Unemployment and AIDS: The Social-Democratic Challenge for South Africa

There are two major economic and social security challenges facing South Africa: addressing large-scale unemployment and the AIDS pandemic. As of 2003, an estimated 14% of all South Africans were HIV-positive, with over a thousand people dying each day of AIDS. According to the government household and labour-force surveys conducted from the mid-1990s onwards, about a third of the labour force is without work (Nattrass, 2000a). This amounts to about 4.7 million people and it is, without question, a socio-economic crisis of major proportions. The life-chances and living-standards of entire households are compromised when working-age adults cannot find employment (Seekings, 2003b). Households burdened by AIDS are in an especially difficult position (Desmond et al 2000, Steinberg et al 2002a, 2002b; Booysen, 2002; Booysen et al, 2002). Addressing AIDS and unemployment poses major challenges for social solidarity in South Africa. Over the past decade, the labour-market and industrial-policy environment has benefited relatively high-productivity firms and sectors (Nattrass, 2001). Business thus had strong incentives to reduce dependence on unskilled labour, and once the price of highly active antiretroviral therapy (HAART) started to fall from 2001 onwards, to supply it, either directly or indirectly through medical aids, to their increasingly skilled workforce (Nattrass, 2003). Those without jobs had neither access to earned income nor life-prolonging medication.

Unemployment, Employment and Labour-Force Participation in Khayelitsha/Mitchell's Plain

This paper provides a rough guide to the labour force in Khayelitsha/Mitchell's Plain with a particular focus on unemployment. The task is partly conceptual (a discussion is provided on statistical norms for measuring unemployment) and partly empirical. Data is drawn from the 2000/2001 Khayelitsha Mitchell's Plain (KMP) survey, which was designed mainly to explore various dimensions of labour market attachment amongst African and coloured people in Cape Town. This survey covered the magisterial district of Mitchell's Plain which includes the African townships of Khayelitsha, Gugulethu and Langa; it is not a representative sample of the Cape Town metropolitan area but rather of working class (predominantly African and coloured) Cape Town. In the discussion that follows, reference is made to the questionnaire. The Stata 'do file's (which generated the results) are available on request. Part 1 of the paper outlines the standard labour force approach to labour statistics and points to areas where standard definitions can usefully be extended or supplemented. Part 2 continues the discussion, but with reference to employment and unemployment in KMP. A distinction is drawn between the strict and broad definitions of unemployment and an intermediate definition of unemployment (which includes active job seekers and those seeking jobs exclusively through social networks) is introduced. Part 3 examines the nonlabour- force participants. Part 4 expands the scope of the labour force by adjusting some of the statistical requirements used in earlier approaches. Using this expanded approach, Part 5 continues the exploration of different dimensions of unemployment.

The quest for healing in South Africa's age of AIDS

Highly Active Antiretroviral Therapy (HAART) is the most effective means of extending the lives of people living with AIDS – yet only 25% of those in South Africa estimated to need it are receiving HAART. Those who cannot access HAART (or choose not to take it) may opt to use ‘traditional’ healing instead. Some people will do both. This article reviews the emerging South African literature exploring the interface between biomedical and traditional healing in this age of AIDS. It includes a discussion of recent relevant biographies and books. Particular attention is paid to the contrasting experiences of Edwin Cameron who took HAART and continues to live a productive life, and Fana Khaba, who rejected HAART in favour of untested substances. The paper notes how the diagnosis of AIDS as being caused by witchcraft may have psychological benefits (it shifts blame and responsibility to others) it can also exacerbate social tensions and undermine the health of those living with AIDS. It is argued that the state has an obligation to provide information to AIDS patients about the best scientifically tested medications

Wages, profits and apartheid: 1939 - 1960

Paper presented at the Wits History Workshop: Structure and Experience in the Making of Apartheid, 6-10 February, 1990

AIDS, unemployment and disability in South Africa: The case for welfare reform

South Africa is facing a dual crisis of AIDS and unemployment. According to the ASSA2002 demographic model, by 2005 19% of adults (and 11% of all South Africans) were HIV-positive. This amounts to a socioeconomic crisis of significant proportions. AIDS undermines the economic security of households by reducing the productivity of (and eventually killing) mainly prime-age adults while simultaneously diverting scarce household resources towards health care. Poor households are especially vulnerable to these shocks. In most of sub-Saharan Africa, where agriculture accounts for a significant portion of employment and output, AIDS has affected the poor mainly through its negative impact on productivity in peasant agriculture. By contrast, South Africa’s history of de-agrarianisation and the destruction of peasant farming under apartheid have left the vast majority of households dependent on wage labour. Under these conditions, the negative impact of AIDS is experienced directly through illness-induced retirement from wage-labour, and indirectly through the contraction of employment opportunities (especially unskilled jobs) by firms trying to avoid AIDS-related costs

