HIV/AIDS Treatment Infrastructure in KwaZulu-Natal, South Africa
Principal Investigators: HIVAN Associates Max ODonnell (Tufts University, Boston USA) and Jennifer Zelnick (University of Massachusetts, Lowell, USA)
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Hlokozi Highflats, KwaZulu-Natal. Photo ? Cedric Nunn / Beyond Awareness Campaign.
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The common wisdom is that anti-retroviral drugs (ARVs) for treatment of HIV/AIDS are too expensive for poor- or middle-income countries. If ARVs are to be used at all, only the prophylaxis of maternal fetal transmission is cost-effective. Yet conventional wisdom is slowly changing, in the light of falling drug costs, ever-increasing projections of HIV/AIDS-associated morbidity and mortality and success stories such as Brazils national HIV/AIDS program. As the cost-effectiveness ratios improve, and political pressure for treatment in Africa builds, we are faced with an important research question: What are the essential requirements to start HAART programmes in resource-poor settings?
This question is asked most urgently in South Africa. South Africa is paradoxically both the epicentre of the global HIV/AIDS pandemic and the country in sub-Saharan Africa with the greatest social and economic capacity to initiate a comprehensive response to the HIV/AIDS pandemic.
The requirements to begin a comprehensive national HIV/AIDS programme are discussed today among scientists, politicians and public health practitioners in South Africa and throughout the world, under the rubric of HIVAIDS treatment infrastructure. Infrastructure is a nebulous term, one which needs further definition. It has been used to signify everything from clinical infrastructure, counselling, testing and drug delivery programmes to Africans lack of wristwatches or their (perceived) general backwardness. The term HIV/AIDS treatment infrastructure embodies the challenges that must be overcome in order to begin large-scale HIV/AIDS treatment programmes in the developing world; as such, it has both technical and socio-political dimensions. For the purposes of this study we will analyse technical as well as socio-economic dimensions to HIV/AIDS treatment infrastructure for KwaZulu-Natal, South Africa.
The technical component of this project will use criteria for HIV/AIDS treatment infrastructure derived from the medical literature, expert panels, multilateral bodies and existing HIV/AIDS treatment programmes in poor- and middle-income countries. In particular, we have developed fairly extensive contacts in Brazil and plan to incorporate lessons learned from Brazils success in developing a national HIV/AIDS treatment infrastructure. We hope to identify measurable structures and processes that provide relatively simple criteria which may be duplicated in South Africa. We will then analyse the health-care delivery system in KwaZulu-Natal using these criteria, to determine where pre-existing structures and processes may be adapted to a future HIV/AIDS treatment programme and where gaps in essential infrastructure exist.
The socio-economic dimensions to HIV/AIDS treatment infrastructure will be analysed by examining the process of HIV/AIDS treatment policy formulation in KwaZulu-Natal. We will develop a research tool using Social Actor Analysis for the purpose of interviewing both formal and non-formal actors in the process of HIV/AIDS treatment policy formulation. This will allow us to model a local theory of the policy formation process as it applies to this region. Social Actor Analysis is a framework that attempts to integrate structural dimensions, history, economics and politics into the analysis of policy formation. It is anticipated that these social actors will include governmental bodies, political parties, trade unions, corporations, NGOs and activist organisations.
This project will be a collaboration between Jennifer Zelnick MSW (Doctoral candidate in Work Environment Policy, University of Massachusetts, Lowell) and Max ODonnell (MD/MPH candidate 02, Tufts University School of Medicine). Jennifer will focus on the socio-economic component and Max will focus on the technical aspects of infrastructure, although there will be significant overlap.
 This project will be based at the University of KwaZulu-Natal, Durban at the Centre for HIV/AIDS Networking (HIVAN). We intend to make full use of HIVANs potential as a place for collaborative work and as a clearing-house for the HIV/AIDS resources of the University of KwaZulu-Natal, Durban. This project will run from November 2001 until August 2002 in Durban, South Africa. It is expected that this research will be written up for publication during late 2002 in Boston, Massachusetts. Our preceptor at the University of KwaZulu-Natal, Durban is Professor Eleanor Preston-Whyte, a Professor of Social Anthropology and Co-Director of HIVAN. The Tufts faculty advisor is Dr Davidson Hamer, Dept. Geographic Medicine and Infectious Disease, New England Medical Center. The University of Massachusetts, Lowell faculty advisor is Dr Eduardo Segueira, Dept. of Work Environment.
One of the real pleasures of interdisciplinary work is the chance to interact with different viewpoints, approaches, and techniques; we welcome your advice, input, questions and requests for clarification.
In health and solidarity,
Max ODonnell [email protected]
Jennifer Zelnick [email protected]
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