There are a number of ways that HIV/AIDS may impact democracy and governance, but these are still uncertain. Stigma and discrimination against people infected and affected by HIV/AIDS could detrimentally impact the rule of law and human rights. AIDS-related crimes, such as the rape of young girls by men who believe they will be cured of AIDS if they sleep with a virgin, also undermine the rule of law. The large number of AIDS orphans, coupled with South Africa’s disproportionately young population, is expected to increase crime and even lead to political and social instability. Alternatively, however, HIV/AIDS could serve as proof of a strong human rights culture, and a test case for the human rights protections in the constitution.

HIV/AIDS could also decrease citizen involvement in democracy, as people become too ill to participate, become preoccupied with caring for others, or simply consider other priorities more important than democratic participation. The epidemic may also decrease citizen compliance with things like rate payments, because ill or dying individuals have less incentive to comply, while affected families may delve into savings or go into debt to pay for medical care or funeral expenses. AIDS may even decrease citizen support for democracy and cause people to embrace non-democratic options, if elected governments fail to meet citizen needs for health care and social services.

AIDS will have an impact on elections, by disenfranchising voters who are too ill or too occupied with caring for others to vote. It will also thin the ranks of the officials necessary to administer and monitor elections, which may undermine their legitimacy and freeness. Turnover of elected officials will also increase, and because by-elections tend to draw a lower turnout, replacement officials will have a weaker mandate.

The development of a strong and vibrant civil society may be hampered by HIV/AIDS, as community leaders and volunteers are affected by the disease and are less able to commit time, energy, and resources to civil society. Organisations whose work is not AIDS-related may face declining support from communities and donors. There is an alternative scenario, however. Many civil society organisations are being formed specifically to deal with HIV/AIDS-related issues, and the epidemic seems to be mobilising civil society to some extent. In this way, the epidemic may have a paradoxically positive effect on civil society.