Antiretroviral treatment and the problem of political will in South Africa

South African AIDS policy has long been characterised by suspicion on the part of President Mbeki and his Health Ministers towards antiretroviral therapy.1,2 The Minister of Health, Manto Tshabalala-Msimang, resisted the introduction of antiretrovirals for mother-to-child transmission prevention (MTCTP) until forced to do by a Constitutional Court ruling – and she resisted the introduction of highly active antiretroviral therapy (HAART) for AIDS-sick people until a cabinet revolt in late 2003 forced her to back down on this too. Since then, the public sector rollout of HAART has gained momentum, but it has been uneven across the provinces and continues to be constrained by a marked absence of political will at high levels

Cultural obstacles to the rollout of antiretrovirals: language, region and the backlash against AIDS funding

This paper employs quantitative analysis to explore the issue of cultural barriers to accessing highly active antiretroviral treatment (HAART) in developing countries. It begins with an econometric analysis of potential socio-economic determinants of HAART coverage, i.e. the number of people on HAART as a percentage of the total number needing it. The analysis suggests that language fractionalisation (a widely used indicator of cultural diversity) acts as a barrier to HAART coverage, whereas ethnic fractionalisation is not significant, although politically salient ethnic divisions may be. The most important drivers of HAART coverage are: region (notably, living in the hyper-epidemic region of the Southern part of the African continent); and access to donor funding. The effect of 'region' may, of course, be proxying for unmeasured 'cultural' variation that is not being picked up by the language and ethnic diversity variables. But it may also be picking up other imperfectly measured variables such as level of economic development and institutional strength or even unmeasured factors such as different variants of HIV. One thus cannot conclude from the fact that regional differences exist, that these have roots in cultural differences. The question of 'cultural barriers' to HAART is usually interrogated at a domestic or local level where understandings of disease aetiology and healing, stigma, conceptions of masculinity etc can be explored (e.g. Ashforth, 2005; Nattrass 2005; Ashforth and Nattrass, 2005; Nattrass, 2008a; Steinberg, 2008). Similarly, country-level research can help shed light on how political factors, such as government leadership on AIDS and civil society mobilisation in favour of HAART, also affect the pace and level of HAART coverage (e.g. Nattrass, 2007; Robbins, 2009). Political factors are crucial in shaping access to HAART (Bor, 2007; de Waal, 2006; Iliffe, 2006; Nattrass, 2008b) but these are not immutable and can be transformed rapidly through domestic and international pressure. The same is true of cultural understandings of HIV and HAART which can change quickly in the presence of civil society mobilisation and in response to the lived experience of successful antiretroviral treatment. This paper, by virtue of its focus on cross-country differences in HAART coverage, does not address the kinds of cultural and political obstacles that are more appropriately addressed through ethnographic research. However, the analysis highlights a potentially important over-arching cultural issue which is easily missed by country-level analysis – namely the role of donor attitudes and beliefs in shaping access to HAART. Donor funding is typically seen as an economic issue. But to understand it merely as a resource flow is to miss the importance of 'donor culture' in shaping and sustaining that resource flow

Trading-off income and health: AIDS and the disability grant in South Africa

The number of disability grant recipients in South Africa is rising sharply, largely because of the AIDS pandemic. Now that the government is ‘rolling out’ antiretroviral treatment, many people living with AIDS stand to lose their grants as a result of restored health. Given South Africa’s high unemployment rates and lack of adequate welfare provision for the unemployed, those who do not find work will suffer a significant decline in income. They thus face a stark choice: to go on antiretroviral treatment and lose their disability grant, or avoid treatment and keep the grant for the rest of their (shorter) lives. Some may opt to start treatment, and then when the disability grant expires, discontinue their medication in order to become eligible once more for the disability grant. Such behaviour will foster drug resistance, thereby undermining the antiretroviral treatment rollout and exacerbating the AIDS pandemic. This is a direct consequence of a welfare system that does not provide support for the unemployed and that places poor people in a situation of having to choose between health and income. Replacing the disability grant with a basic income grant would help address the problem