Abstracts

84 The apartheid regime came to power in 1948 and systematically oppressed everyone who was not white based on the relative darkness of their skin. Legal institutions directly disenfranchised the colored population by cultural and geographical segmentation. These structures of legal and social oppression created a system that placed a large portion of the population at an extremely high risk of suffering an epidemic. The key factors that created the perfect epidemic conditions were consistent through most of the country’s history: a social hierarchy that segregated the population by skin tone and a patriarchal society that further marginalized women. Apartheid formalized the social hierarchy that previously existed and created a system in which the lower classes were arguing and battling against each other to get every little step closer to the top tier. This class system caused prejudices between all groups classified as different by the apartheid government and created a lasting social segregation that is only just beginning to come undone. History also acts as proof that South African women “accepted their subordinate and inferior position [to men] in society… as natural and as a fact of life that cannot be altered” (Coetzee, 2001, p. 301). This mentality limits women’s autonomy and disables their ability to speak up for themselves in all areas of life. In sexual relationships, South African women are expected to prioritize the pleasure of their partners; thus, they often cannot or will not ask for their partner to use a condom (Jewkes et al., 2003). It is also possible that discussions of condom use and sexual history require a greater intimacy than is allowed by South Africa’s society; consequently, a segregated and patriarchal society likely puts women at more risk for contracting HIV (“Factors That Contribute…,” 1997). At the end of the apartheid regime, when the disenfranchised populations were at their weakest, an era of denialism toward HIV/AIDS began that allowed the epidemic to fester and swell into an uncontrollable problem. When Nelson Mandela became president in 1994, his priorities needed to be stabilizing the military and political climates, sorting out economic policy, and reconciling racial tensions. HIV/ AIDS was such a minor issue compared to these that it was ignored in the confusion amid the change in power. Much like the lives of individuals in South Africa, at the national level there simply were more pressing issues to be dealt with before HIV/AIDS. The unfortunate result was that the country adopted denial as a psychological defense mechanism; the quality of life was finally improving for the disenfranchised groups; thus, they would deny anything that said otherwise (Breslow, 2013). Former president Thabo Mbeki (1999–2008) is a perfect example of this behavior; he denied the link between HIV and AIDS for years and questioned the usefulness of ART. His doubts, which were themselves a product of the country’s history, caused him to limit testing and drug availability that were freely donated (Chigwedere et al., 2008). He is not alone in his denial; it was commonplace for deaths due to AIDS to be claimed as tuberculosis or pneumonia to avoid the shameful diagnosis (Getahun et al., 2010). South Africa’s state of denial during this time caused approximately 334,000 people to die prematurely from AIDS and at least 35,000 babies to be born with HIV infections that could have been prevented. By the end of 2005, two years after international help was accepted, South Africa had only 23% of HIV patients on treatment as compared to greater than 70% in Botswana and Namibia (Chigwedere et al., 2008). The era of denialism ended in 2009 when Jacob Zuma became president, at which point the national focus could shift away from issues of stability and toward other threats. Zuma enacted new legislation to increase ART access for pregnant women, children, and those also suffering from tuberculosis. However, a few people continue to criticize Zuma’s impact on the epidemic, despite the huge increases in testing and treatment that came out of his presidency, due to his promotion of promiscuity and clinical misinformation. He claimed that showering after unprotected sex would protect him from HIV, and he publicly discussed having multiple sexual partners, which is one of the easiest ways to spread the disease (SAHO, 2011). Independent of these claims, funding for the fight against HIV/AIDS from South Africa itself surpassed that from foreign