An Exploration on HIV/AIDS Funding in South Africa

Abstract

The human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS) epidemic, is a global concern in which billions of dollars have been poured into various countries for the prevention and management of this life threatening disease. African countries contain the highest populations of individuals carrying HIV, and the majority of global funding is poured into the Sub-Saharan region. The purpose of this report is to explore and examine the source and utilization of these funds from bilateral and unilateral countries and entities. The goal is to identify the origin of these funds that are estimated between US$7 and US$8 billion annually, and determine if the allocation of monies is reaching its potential recipients. Recommendations will be provided for any potential breaks in the logistical chain to ensure those in need are receiving these funds.

Keywords

human immunodeficiency virus acquired immunodeficiency syndrome HIV/AIDS pandemic HIV/AIDS global donors Sub-Saharan South Africa corruption

Introduction

Based on the most recent data from the World Health Organization (WHO; 2016), acquired immunodeficiency syndrome (AIDS) has claimed close to 35 million lives. Additional statistics document 36.7 million people as carriers of the disease globally, and 25.6 million of these individuals live in Sub-Saharan Africa. This is recorded as the most infected region in the world. Many of these 25.6 million infected individuals are South Africans. Journalist Helen Epstein (2000) published the article The Mystery of AIDS in South Africa in 2000, and believed that AIDS was the greatest threat in the country’s history.

Various researchers have debated multiple topics on this critical matter including origin, disease transference, cures, and mostly funding to treat those infected (Sharp & Hahn, 2011). Several nongovernment organizations (NGOs), charities, events, celebrity causes, and nonprofits have been formed in the past 30 years in an attempt to remedy this disease (Aid for Africa, 2015).

The purpose of this research is to explore current initiatives that attempt to help individuals who carry the human immunodeficiency virus (HIV), and to analyze if funds from these various organizations are effective in decreasing the incidence of new HIV infection in the South African region. South Africa is estimated to have the highest rates of morbidity and mortality from AIDS (Joint United Nations Programme on HIV/AIDS (Avert, 2015). A review of Aid for Africa (2015) supplied a list of over 80 organizations dedicated to the help and eradication of HIV in this region. However, Funders Concerned About Aids (FCAA; 2013) provided a donor list of close to 300 organizations, but only included funds reported at US$300,000 or more. The following analysis will provide a brief history of HIV/AIDS, highlight current programs and statistics, and conclude with recommendations for future progress. It is important to note that HIV/AIDS statistics are only current through 2015 (WHO, 2016).

Literature Review

Nelson Mandela stated, “AIDS is no longer just a disease, it is a human rights issue” (Tutu, 2012, p. 137). Mandela was instrumental in providing global awareness to this gruesome disease, and became even more impassioned about this topic upon the death of his last surviving son from AIDS in 2005. Among the estimated 7 million individuals infected in South Africa, 6.7 million are adults aged 15 years and above, 240,000 are children of 14 years or younger, and 2.1 million children between the ages of 0 and 17 are orphaned due to one or more parents dying from the disease (UNAIDS, 2015a). In 2015, close to 180,000 individuals had died from this disease.

History

Research estimates that the origin of HIV can be traced back to Central Africa around 1930 (Avert, 2016). However, researchers were unable to properly identify HIV-1 and HIV-2 until the 1980s (Hillis, 2000). Although multiple theories attempt to identify the physical origins of these diseases, the most popular theories include the Bushmeat theory versus HIV–Oral Polio Vaccine (OPV) theory (Avert, 2016). The Bushmeat theory, more popular of the two theories, hypothesizes that this killer disease originated in humans who consumed the meat of infected monkeys in Africa. The latter theory claims that vaccinations incubated in monkeys to combat Polio were given to 1 million Africans. Although the Bushmeat and HIV-OPV are the most popular, additional theories listed by researchers for Avert (2016) include contaminated needle theory, colonialism theory, and conspiracy theory. Regardless of this debate, all researchers agree that Africa is the origin of the disease.

The most current data supplied by the WHO (2016) estimates 35 million people are affected worldwide. Aforementioned paragraphs include evaluations claiming the majority of infected live in Sub-Saharan Africa, and South Africa claims 39% of these staggering statistics. At the time of this report, UNAIDS (2013) also noted that South Africa has the fastest growing rate of newly infected individuals, and ranks 2 behind Nigeria for the most AIDS-related deaths worldwide.

Epidemiologically, the HIV pandemic has claimed as many lives as the Spanish influenza in the early 1900s and the Bubonic plague in the 1500s (Centers for Disease Control and Prevention, 2006). HIV is transmitted via sexual transmission (both heterosexual and homosexual), parenteral transmission (largely via intravenous drug use), and perinatal transmission during pregnancy, delivery, and nursing (Cohen, Hellmann, Levy, Decock, & Lange, 2008). The time of HIV acquisition to the diagnosis of AIDS is on average 8 to 10 years, and during this phase, patients are often asymptomatic, contributing to the spread of the disease (Schacker, Hughes, Shea, Coombs, & Corey, 1998). Once patients are in the late stages of AIDS, the median survival without antiretroviral treatment (ART) is 12 to 18 months (Phillips et al., 1992). The virus infects specific CD4 T-lymphocytes, killing them and causing immune suppression (Ho et al., 1995, p123-126). This in turn causes the patient to die of an opportunistic infection once the immune system is sufficiently suppressed (Hanson, Chu, Farizo, & Ward, 1995).

