Implementation of AIDS Control Policies in Australia and South Africa

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The term AIDS was coined in 1982. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a worldwide epidemic that requires prompt intervention (Carr as cited in Timewell, Minichiello & Plummer, 1992). The Human Immunodeficiency Virus (HIV) is the etiologic agent for AIDS. The virus compromises the body’s immune system in 3 to 7 years (Raper & Aldridge, 1988; Webb, 1997). HIV was discovered between 1979 and 1981 in the US (Raper & Aldridge, 1988).

The virus spread fast to the rest of the globe (Commonwealth of Australia, 1989). The World Health Organization (WHO) (as cited in Walraven, 2011) indicates that 17,000 cases of AIDS had been registered by 1985 in 71 countries. Statistics from 144 countries in 1989 showed that 151,790 cases had been documented by the WHO (Commonwealth of Australia, 1989).

Approximately 7.7 million cases of AIDS had been documented by 1996, and close to 22 million HIV infections were registered. This is according to reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS) (as cited in Webb, 1997). HIV infections have increased year by year, with 2.5 million cases being reported by 2007. Cases of mortality from AIDS and related illnesses stood at 2.1 million as of 2007. There was a sharp increase in the number of infected persons to 33 million by 2011 (Walraven, 2011).

The main HIV transmission modes are mother-to-child transmission, sexual contact and contact with infected blood (Timewell, Minichiello & Plummer, 1992; Commonwealth of Australia, 1988; Grmek as cited in Maulitz & Duffin, 1990). Sexual transmission of HIV can occur via two ways. Unprotected sex with an infected partner of the opposite sex is the first way. The second way is sexual contact with an infected partner of the same sex.

Mother-to-child transmission is also called vertical transmission, whereby the infant is infected by the HIV positive mother via the placenta or through breast milk. Blood-borne HIV transmission happens when contact is made with infected blood during blood transfusion, contact with HIV-positive body fluids and piercing with infected instruments (Commonwealth of Australia, 1988; Webb, 1997).

AIDS evolved to be a global health epidemic since it spread uncontrollably. Australia’s first HIV-AIDS case was registered in 1982 in homosexuals who had sexual contact with gay men in the US. The gay community later spread HIV to the rest of the population in Australia (Timewell, Minichiello & Plummer, 1992).

South Africa’s first HIV case was also reported in 1982 (Webb, 1997). It is evident that cases of HIV infection and deaths resulting from AIDS continued to increase globally during the early years of HIV discovery in the 1980s, including in Australia and South Africa, but the trend has been reversing as a result of various measures being implemented effectively.

This essay will examine four policies including condom use policy, privacy policy, nutrition strategy, needle exchange policy and factors affecting implementation of AIDS control strategies adopted by Australia and South Africa to control the spread of HIV-AIDS.

The four policies are compared and contrasted, before evaluating the factors that affect implementation of the strategies for both countries. Finally, the paper will comment on the need for global cooperation and combined efforts to avert HIV-AIDS spread instead of an individual approach, more so in the developing world.

Both Australia and South Africa champion the use of condoms as one of the most effective ways of curbing HIV spread. Condoms are used to prevent contact with infected body fluids during sexual contact (Commonwealth of Australia, 1988). Both countries have used this strategy effectively.

The Australian government has promoted availability and use of condoms by waiving all restrictions on advertising, sale and distribution of condoms (Commonwealth of Australia, 1989). The government has banned the sale of condoms that have no expiry date stated, as well as condoms that are of low quality (Commonwealth of Australia, 1988).

To enhance awareness on correct use of condoms, condom manufacturers are mandated to indicate guidelines on how to use condoms on the packets (Commonwealth of Australia, 1988). South Africa has also registered increased uptake in condom use (Abdoolkarim & Abdoolkarim, 2010). Statistics indicate that approximately 75% of young females use condoms compared to 87.4% of young men (Abdoolkarim & Abdoolkarim, 2010).

South Africa’s success in condom use can be attributed to the ease of access to both male and female condoms, as well as the knowledge on how to use the condoms. There are 3 sources of condoms in South Africa (Abdoolkarim & Abdoolkarim, 2010). The National Department of Health provides condoms freely to the public through health centres and AIDS Training, Information and Counselling Centres (ATICCS) among other public avenues.

Condoms are also availed by governmental and NGOs such as Planned Parenthood Association of South Africa (PPASA) through social marketing initiatives. Individuals and organizations are licensed to distribute condoms through local stores. The third source of information on condom use is use of condom commercials to generate public awareness (Abdoolkarim & Abdoolkarim, 2010). There has been a whooping increase in condom distribution by the SA government since 1994 (Abdoolkarim & Abdoolkarim, 2010).

It is reported that 270 million condoms were distributed in 2001-2002. In 2006-2007, the number of condoms distributed nationally increased to 380 million. This widespread distribution has stemmed HIV infections significantly (Abdoolkarim & Adoolkarim, 2010). There is no doubt that both Australia and South Africa have taken substantive steps in their campaigns on use of condoms in preventing the spread of HIV/AIDS, which is a great step in stemming the spread of HIV.

