Relatively few people have access to antiretroviral treatment in South Africa. The government justifies this on grounds of affordability, a view that Nicoli Nattrass argues is insulating AIDS policy from social discussion and the possibilities of financing a large scale intervention. Nattrass addresses South Africa's contentious AIDS policy from both an economic and ethical perspective. This relevant and accessible work is a valuable resource for readers with an interest in AIDS policy and the social and economic implications of the pandemic.
With a fifth of its adult population HIV positive, South Africa arguably suffers from the world's most intractable AIDS crisis. Compared to other afflicted African countries, it benefits from above-average financial resources and health infrastructure. Yet progress has been slower there than in countries such as Botswana and Uganda. Nattrass, an economist at the University of Cape Town, offers an excellent introduction to South Africa's AIDS crisis as well as a carefully argued brief for a much more aggressive public policy to address it: universal access to antiretroviral drug treatment for HIV positive patients. For Nattrass, overcoming the AIDS crisis will require much more than merely changes in health policy; not everyone will agree with her linkage of AIDS policy to a massive anti-poverty program that would require an increase in taxation equivalent to as much as a quarter of South Africa's GDP. On the other hand, few will walk away from this book without the conviction that South Africans need a more ambitious approach to fighting the disease.
1. Introduction; 1.1 An overview of the book; 1.2 The socio-economic determinants of AIDS in Africa; 1.3 Economic analysis and the development dilemma; 2. AIDS policy in South Africa; 2.1 A History of AIDS policy making in South Africa; 2.2 The moral economy of triage; 3. Mother-to-child transmission prevention in South Africa; 3.1 Introduction; 3.2 Why South Africa cannot not afford mother-to-child transmission prevention; 3.3 The government's response: a moral economy of triage; 3.4 How many children could be saved from HIV infection?; 4. Expanding an AIDS intervention to include HAART for all who need it; 4.1 The impact of a limited AIDS intervention; 4.2 The impact of HAART; 4.3 The cost of AIDS interventions; 4.4 'Scaling-up' the use of HAART un the public sector; 4.5 HAART or a disability grant?; 5. AIDS, HAART and behaviour change; 5.1 Does HAART lead to riskier sex?; 5.2 Could failure to provide HAART lead to riskier sex?; 5.3 Voluntary counselling and testing and behaviour change; ; 6. AIDS, economic growth and inequality in South Africa; 6.1 Some relevant demographics; 6.2 Modelling the macroeconomic impact of AIDS; 6.3 The impact of AIDS on firms; 6.4 AIDS and inequality in South Africa; 7. Conclusion; 7.1 The moral challenge posed by AIDS for society; 7.2 Alleviating poverty and addressing AIDS; 7.3 Why social deliberation is necessary; Notes; References; Index.