Awareness

Although South African history estimates that HIV made its transition from animals to humans between the 1930s and 1940s (South African History Online [SAHO], 2000), global awareness was not birthed until 1981 when the first known case of AIDS was reported among gay men in the United States—Los Angeles, CA (AIDS.gov, 2005). The WHO did not address the global concerns of this growing disease until October 1983, when the first meeting was held to assess the global AIDS situation, which then triggered the beginning of an international surveillance campaign (AIDS.gov, 2005). However, the first international AIDS conference between the U.S. Department of Health and Human Services and WHO did not commence until April 15-17, 1985, in Atlanta, GA. In 1987, the WHO launched the Global Program on AIDS, and by 1987, US$30 million was committed by 160 countries through collaborative agreements to combat this growing pandemic (Fee, 2006). Worlds AIDS Day was officially launched in 1988 and declares December 1 as the global date to bring recognition to this disease (National AIDS Trust [NAT], 2015).

The focus on HIV remained primarily in the United States and global awareness did not truly begin until 1996 upon the creation of UNAIDS (2015b). UNAIDS (2008) was the first to report that upon the creation of their organization (15 years after the first case was reported), more than 4.6 million people perished from AIDS globally, and over 15 million HIV-infected individuals were living in Sub-Saharan Africa. It is important to note that Africa attempted prevention campaigns during the late 1980s and early 1990s, but did not receive global recognition until the creation of UNAIDS (Avert, 2014). In 1999, President Clinton created the Leadership and Investment in Fighting an Epidemic (LIFE), and committed to international funding to slow the diseases that had taken the lives of an estimated 14 million people (USAID.gov, 1999).

Donors

In 2013, the Kaiser Family Foundation (KFF) provided a comprehensive report reviewing the largest bilateral and multilateral donors globally. The analysis for their reporting was obtained through collaboration with the Organisation for Economic Co-Operation and Development (OECD), and reviewed data by donors for 2009-2011 (Kates, Michaud, Wexler, & Valentine, 2013). For the remainder of this analysis, the authors will be referred to as KMWV (2013). Bilateral and multilateral donors are differentiated by means of distribution of funds. For example, a country that is a bilateral donor passes funds directly to the country they wish to assist, versus sending their funding to an organization such as the UNAIDS to distribute as they see fit (Evans, 2012).

According to the 2013 report, 37 different donors (including 26 bilateral donor governments and 11 multilateral organizations) provided assistance for 1 year, while 30 reported assistance in all three years evaluated (KMWV, 2013). The estimated donor collective average per year was US$7.6 billion, in which the United States contributed an approximated 61% of total funding. Additional top donors included Global Fund (19%), the United Kingdom (4%), UNAIDS (3%), and the World Bank (2%). Reports from RUSH (2014) estimate increased donations for 2012-2013 ranging from US$8.1 to US$8.3 billion. RUSH also provides data to reflect that the largest donor is the United States accounting for nearly 66.4% annually in contributions. For fiscal year (FY) 2015, the United States has an estimated budget of US$6.6 billion allocated for global assistance, and the president has requested US$6.3 billion for FY 2016 (KFF, 2015).

Distribution and Corruption

Based on KMVW’s (2013) report, Sub-Saharan Africa is the largest recipient of all donations at a 57% total consumption rate with South Africa utilizing 14% of these funds. The United States and Global Fund are the two largest donors to this area accounting for 83% of total funding, and the United Kingdom, World Bank, and Sweden round out the top five contributors to this region.

Avert (2012) reported that the majority of HIV and AIDS funding is distributed through two conduits: preventive care and life-saving methods, that is, ART. The means of distribution for these two methods are available through the following programs: HIV testing and counseling (HTC), mobile HIV testing, home-based HIV testing, prevention of mother-to-child transmission (PMTCT), condom use and distribution, voluntary male circumcision (VMMC), HIV education, HIV awareness, and ART.

Although evidence verifies the utilization of funds allocated to aforementioned various programs, the OECD reported in 2012 that an increase in spending from 1996 to 2009 does not necessarily equal success (OECD, 2012). Researchers Tayler and Dickinson (2006) echo a similar opinion in their report “Corruption and HIV/AIDS.” Their assessment provided evidence that corruption within the following areas (but not limited to) impeded efforts for prevention and treatment of HIV and AIDS:

Materials never purchased and false claims of treatment

Procurement and distribution issues

Health workers using non-sterile equipment

Exploitation of the sale of ART drugs

Theft

Government corruption (Tayler & Dickinson, 2005, p. 104)

Researchers for Transparency International (2006) corroborate the findings of Tayler and Dickinson by highlighting additional corruption issues such as the following:

Official increasing budgets and siphoning off significant volumes of drugs without public awareness

Lack of monitoring and oversight

Diversion of funds by ministries and national AIDS councils

Extortion of funds from health workers (Tayler & Dickinson, 2006, p. 105)

Research Analysis

Based on the findings of this report, the United States is the largest supporter of HIV/AIDS funding globally and is the number one contributor for relief to South African countries. Billions of dollars are contributed through bilateral and multilateral agreements, and comprehensive data in the aforementioned paragraphs provided a high-level breakdown of the largest contributors (KFF, 2015).

