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Human Rights Defender |
Alan Morris
The 1990s have been a period of much joy in South Africa. In 1990 the liberation movements were unbanned and Nelson Mandela and his fellow political prisoners were released from gaol. After a series of setbacks and near civil war, April 1994 saw the advent of the first democratic elections and the African National Congress (ANC) was swept into power with 62% of the popular vote. Nelson Mandela became President and South Africa was viewed as the beacon of hope in a continent ravaged by war, corruption, authoritarianism and poverty. