South Africa is infamous for its obfuscation and prevarication on aids policy. It took a Constitutional Court ruling in 2002 to force the government to implement a national mtctp intervention (and progress has subsequently been slow and uneven). Public pressure, a campaign of civil disobedience, and concerns about the 2004 election resulted, finally, in August 2003, in the government accepting the need for an aids treatment programme. Having accepted that antiretrovirals are beneficial, the major constraint on the roll-out of mtctp and haart is now the availability of resources. Given the ongoing discourse of affordability, it is argued that an implicit moral economy of triage informs the South African government's policy on aids.

A history of AIDS policy making in South Africa

The history of aids policy in South Africa is a sorry tale of missed opportunities, inadequate analysis, bureaucratic failure and political mismanagement. In the early 1990s, when the antenatal survey indicated that less than 3% of pregnant women attending government clinics were hiv-positive, there were already clear warnings of an impending aids pandemic. Metropolitan Life's demographic model (the ‘Doyle model’) had established the potential for a demographic disaster, and health professionals and analysts (e.g. Crewe 1992) were arguing strongly for an integrated aids prevention strategy. This finding was subsequently reinforced by the assa2000 model. As shown in Figure 2.1, hiv prevalence among pregnant women attending government antenatal clinics rose sharply in the 1990s, as did estimated population hiv-prevalence.