South Africa’s HIV/AIDS policy, 1994–2004: How can it be explained?

This article aims to explain South Africa’s controversial post-1994 HIV/AIDS policy. It isolates two competing sets of policy prescriptions: a ‘mobilization/biomedical’ paradigm that emphasized societal mobilization, political leadership and anti-retroviral treatments; and a ‘nationalist/ameliorative’ paradigm that focused on poverty, palliative care, traditional medicine, and appropriate nutrition. It explains the ascendancy of the ameliorative paradigm in terms of its administrative and political viability in South African conditions. It explores how public sector institutions circumscribed the viability of biomedical interventions, while political institutions and state-society relations reduced knowledge transfer and policy learning. It then investigates the intellectual context that shaped the political viability of each paradigm. Finally it argues that the ANC accommodated proponents of each policy paradigm, and that instrumental calculation of the dangers of an inequitable and unsustainable anti-retroviral programme best explains the government’s continued adherence to a cautious prevention and treatment policy.