One burden too many: public policy making on HIV/AIDS in South Africa, 1982-2004

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 Sadi