The Faculty of Economic and Management Sciences’ recent Research Day showcased a thought-provoking presentation by Huijie Zhang from the Africa Centre for Inclusive Health Management. Her presentation, titled “Decolonising the Political Economy of Health: A Structural Framework for Understanding the HIV/AIDS Epidemic in Post-Apartheid South Africa,” forms part of her doctoral research and explored five interconnected areas.

HIV/AIDS progress: A persistent burden

Zhang started off by outlining South Africa’s long-term HIV/AIDS response, noting both progress and enduring challenges.

“Despite a falling rate of new infections and deaths, the overall burden of the epidemic remains immense,” she said. Current research (Johnson & Dorrington, 2024) show that approximately 50 000 individuals died from HIV-related complications, while an estimated 7.8 million people live with the disease.

She highlighted uneven progress toward the Joint United Nations Programme on HIV/Aids (UNAIDS) 95-95-95 targets, with South Africa still falling short of the goal that 95% of people diagnosed with HIV should be on sustained antiretroviral therapy. She also pointed out that the HIV/Aids burden is borne mostly by women, adolescent girls and young women aged 
15-24.

As a way forward, Zhang advocated shifting from a primarily medical focus to a structural perspective – one that addresses root causes of vulnerability and dismantles barriers to sustained, effective care.

Literature review: understanding historical roots

Focusing on the foundational period of 1988 to 1998, Zhang expanded on her core research question: How has South Africa’s race-based political-economic system – from its colonial-industrial origins to its post-apartheid neoliberal reconfiguration – systematically produced vulnerability to HIV/Aids and hindered effective treatment responses?

Her objective is to produce a historically grounded political-economy analysis of the epidemic and to develop a multi-layered analytical framework linking direct causes to deeper social conditions and political-economic structures.

Research methodology and design

Zhang’s approach is guided by the principle of understanding the world through the experiences of the people living in it, while critically examining systems of power, inequality and domination. The goal is not only to interpret social realities, but to reveal why they are unequal and how they can be changed.

Research logic: three complementary methods

To address the research question from different angles, the study employs three qualitative methods:

1. Historical Research – to establish long-term structural foundations (The Past).
2. Content Analysis – to examine institutional and ideological frameworks (The System).
3. In-Depth Interviews – to explore contemporary lived experience (The Present).

Theoretical and Conceptual Framework

At the heart of Zhang’s study is a multi-layered critical framework designed to trace the root causes of health inequalities. She argues that health inequalities are not accidental but are structural outcomes of a political-economic system.

The framework progresses from deep systemic structures to surface-level outcomes, consisting of four layers:

• Layer 1: Foundational Engine
  The intertwined roles of the state (as guarantor) and capital (as driver of accumulation and profit) in reproducing the capitalist mode of production.
• Layer 2: Core Logics of Accumulation
  The dynamics within the spheres of production and social reproduction.
• Layer 3: Intermediate Structural Determinants
  Direct and observable social consequences of Layers 1 and 2 – such as land dispossession, housing insecurity and barriers to healthcare access.
• Layer 4: How Structural Determinants Create Health Issues
  Manifest health inequalities, such as the loss of livelihood which leads to poverty, malnutrition and disease susceptibility.

“To truly address health inequality, we must move beyond health policy alone,” Zhang emphasised. “It requires a broader transformation of the social and economic systems that produce and perpetuate inequality in the first place.”

Applying the framework: A staged analytical process

In the final section of her presentation, Zhang outlined three key stages of analysis:

• Stage 1: Historical Data Collection (Upstream Analysis)
  Mapping data across three major political-economic eras: the colonial period (1860s–1948), apartheid (1948–1994) and post-apartheid South Africa (1994–present).
• Stage 2: Integrative Analysis (Connecting Upstream to Mid-Stream)
  Tracing how deep historical structures shape contemporary social conditions.
• Stage 3: Synthesis and Re-interpretation (Downstream Explanation)
  Using the integrated findings from Stages 1 & 2 to reinterpret South Africa’s “persistent HIV/AIDS challenge”.

“This research will reframe the epidemic not as a simple biomedical problem, but as the logical, predictable outcome of a broader, continuous historical, political and economic landscape,” Zhang concluded.