ArticleHealth policy OPEN2026
Structural determinants of HIV inequities in South Africa: Policy analysis of the national strategic plan for HIV 2023-2028.
Article in Health policy OPEN, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Trends in HIV Incidence, Prevalence, Antiretroviral Therapy Coverage and Mother-to-Child Transmission Among Pregnant and Breastfeeding Women in the Eastern Cape Province, South Africa, 2000-2023.Tropical medicine and infectious disease · 2026Article
- Observational
- Rural health inequalities in perceived HIV vulnerability and nutritional status: a cross-comparison of rural communities in West and Southern Africa.BMC public health · 2026Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: South Africa continues to experience the world's highest HIV burden despite major progress in antiretroviral therapy (ART) scale-up. Persistent disparities across gender, geography, and socioeconomic status reveal that structural and political inequities shape vulnerability, access, and outcomes. This paper examines inequalities in HIV outcomes and evaluates how social, economic, and political structures influence policy effectiveness despite expanded ART coverage. Methods: A document-based policy analysis was conducted using Walt and Gilson's Policy Triangle framework. National strategic plans, government policy documents, and peer-reviewed literature published between 2015 and 2025 were identified through targeted database and grey literature searches. Documents addressing HIV policy, health system reform, or structural determinants were thematically analysed across four domains: policy content, context, actors, and processes. Results: Structural inequities in HIV incidence, access, and treatment outcomes remain despite expanded services. The 2023-2028 National Strategic Plan adopts a more equity-oriented and multisectoral approach, aligning with Universal Health Coverage and WHO behavioural insights. It includes differentiated service delivery, community-led monitoring, legal reform, and social protection integration. However, implementation is constrained by health system fragmentation, workforce shortages, donor dependency, and weak accountability. The suspension of PEPFAR funding disrupted community-based services, demonstrating the fragility of external financing. International experiences (eg, Thailand, Kenya) show that integrating HIV services within UHC and decentralising delivery can improve retention and equity when supported by domestic investment. Conclusions: Policy commitments increasingly recognise that equity requires structural transformation rather than solely biomedical solutions. Without stronger domestic investment, clearer implementation mechanisms, and alignment with broader reforms such as National Health Insurance, equity goals risk remaining aspirational. Embedding HIV services within a decentralised, accountable, and people-centred UHC framework offers a credible pathway to sustainability and health equity.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.