Australia and South Africa also use privacy as an AIDS control policy. Privacy in AIDS control is paramount since breaching confidentiality exposes the infected person to stigma and discrimination (Timewell, Minichiello & Plummer, 1992).

Australia’s privacy law on HIV infected persons is weak since government staff and health professionals have ease of access to the information. The New South Wales state recently approved a new law allowing disclosure of a person’s HIV status by health providers (Timewell, Minichiello & Plummer, 1992).

While this disclosure is meant for health related use, there is no guarantee that the privacy of the infected person would not be exposed to public limelight (Timewell, Minichiello & Plummer, 1992). Similarly, HIV-infected persons in South Africa are wary about disclosing their HIV status even with medical personnel out of fear of breach of confidentiality (Kauffman & Lindauer, 2004).

For instance, Galeshewe Clinic has two condom distribution points. A contraceptive nurse first engages a person in an environment that lacks privacy of conversation, before accessing condom dispensers that are openly situated at the waiting bay. This lack of privacy deters people from accessing condoms since they feel uncomfortable (Kauffman & Lindauer, 2004).

There are gaps in privacy policies in both countries in regard to securing patient confidentiality as a way of curbing the spread of HIV/AIDS. This calls for both countries going a step further in making reinforcing the existent privacy policies to safeguard privacy of HIV/AIDS in order to eradicate HIV/AIDS related stigma, especially among health professionals.

Both Australia and South Africa also employ the nutrition strategy for AIDS patients in control of HIV. Proper nutrition is meant to enhance the quality of life for HIV/AIDS patients (Commonwealth of Australia, 1988). Observing proper nutrition in the initial stages of HIV infection improves the health of the infected person by delaying progression to AIDS. A good diet for HIV-positive persons can greatly prevent weight loss (Timewell, Minichiello & Plummer, 1992).

Most Australian health care facilities provide diets that are rich in protein for AIDS patients to curb and treat weight loss (Timewell, Minichiello & Plummer, 1992; Commonwealth of Australia, 1988). South Africa also has nutrition care services (NCS) where AIDS patients are assessed on their nutrition and given appropriate counselling (Oketch, Paterson, Maunder & Rollins, 2005).

Nutritional support helps in providing sufficient body energy and strengthening the patient’s immune system (Commonwealth of Australia, 1988; Abdoolkarim & Abdoolkarim, 2010; Sahn, 2010). It is very encouraging that both Australia and South Africa have enacted nutritional policies given the importance of proper nutrition in managing AIDS, and these efforts should be upheld and improved.

Australia and South Africa differ in the needle exchange policy in controlling HIV transmission. Australia has set up programs targeting drug users, where drug users are informed that sharing needles can transmit the HIV virus. Drug users connect with service networks and learn how to use and dispose needles and syringes safely (Commonwealth of Australia, 1989; Timewell, Minichiello & Plummer, 1992).

There are needle exchange programs that advocate for ease of access to needles for drug users without discrimination. Information on sharing needles as potential risk to the transmission of hepatitis and other blood-borne disease is also disseminated (Commonwealth of Australia, 1989; Abdoolkarim & Abdoolkarim, 2010). The New South Wales, for instance, distributes close to 2 million needles and syringes annually (Timewell, Minichiello & Plummer, 1992).

The only legal distribution channels in Australia are authorised pharmacies and needle and syringe exchange programs (NSEPs) (Timewell, Minichiello & Plummer, 1992). Addition, it is very bureaucratic to set up a new NSEP outlet. It takes 4-5 months to set up a new NSEP outlet in Victoria State. South Africa, on the other hand, does not criminalise the distribution of drug paraphernalia.

The needle exchange program in South Africa, therefore, is able to reach more drug users and educate them on the risks associated with sharing needles and syringes. Moreover, NGOs and private organizations take needles to the location of drug users. Australia needs to adopt a less bureaucratic approach in distribution and exchange of needles and syringes to drug users to realize the success that South Africa has achieved in the control of HIV spread in its needle exchange policy.

Australia has registered better progress in implementing AIDS prevention programs compared to South Africa. There has been a steady decline in AIDS cases diagnosed in Australia, with the 954 cases registered in 1992 dropping to 144 cases by 2001. There was an 85% decrease in the total number of diagnosed cases from 1992 to 2001 (McDonald, Li, Dore, Ree & Kaldor, 2003).

South Africa, on the other hand, registered a sharp increase of 75% in new AIDs cases; 1.3 million cases in 1992 rose to more than 4.3 million cases in 2001 (Nyabadza, Mukandavire & Hove-Musekwa, 2011). Implementing AIDS policies in both countries mainly depends on the politico-economic systems of the countries.

