic is understood in popular discourse.

Abstract not available

This study was concerned with the social construction of HIV/AIDS at the policy level in contemporary South Africa, and how such constructions shape the manner in which the epidemic is understood in popular discourse.

Lack of access to essential medicines has proven to be a persisting problem which is in conflict with the goal of realising the right to health envisaged by the South African constitution and international human rights instruments. With more than twenty years of democracy, South Africa is still plaguing with a multiplicity of pandemics such as HIV and AIDS, cancer, malaria, tuberculosis, among others, leading to premature death and untold suffering of the people. According to a 2015 United Nations AIDS (UNAIDS) Gap report, South Africa is still regarded as the epicentre of HIV and other infectious diseases. The 2015 UNAIDS Gap report states that South Africa has more women than men living with HIV and AIDS. The report further indicates that the impact of this pandemic is worsened by the inaccessibility of essential medicines that are vital for life saving. This dissertation posits that the epidemiological health crisis described above can be largely eradicated through the utilisation of the right to health. The right to health, according to this dissertation, contains a legal and transformative power which can be utilised to limit the negative impact of patent laws on access to essential medicines in South Africa. This dissertation validates the long held view that World Trade Organisation (WTO) intellectual property laws have contributed to the inaccessibility of essential medicines through causing patent ever greening, patent linkages and pharmaceutical company’s monopolies. Consequently, many marginalised groups in South Africa lack access to essential medicines owing to the higher prices charged for such medicines thus violating the right to health, life and other fundamental human rights. The right to health which is the immediate right infringed when there is lack of access to essential medicines form the core theme of this dissertation. This dissertation argues that access to essential medicine is a fundamental part of the right to health protected under international and national human rights instruments. This dissertation further argue that the right to health imposes obligations which requires South African government to take reasonable legislative and other measures, within its available resources, to provide access to essential medicines. The dissertation‘s key contribution is its proposed solutions on how to ensure that patents rules in South Africa are tamed with obligations consistent with the right to health. If properly implemented, these solutions have the potential to give greater specification to the normative commitments imposed by the right to health in the patent claims scenarios.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This study aims to understand the processes and factors that explain the framing of HIV and AIDS policy in Botswana, South Africa and Swaziland. Africa remains the global epicentre of the HIV and AIDS epidemic with Southern Africa remaining the most affected region in the world. The investigation centres on the HIV and AIDS policymaking discourses and dynamics leading to the securitisation of the epidemic in the three countries. The central focus of the study covers the timeframe of the leadership of President Mogae in Botswana, President Mbeki in South Africa and King Mswati III in Swaziland. This period is important as it characterises the HIV and AIDS epidemic being elevated onto the political agenda of the respective countries. This dissertation relies on two strands of theoretical literature namely, public policy theory and securitisation theory to help explain the framing of policy decision-making that leads to the process of securitisation of the HIV and AIDS epidemic in the three countries. This study is a multiple case study within the qualitative research paradigm. This research is based on three case studies: Botswana, South Africa and Swaziland. As far as data collection is concerned, this study drew on primary sources of data, which consisted of documents obtained during the fieldwork from various stakeholders such as such as official government documents, as well as official documents from international and domestic HIV and AIDS organisations. Twenty semi-structured interviews were also conducted between 2007 and 2008 with various stakeholders including government