This article argues AIDS was a 'Black Swan' event in South Africa: something that could not be predicted, that has had major impact. The disease, identified in 1981 in the west, only began to spread in South Africa in 1990. The increase in HIV infections, with AIDS cases lagging some years behind, was almost exponential. The apartheid legacy and violence that lead up to the 1994 election (and beyond) created a fertile environment for the epidemic. The new democratic ANC led Government of National Unity did not understand the potential impact of AIDS and it was not a priority.
Unfortunately, although treatment was available from 1996, when Thabo Mbeki became president, the country entered a damaging denialist phase. Treatment was withheld and civil society mobilised, taking the government to court. With the departure of Mbeki in 2009, and the beginning of the Zuma presidency, the government response ramped up. It was, however, too little and too late. Treatment is available, at a price, but South Africa is one of the least donor dependent nations. This means the anti-retroviral therapy programme is a huge cost to the exchequer. There is little choice; if people are not provided with the drugs they will die.
The price of AIDS is not just financial; the nation can be described as living in a state of normal abnormality. The range of social grants has mitigated the worst impacts. AIDS means South Africa is a very different society from that anticipated when Nelson Mandela walked out of Pollsmoor Prison in February 1990, but attributing causality is impossible. There are lessons to learn from both the epidemic and response.