The Challenge of AIDS diplomacy: South Africa Short-changed?

This piece was co-authored by Kathy R. Fitzpatrick.

Since 2004, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has funded HIV/AIDS prevention, care and treatment programs credited with extending the lives of millions of people in sub-Saharan Africa, including South Africa, which has received the majority of PEPFAR funding, reaching more than $500 million annually.[1] In a place where a positive diagnosis of HIV/AIDS used to be a death sentence, America brought hope for longer lives.

That’s why the Obama administration’s decision to cut South Africa’s PEPFAR budget in half by 2017 and transfer responsibility for its HIV program to South Africa[2] has raised concerns among citizens worried that their country might not be able to sustain current levels of HIV/AIDS treatment without U.S. aid.[3] In fact, as the New England Journal of Medicine recently reported, the impact of the cuts are already being felt, with the closure of specialized treatment centers created by PEPFAR, leaving patients to rely on government-run, community-based health care.[4] Both the extent of future changes and the long-term implications of such changes on the health of South Africans are uncertain. A key issue is whether South Africa is adequately prepared to manage the prevention, testing, counseling, and treatment aspects of the program.[5] Although past policies of South African leaders showed a profound lack of seriousness about the epidemic, recent changes both in government leadership and approach are far more promising.

The long-term diplomatic implications of pulling back on an initiative that has contributed to overwhelmingly favorable attitudes toward the United States among the South African people are also unknown. But, if early public response is any indication, a program widely cited as one of America’s most successful diplomatic initiatives of the past decade may be at risk of losing the affection of those it was intended to support.

In April of 2008, I was driving north from Pretoria, going deeper into rural stretches and passing grasslands burnt by the African sun after having visited the largest HIV/AIDS dedicated hospital in the Southern Hemisphere. I had come to South Africa to report on the epicenter of the HIV/AIDS pandemic. At the hospital, I saw grannies clutching babies and holding hands with little boys and girls whose mothers had been taken by a grotesque virus that had swarmed over and seized this arid land, making all seem defenseless. It felt like a world in a bubble, abandoned, even though I was in a U.S. State Department van, accompanied by a P.I.O. from USAID, and being guided to see how U.S. dollars were supporting orphanages for HIV/AIDS-infected children.

Images of the poor and struggling Africans stayed with me. That sense of a renegade virus that covered a land like a fog that had rolled in and remained. But on the plane back to the States, when I had some distance and perspective, I recognized that the immense and collective human effort that was being made by so many, from so many walks of life, to fight HIV/AIDS in South Africa was making a difference and a feeling of good will warmed me. This was a war. And I was proud to be contributing a small amount as a journalist, and actually quite proud as an American, that our country had come to war again, but this time against sickness and the nightmare of this epidemic. I returned home inspired by the many people I had met and interviewed and their determined battle on behalf of thousands of stricken South Africans.

This was the story I told in a documentary called “Lessons from South Africa” – a story of hope and progress in the fight against HIV/AIDS. A story of how doctors and hospitals and U.S. aid workers and NGOs and foundations and public health experts and media and film makers and corporations came together to solve one of the world’s most urgent health problems.

The PEPFAR experience in South Africa shows the tremendous impact of U.S. sponsored aid on the health and wellbeing of the South Africa people. It also illustrates the effectiveness of collaborative public diplomacy that perceives global society as a network of interdependent communities with shared interests and common concerns. In this respect, the South African HIV/AIDS initiative provides a good laboratory for understanding how collaborative public diplomacy works and how it might work effectively in other parts of the world.

At the same time, the decision to roll back PEPFAR funding in South Africa raises questions about the long-term impact of public diplomacy efforts perceived to be short-changed by targeted publics. Questions about America’s credibility. Questions about America’s commitment to the South African people. Questions about responsibility. Questions about trust.

Although the United States government considers South Africa to be a strategic partner on the continent, the relationship is still evolving. Recent dialogues on such issues as law enforcement, trade, transportation, human rights, agriculture, energy and defense, as well as health, show signs of progress in strengthening official relations.[6] However, if the work on HIV/AIDS is perceived to be left undone, the disappointment of South Africa’s people may well be felt in other areas.

[1] Partnership Framework in Support of South Africa's National HIV & AIDS and TB Response 2012/13 - 2016/17 between the Government of the Republic of South Africa and the Government of the United States of America (December 2010).
[2] Partnership Framework Implementation Plan in Support of South Africa's National HIV, STI & TB Response, (August 2012).
[3] See, e.g., Aides Healthcare Foundation, “South Africa: 1,000 protest U.S. AIDS funding cuts,” March 18, 2013.
[4] Ingrid T. Katz, Ingrid V. Bassett and Alexi A. Wright, “PEPFAR in Transition — Implications for HIV Care in South Africa,” New England Journal of Medicine, October 10, 2013.
[5] Ibid.
[6] Lauren Ploch, South Africa: Current Issues and U.S. Relations, Congressional Research Service, January 4, 2011.

Allan Richards and Kathy Fitzpatrick are associate deans in the School of Journalism and Mass Communication at Florida International University. Richards’ documentary “Lessons from South Africa” is available at http://www.youtube.com/watch?v=UVYx0B8soMg. This work is part of an ongoing investigation of the campaign against HIV/AIDS in South Africa with the aim of better understanding the communication dimensions that contributed to the success of this collaborative public diplomacy initiative.