Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium.
Health Policy Plan. 2010 May;25(3):171-85. doi: 10.1093/heapol/czp057. Epub 2009 Dec 1.
Hitherto, the story of HIV/AIDS in South Africa is, to a large extent, one of lost opportunities. Whereas the country has one of the worst epidemics in the world, consecutive national AIDS strategies have been repeatedly marked by failure over almost three decades. Understandably, South Africa's most recent HIV/AIDS policy, the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP), has been greeted with general acclaim. However, what are its real prospects of success against the backdrop of the repeated failures of the past? The first objective of this review is to systematically identify the core reasons for past policy failures. Using a comprehensive analytical framework, this article presents a systematic review of the literature on postapartheid AIDS policy in South Africa. The analysis demonstrates that a complex interplay among the content, context, actors and process of AIDS policy created a gap between policy making and policy implementation, which rendered near-ideal AIDS policies ineffective. Secondly, we evaluate the chances of success of the current NSP by examining both the policy-making phase and the resulting policy document in light of the reasons for past policy failures. Our analysis shows that the NSP contains dynamic and comprehensive policy content, sensitive to the socio-economic and cultural dimensions of HIV/AIDS. However, many of the political actors that hampered treatment implementation in the past, and who deepened the gap between government and civil society, are still in office. Monetary and human resource shortages also create a policy context that is infertile for the implementation of a comprehensive HIV/AIDS strategy, as envisaged in the NSP. Finally, these health system restrictions have a clear negative impact on the process of policy implementation. Without the mobilization of people living with HIV/AIDS and their communities, the NSP will be ineffective in bridging the gap between policy intentions and policy implementation. The strength of this article lies in its systematic analysis of previous policy responses, as a basis for appraising current AIDS policy. Although such an approach tends to simplify the complexities of the actual policy environment, it nonetheless draws to the attention of policy participants the importance of and the complex interrelationships among the different dimensions of AIDS policy.
迄今为止，南非艾滋病的发展历程在很大程度上是错失良机的写照。南非是世界上艾滋病疫情最严重的国家之一，而连续几版国家艾滋病战略在近 30 年里也都因失败而告终。可以理解的是，南非最近的艾滋病政策——《2007-2011 年南非艾滋病毒/艾滋病和性传播感染战略计划》（NSP）——得到了广泛的认可。然而，在过去政策屡屡失败的背景下，该政策真正成功的前景如何？本文的首要目标是系统地找出过去政策失败的核心原因。本文利用一个全面的分析框架，对南非后种族隔离时代艾滋病政策的文献进行了系统回顾。分析表明，艾滋病政策的内容、背景、行为者和过程之间的复杂相互作用造成了政策制定与政策实施之间的差距，使近乎理想的艾滋病政策失效。其次，我们通过考察过去政策失败的原因，从政策制定阶段和由此产生的政策文件两方面来评估现行 NSP 的成功机会。分析表明，NSP 包含了动态而全面的政策内容，对艾滋病毒/艾滋病的社会经济和文化层面十分敏感。然而，许多在过去阻碍治疗实施并加深政府与民间社会之间差距的政治行为者仍在任。资金和人力资源短缺也使政策环境不利于实施 NSP 中设想的全面艾滋病毒/艾滋病战略。最后，这些卫生系统的限制对政策实施过程产生了明显的负面影响。如果没有艾滋病毒感染者和他们的社区的动员，NSP 将无法弥合政策意图与政策实施之间的差距。本文的优势在于，它对以往政策反应进行了系统分析，为评估当前艾滋病政策提供了依据。虽然这种方法往往会简化实际政策环境的复杂性，但它确实引起了政策参与者对艾滋病政策不同维度的重要性和相互关系的重视。
