Integrating the prevention of mother-to-child transmission of HIV after AIDS denialism in South Africa: Perspectives of experts and health care workers - A qualitative study

Background Integrating vertical programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of Prevention of Mother-to-Child Transmission programmes (PMTCT) in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing health services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. We explored the perspectives of both experts and frontline health workers (FHCWs) in South Africa on PMTCT integration into primary health care (PHC) in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods We conducted a total of 20 in-depth semi-structured interviews; 10 with experts (PMTCT and health system experts, policymakers, researchers and activists) and 10 with FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programs into PHC following its initial rollout as a stand-alone program in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructure issues (such as lack of rooms, small spaces, etc.) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to protein-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT programmes in PHC, especially postpartum. Our results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.

Thabo Mbeki’s ‘AIDS Denialism’

In his nine years as South Africa’s president, Thabo Mbeki was known as a leading pan-Africanist and an advocate of the African Renaissance. Pan-Africanism is an ideology aimed at uniting Africans into a strong force for total liberation. The African Renaissance is a project aimed at restoring Africans’ self-esteem damaged by colonialism and slavery. During and after his presidency Mbeki was criticised by the local and international media for putting at risk hundreds of thousands of South African lives by questioning the link between HIV and AIDS, and blocking drugs that could have saved many lives. If true, this would suggest that there is a contradiction between Mbeki’s pan-Africanism and the African Renaissance, which are supposed to be life-affirming on one hand, and exposing Africans to the perils of a fatal disease, on the other. This article examines Mbeki’s opponents’ arguments, and Mbeki’s stance in the context of pan-Africanism and the African Renaissance.

“HIV Does Not Cause AIDS”: A Journey into AIDS Denialism

HIV is a virus that causes AIDS. This fact is well established. And yet a vocal group of fringe scientists, freelance journalists, and Internet bloggers persistently deny the existence of HIV. AIDS deniers share the same strategies and tactics seen in other denialist groups, including climate change deniers, Holocaust deniers, and anti-vaccine activists. Refuting the basic science of HIV has caused the early death of people infected with the virus who have ignored their diagnosis and refused life-saving treatments. In South Africa, AIDS denialism resulted in hundreds of thousands of senseless deaths. Most recently, AIDS denialism has infiltrated the criminal justice systems in the US, Canada, and Australia. AIDS denialism is best addressed by correcting medical misinformation, improving science literacy and calling out the pseudoscientific backgrounds and fraudulent claims of AIDS denialists.