The end of AIDS? HIV and the new landscape of illness in rural South Africa

ABSTRACT

The global HIV/AIDS scientific community has begun to hail the dawn of ‘the End of AIDS’ with widespread anti-retroviral therapy (ART) and dramatic declines in AIDS-related mortality. Drawing on community focus groups and in-depth individual interviews conducted in rural South Africa, we examine the complex unfolding of the end of AIDS in a hard-hit setting. We find that while widespread ART has led to declines in AIDS-related deaths, stigma persists and is now freshly motivated. We argue that the shifting landscape of illness in the community has produced a new interpretive lens through which to view living with HIV and dying from AIDS. Most adults have one or more chronic illnesses, and ART-managed HIV is now considered a preferred diagnosis because it is seen as easier to manage, more responsive to medication, and less dangerous compared to diseases like cancer, hypertension, and diabetes. Viewed through this comparative lens, dying from AIDS elicits stigmatising individual blame. We find that blame persists despite community acknowledgement of structural barriers to ART adherence. Setting the ending of AIDS within its wider health context sheds light on the complexities of the epidemiological and health transitions underway in much of the developing world.

KEYWORDS:

• HIV
• AIDS
• South Africa
• stigma
• chronic disease

Acknowledgements

We are grateful to the anonymous reviewers for their helpful comments and critiques. We thank all the respondents who participated in this study. We also thank the people of the Agincourt sub-district for their long involvement with the MRC/Wits Rural Public Health and Health Transitions Research Unit as well as the Izindaba Za Badala (HIV after 40) field teams, especially Meriam Maritze. We are grateful for funding support from: the National Institute on Aging – R01 AG049634 – HIV after 40 in rural South Africa: Aging in the Context of an HIV epidemic (PI Sanyu Mojola). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We are also grateful to the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and the funding agencies that support it: the Wellcome Trust, UK (grants 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z – PI Stephen Tollman); the Medical Research Council, University of the Witwatersrand, and Anglo-American Chairman’s Fund, South Africa. This work has also benefited from research, administrative, and computing support from the Office of Population Research (OPR) at Princeton University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute on Aging: [Grant Number R01 AG049634]; Wellcome Trust: [Grant Number 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z].