officials, representatives of domestic and international HIV and AIDS organisations operating in the respective countries, researchers from think tanks and academics. In addition, eleven exploratory interviews were also conducted as part of the fieldwork process. Furthermore this study also relied on various secondary sources of data such as scholarly articles and books, official documents and legislation and newspaper articles. The preliminary results collected and analysed in this study suggest that Botswana, South Africa and Swaziland have all demonstrated a degree of formal commitment to adopting international guidelines to combat the epidemic. The thesis shows that while all three countries may share the burden of the epidemic, each presents a different political, social and cultural identity with different institutional architects (both foreign and domestic) that determined the nature of the response policy to the epidemic. The study shows that each of the three case studies presents an example of differing degrees of securitisation attempts: i) Botswana - successful securitisation; ii) South Africa - unsuccessful securitisation; and iii) Swaziland - partial securitisation because different actors and audiences are positioned at varying points along a spectrum of securitisation. This degree of securitisation can be linked to the acceptance of international ideas and the prevailing global discourse regarding the HIV and AIDS epidemic and the openness to forming collaborative agreements between state and non-state actors in each of the three countries. / AFRIKAANSE OPSOMMING: Hierdie studie poog om ’n begrip te ontwikkel van die prosesse en faktore wat verklaar hoe beleid rondom MIV en VIGS in Botswana, Suid-Afrika en Swaziland geraam word. Die Afrikavasteland is nog steeds die wêreld se MIV en VIGS-episentrum en die Suider-Afrika-streek loop die mees gebuk onder die epidemie. Die ontleding sentreer op die MIV en VIGS beleidsdiskoerse en die dinamieke wat aanleiding gee tot die beveiliging van die epidemie in die drie lande. Die kollig val op die tyd toe President Mogae van Botswana, President Mbeki van Suid-Afrika en Koning Mswati III van Swaziland aan bewind was. Hierdie periode is van belang omdat dit die tyd was toe MIV en VIGS op die drie lande se politieke agendas geplaas is. Die proefskrif gebruik literatuur uit twee teoretiese velde, naamlik openbare beleidsteorie en sekuriteitsteorie, om te verklaar hoe daar op bepaalde beleide besluit word, hoe dit geraam word, en die proses waarvolgens MIV en VIGS gevolglik in die drie lande beveilig word. Die studie is ’n meervuldige gevallestudie binne die kwalitatiewe navorsingsparadigma. Die navorsing is op drie gevallestudies gebaseer, te wete Botswana, Suid-Afrika en Swaziland. Ten opsigte van data-insameling, het die studie van primêre databronne gebruik gemaak bestaande uit bewysstukke wat van verskeie belangegroepe verkry is. Hierdie stukke beslaan amptelike regeringsdokumente en amptelike dokumentasie van internasionale sowel as nasionale MIV en VIGS-organisasies. Daar is ook met verskeie belangegroepe onderhoude gevoer. Die belangegroepe het bestaan uit regeringsamptenare, die verteenwoordigers van nasionale en internasionale MIV en VIGS-organisasies betrokke in die drie lande, akademici, en kundiges by navorsingsinstansies. Twintig semi-gestruktureerde onderhoude is in 2007 en 2008 gevoer. Boonop is daar as deel van die empiriese navorsing 11 verkenningsonderhoude gevoer. Die studie het ook van verskeie sekondêre databronne soos vakwetenskaplike artikels en boeke, amptelike dokumentasie, wetaktes en koerantartikels gebruik gemaak. Die voorlopige bevindinge dui dat Botswana, Suid-Afrika en Swaziland elkeen hulself tot ’n mate formeel tot internasionale riglyne verbind het om die epidemie te beveg. Die proefskrif bewys dat ofskoon al drie lande swaar aan die las van die epidemie dra, daar by elkeen verskillende politieke, maatskaplike en kulturele identiteite, asook institusionele argitekte (plaaslik sowel as buitelands) bestaan wat die aard van die beleidsrespons bepaal het. Die studie dui verskillende grade van beveiliging by elkeen van die gevallestudies: i) Botswana – suksesvolle beveiliging; ii) Suid-Afrika – onsuksesvolle beveiliging; en iii) Swaziland – gedeeltelike beveiliging. Hierdie grade van beveiliging kan verklaar word aan die hand van die mate waartoe daar by elkeen van die lande aanvaarding was van internasionale denke en diskoers oor die MIV en VIGS-epidemie en of samewerking tussen staats- en nie-staatsakteurs bewerkstellig is.