The ARV roll out and the disability grant: a South African dilemma?
Prior to the antiretroviral (ARV) drug roll out in 2004, people living with HIV (PLHIV) in South Africa received disability grants when they were defined as “AIDS-sick". In the absence of available and effective medication, a diagnosis of AIDS portended disability. The disability grant is a critical component of South Africa's social security system, and plays an important role in addressing poverty among PLHIV. Given the prevalence of unemployment and poverty, disability grants ensure access to essential resources, like food, for PLHIV. Following the ARV roll out in South Africa, PLHIV experienced improved health that, in turn, affected their grant eligibility. Our aim is to explore whether PLHIV reduced or stopped treatment to remain eligible for the disability grant from the perspectives of both PLHIV and their doctors.
A mixed-methods design with concurrent triangulation was applied. We conducted: (1) in-depth semi-structured interviews with 29 PLHIV; (2) in-depth semi-structured interviews with eight medical doctors working in the public sector throughout the Cape Peninsula; (3) three focus group discussions with programme managers, stakeholders and community workers; and (4) a panel survey of 216 PLHIV receiving ARVs.
Unemployment and poverty were the primary concerns for PLHIV and the disability grant was viewed as a temporary way out of this vicious cycle. Although loss of the disability grant significantly affected the well-being of PLHIV, they did not discontinue ARVs. However, in a number of subtle ways, PLHIV “tipped the scales” to lower the CD4 count without stopping ARVs completely. Grant criteria were deemed ad hoc, and doctors struggled to balance economic and physical welfare when assessing eligibility.
It is crucial to provide sustainable economic support in conjunction with ARVs in order to make “positive living” a reality for PLHIV. A chronic illness grant, a basic income grant or an unemployment grant could provide viable alternatives when the PLHIV are no longer eligible for a disability grant.
Supplementary Material (0)
- UNAIDS: [http://www.unaids.org/globalreport/Epi_slides.htm] Report on the Global AIDS Epidemic. Geneva, UNAIDS; 2010.
- Seekings J, Nattrass N: Class, race and inequality in South Africa. Yale University Press: Yale; 2005.
- Department of Health: HIV and AIDS and STI. Strategic Plan for South Africa 2007–2011. [http://www.info.gov.za/otherdocs/2007/aidsplan2007/index.html] Department of Health, Republic of South Africa 2007.
- De Waal A: AIDS and Power: Why there is no political crisis - yet. Zed Books: Cape Town; 2006.
- Robins S: AIDS, science and citizenship after apartheid. In Science and Citizens. Globalisation and the challenge of engagements. Edited by: Leach M, Scoones I, Wynne B. London, Zed Books; 2005.
- Nattrass N: The Moral Economy of AIDS in South Africa. Cambridge: Cambridge University Press; 2004.
- Rose N, Novas C: Biological Citizenship. In Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Edited by: Ong A, Collier S. Maldon, Blackwell; 2005.
- Patton P: Agamben and Foucault on Biopower and Biopolitics. In Giorgio Agamben: Sovereignty and Life. Edited by: Calarco M, DeCaroli S. Stanford: Stanford University Press; 2007.
- Nadesan MH: Governmentality, biopower and everyday life. Routledge: New York; 2008.
- Lock M, Nguyen V-K: An Anthropology of Biomedicine. Wiley-Blackwell: Oxford; 2010.
- Mbuli BN: Poverty reduction strategies in South Africa: Master thesis in Economy. University of South Africa: Pretoria; 2008.
- Department of Social Development: Annual Report 2008. [http://www.dsd.gov.za/dmdocuments/Annual%20Report%20March%202008.pdf] Department of Social Development - Republic of South Africa; 2008.
- Taylor V: Transforming the present - Protecting the future. Pretoria, Department of Social Development: Report of the Committee of Inquiry into a comprehensive system of social security for South Africa; 2002.
- Statistics South Africa: Quarterly Labour Force Survey. Quarter 1, 2009. Statistical release P0211, Pretoria, Statistics South Africa; 2009.
- Gray M: The progress of social development in South Africa. International Journal of Social Welfare 2006,15(1):53–64. CrossRef
- Seekings J: Deserving individuals and groups: justifying the shape of South Africa's welfare state. CSSR Working Paper no 193. Cape Town,Center for Social Science Research, University of Cape Town; 2007.
- South African Social Security Agency: [http://www.sassa.gov.za/Portals/1/Documents/23047402-2ddc-471a-8670-0366d758aeb9.pdf] You and your grant 2010/11.
- South African Social Security Agency: Statistical Report on Social Grants. Report no. 31, Pretoria, Department of Monitoring and Evaluation, South African Social Security Agency; 2010.
- Nattrass N: Trading off income and health? AIDS and the disability grant in South Africa. Journal of Social Policy 2006,35(1):3–19. CrossRef
- Booysen F: Social grants as safety net for HIV and AIDS-affected households in South Africa. Journal of Social Aspects of HIV and AIDS Research Alliance 2004,1(1):45–56.
- Booysen F, van der Berg S: The role of social grants in mitigating the socio-economic impact of HIV and AIDS in two free state communities. South African Journal of Economics. Special Edition on HIV and AIDS 2005,73(1):545–563.
