Home Institution

Harvard University

Publication Date

Fall 2005

Program Name

South Africa: Multiculturalism and Social Change


In South Africa today, it is estimated that there are 6.5 million people living with HIV/AIDS, at least half a million of whom require urgent treatment. On the continent of Africa as a whole the numbers are even more startling. Unfortunately, although the South African government has now committed itself to rolling out anti-retroviral therapy through the public healthcare system, progress has been slower than expected. Yet in numerous sites around South Africa, rollout centres have been established successfully, even in the most rural parts of the country. These programmes rely on existing community initiatives, community health workers and volunteers, and positive people themselves to educate, counsel, and monitor ARV patients. In this study I suggest that this model of care can be extremely empowering for the patient and reconceptualises healthcare as a path to social change. Drawing primarily from the examples of Madwaleni Hospital in the Eastern Cape, and the Edendale community in KwaZulu-Natal. I examine the dynamics of ARV programmes and the ways in which they create the "empowered patient"-- one who is knowledgeable, articulate, and motivated to effect change in his/her personal life and the social conditions under which he/she lives. Finally, I relate the idea of patient empowerment to a philosophy of primary healthcare and analyse the potential of primary healthcare to improve health in communities through permanent social transformation.


Health Services Administration | Public Health


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