In consideration of the various programs available to South Africans, a year-over-year comparison of HIV-infected persons and victims are provided in Table 1, to examine the effectiveness of these programs. Malan (2014) estimated that, in 2008, 1.2 million South Africans were infected, and this number grew to 6.4 million by 2012. During this time frame, an estimated 1.2 to 2.5 million individuals lost their lives though substantial efforts were made in donor contribution to this region (Walensky et al., 2008). In 2013, UNICEF (United Nations Children’s Fund) estimated that between 6.3 and 6.5 million were infected and approximately 1.1 million had perished (UNICEF, 2013). The most current data provided through President’s Emergency Plan for AIDS Relief (2014) estimate that 6.3 million South Africans are currently infected and, at the time of the report, an estimated 200,000 had died. However, estimates from the Statistics South Africa provided lower estimates mid-2014 and report only 5.51 million Africans infected (Statistics South Africa, 2014). Regardless of the discrepancy of estimated infected, both parties agree that the number of infected has been steadily increasing since 2008.

Table 1.

HIV/AIDS Infected and Deaths Statistics.

Group	Year	Infected	Deaths
South Africans	2008-2012	1.2-6.4 million	1.2-2.5 million
South Africans	2013	6.3-6.5 million	1.1 million
South Africans	2014	6.3 million	200,000

Note. Estimates of HIV-infected individuals and deaths from 2008 to 2014 in South Africa (Malan, 2014). HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome.

The results of these findings do not provide sufficient evidence that the billions of dollars poured into the South African region have made a significant impact in prevention of new HIV-infected recipients. There is no clear documentation on how the monies are allocated through each program by providing transparent processes or accountability metrics. However, statistics show that deaths have been significantly decreasing year over year due to methods such as usage of antiretroviral drugs (ART). In 2014, the British Broadcasting Corporation reported that South Africans were living “on average” up to 61.2 years compared with 52.2 years nearly 10 years ago (“HIV Drugs,” 2014). The report also indicated that infant death had fallen from 58 deaths per 1,000 to 34 deaths per 1,000 due to infected mothers receiving ART.

Conclusion

The global community has poured billions of dollars into the HIV pandemic since the mid 1980s (AID for Africa, 2015). UNAIDS (2015a) has estimated millions of individuals have died from lack of medical care and prevention since the discovery of this deadly disease. The review of various donor entities throughout this research article provides a comprehensive list of funding to attempt to combat this situation. However, due to corruption on various levels, preventive care had marginal impact to the citizens of South Africa (Walensky et al., 2008). The ability to correctly identify, size, and prove the governmental corruption is difficult to assume and retrieve.

Recommendations for improvement should commence at the government level and should impact each entity that is designed to distribute prevention and maintenance tools. Large donors such as the United States and the United Nations should be allowed full transparency into the distribution chain, and be empowered to identify corruption and move quickly to remedy. These empowerments should also include proper security measures and allowances to discipline those who abuse the system. Also, the agencies responsible for administering help to the infected should be held accountable, or consequently their funding should be revoked. Individuals who opt-in for services should also be held accountable by maintaining certain standards of prevention.

The issue of spreading HIV could also be attributed to poverty and inequality issues in Africa. Organizations such as SVRI track prostitution in South Africa and conclude that lack of education, opportunity, and marginalization of this population increases the pandemic. Research in economic development and opportunity is also recommended in this area to combat the sex industry within this region.

The final conjecture for this research finds reasonable evidence that funding is ample and is generously available to this particular region. However, increased funding is not leading to reduction in newly HIV-infected individuals. The global community is aware of the severity of this disease in South Africa, and has continued to pour billions of dollars in support. If this region desires to see a significant decrease in newly infected, then a change must be initiated at the government level.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Anida A. Duarte serves as the chief of staff to the chief technology officer at the largest privately held financial institution in the United States serving the U.S. Military. Her previous roles include advisor to the chief security officer, senior real estate analyst, international assignment consultant, and licensing coordinator. She completed her doctorate at The University of the Incarnate Word and her dissertation focuses on Blended Learning Institutional Frameworks for Adoption and Implementation.

John W. Hancock attended Texas A&M University for his undergraduate and Masters degrees, and received his doctorate from The University of the Incarnate Word. Hancock has worked in both the academic world, teaching Statistics and Management Science; and in the private sector as an administrator serving chronically medically dependent children.

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