South Africa’s poor implementation of the AIDS control policies can be attributed to the fact that the AIDS epidemic coincided with the time when South Africa was transiting to a democratic republic. Failure to implement the programs successfully also resulted from lack of a good structure (Marais, 2000 as cited in Kauffman & Lindauer, 2004), under-utilization of the money allocated for HIV/AIDS prevention, and the fact that the government took over as the primary funder of AIDS program from donors.

This resulted in under-funding of AIDS prevention programs (Kauffman & Lindauer, 2004). Conversely, Australia achieved great success in curbing spread of HIV due to a stable political system. The states take the role of implementing national strategies, including overseeing NGOs that are involved in provision of health services.

Commonwealth, on its side, funds the states (Timewell, Minichiello & Plummer, 1992). For instance, the first funding toward the HIV epidemic by the Commonwealth was done in 1984 with an initial fund of $5 million (Commonwealth of Australia, 1988). More funds would be obtained depending on the number of HIV cases in a state. There was smooth collaboration among all stakeholders, and this resulted in effective policy implementation.

Australia is a perfect case of success in preventing HIV/AIDS spread due to a stable and financially able government, while South Africa showcases the hardships experienced in implementing HIV/AIDs prevention programs in countries that are struggling politically and economically. It is, therefore, clear that the role of political goodwill, economic ability and the political stability of a nation are significant factors in seeing to it that HIV/AIDS prevention policies are implemented.

In conclusion, this essay has established that both Australia and South Africa have used the condom use strategy effectively to control HIV spread. Condoms act as barriers from contact with HIV-positive body fluids.

Provision and distribution of high quality condoms has been observed by both governmental and non-governmental bodies in both countries. Both countries also have similar nutritional approaches in effective management of AIDS. Proper diet that is rich in proteins at the early stages of infection has been advocated in management of AIDS.

The paper has also established that the needle exchange program in Australia is highly restricted and left to a few authorised bodies only. However, South Africa has liberalized provision and distribution of drug paraphernalia. While Australia had a stable political and economic system during the HIV/AIDS epidemic, South Africa was undergoing a political shift accompanied by tough economic times. Australia is, therefore, more successful than South Africa in implementing the HIV/AID control strategies.

It is recommended that a global approach, instead of individual country approach, should be taken to tackle the AIDS pandemic successfully. Such an approach would, for instance, see South Africa get financial and strategy support from Australia. Sharing experiences and resources on successful and failed policies among countries will hasten the global efforts of controlling the spread and effects of HIV/AIDS.

References

Abdoolkarim, S., & Abdoolkarim, Q. (2010). HIV/AIDS in South Africa. Cape Town: Academic Press.

Commonwealth of Australia (1988). AIDS a time to care a time to act. Canberra: Australian Government Publishing Service.

Commonwealth of Australia (1989). National HIV/AIDS Strategy. Canberra: Australian Government Publishing Service.

Grmek, M., translated by Maulitz, R., &Duffin, J. (1990). History of AIDS. Princeton, NJ: Princeton University Press.

Kauffman, K. D., & Lindauer, D. L. (Eds). (2004). AIDS in South Africa: the Social Expression of Pandemic, (p. 141). Quincy, MA: Palgrave Macmillan.

Mcdonald, A., Li Y., Dore, G., Ree, H., & Kaldor, J. (2003). Late HIV presentation among AIDS cases in Australia, 1992-2001. Australian and New Zealand Journal of Public Health, 27(6), 608-613. doi: 10.1111/j.1467-842X.2003.tb00607.x

Nyabadza, F., Mukandavire, Z., and Hove-Musekwa, S. (2011). Modelling the HIV/AIDS epidemic trends in South Africa: Insights from a simple mathematical model. Nonlinear Analysis: Real World Applications, 12(2011), 2091–2104. doi: 10.1016/j.nonrwa.2010.12.024

Oketch, J., Paterson, M, Maunder, E., & Rollins, N. (2005). Too little, too late: Comparison of nutrition status and quality of life of nutrition care and support recipient and non-recipients among HIV-positive adults in KwaZulu-Natal, South Africa. Health Policy,99(2011), 267-276. doi: 10.1016/j.healthpol.2010.08.018.

Raper, J., & Aldridge, J. (1988). What every teacher should know about …AIDS. Childhood Education, 64(3), 146-149. doi: 10.1080/00094056.1988.10521523

Sahn, D. E. (Ed) (2010). The socioeconomic dimensions of HIV/AIDS in Africa. Ithaca, NY: Cornell University Press.

Timewell, E., Minichiello, V., & Plummer, D. (1992). ‘AIDS in Australia.’ In A. Carr (Eds.), What is AIDS? (p. 3). NSW: Prentice Hall.

Walraven, G. (2011). Health and poverty(p.32). London: TJ International.

Webb, D. (1997). HIV and AIDS in Africa. (p. 1). Redwood City, CA: Redwood Books.

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Implementation of AIDS Control Policies in Australia and South Africa

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