- Mitra S: Disability Cash Transfers in the Context of Poverty and Unemployment: The Case of South Afria. World Development 2010,38(12):1692–1709. CrossRef
- Department of Labour: [http://www.labour.gov.za/downloads/documents/useful-documents/basic-conditions-of-employment/Advert%20New%20Wages%201%20Dec%2008_New%20wages%20advert%202008.pdf] Domestic Workers. New Wages from 1 December 2008. Department of Labour, South Africa; 2008.
- Leclerc-Madlala S: “We will eat when I get the grant”: AIDS, poverty and antiretroviral treatment in South Africa. African Journal of AIDS Research 2006,5(3):249–256. CrossRef
- Simchowitz B: Social security and HIV/AIDS: assessing "disability" in the context of ARV treatment. CSSR Working Paper No.99. Cape Town, Centre for Social Science Research, University of Cape Town; 2004.
- Creswell JW, Clark VLP, Gutmann ML, Hanson WE: Advanced mixed methods research designs. In Handbook of mixed methods in social and behavioural research. Edited by: Tashakkori A, Teddlie C. London, SAGE Publications; 2003:209–240.
- Venkataramani AS, Maugham-Brown B, Nattrass N, Ruger JP: Social grants, welfare and the incentive to trade-off health for income among individuals on HAART in South Africa. AIDS Behav 2009,14(6):1393–1400. CrossRef
- Corbin J, Strauss J: Basics of qualitative research. Techniques and procedures for developing grounded theory. Thousand Oaks, California Sage Publications, Inc; 2008.
- Winkvist A, Dahlgren L, Emmelin M: Open Code Qualitative Programme. [http://www.phmed.umu.se/enheter/epidemiologi/forskning/open-code/]
- Seekings J: Racial and class discrimination in assessments of 'just desert' in post-apartheid Cape Town. CSSR Working paper no. 199. Cape Town, Centre for Social Science Research, University of Cape Town; 2007.
- Bachmann MO, Booysen FLR: Health and economics impact of HIV/AIDS on South African housholds: a cohort study. BMC Public Health 2003, 3:14. CrossRef
- Coetzee C: The impact of highly active antiretroviral treatment (HAART) on employment in Khayelitsha. CSSR Working Paper No. 201. Cape Town, Center for Social Science Research, University of Cape Town; 2007.
- Nattrass N: Disability and welfare in South Africa's era of unemployment and AIDS. In State of the Nation. South Africa. Volume 2007. Edited by: Buhlungu S, Daniel J, Southall R. Cape Town, HSRC Press; 2007:179–200.
- CASE (Community Agency for Social Enquiry): Investigation into the increase in uptake of disability and care dependency grants since December 2001. CASE, Johannesburg; 2005.
- Nachega JB, Knowlton AR, Deluca A, Schoeman JH, Watkinson L, Watkinson L, Chaisson RE, Maartens G: Treatment supporter to IMPROVE adherence to antiretroviral therapy in HIV-infected South Afrcian adults. A qualitative study. J Acquir Immune Defic Syndr 2006, 43 Suppl 1:S127-S133.
- Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C, Thabane L, Wilson K, Guyatt GH, Bangsberg DR: Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 2006,926(6):679–690. CrossRef
- Mills EJ, Nachega JB, Bangsberg DE, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ, Cooper C: Adherence to HAART: A systematic reveiw of developed and developing nation patient-reported barriers and facilitators. PLoS Medicine 2006.,3(11):
- Coetzee C, Nattrass N: Living on AIDS treatment: A socio-economic profile of Africans receiving antiretroviral therapy in Khayelitsha, Cape Town. CSSR Working Paper No. 071, Cape Town: Centre for Social Science Research, University of Cape Town; 2004.
- Dorrington R, Johnson L, Brtadshaw D, Daniel T: Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa: Cape Town; 2006. The demographic impact of HIV/AIDS in South Africa: National and provincial indicators for 2006
- Edwards W, Coleman E: Defining Sexual Health: A Descriptive Overview. Archives of Sexual Behaviour 2004,33(3):189–195. CrossRef
- Fakir E: Public Service Delivery in a Democratic, Developmental State. Policy issues and actors. 2007, 20(3) Centre for Policy Studies; 2007.
- Jones PS: AIDS treatment and human rights in context. Palgrave Macmillan: New York; 2009. CrossRef
- Macgregor H: “The grant is what I eat”: The politics of social security and disability in the post-apartheid South African state. Journal of Biosocial Science (Anthropology & Public Health special issue) 2006, 38:43–55.
About this Article
- The ARV roll out and the disability grant: a South African dilemma?
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of the International AIDS Society
- Online Date
- February 2012
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Fafo, Institute for Applied International Studies, PO Box 2947, Tøyen, NO-0608, Oslo, Norway
- 2. Institute of Development Studies, Library Road, Brighton, BN1 9RE, United Kingdom
- 3. Fafo, Institute for Labour and Social Research, PO Box 2947, Tøyen, NO-0608, Oslo, Norway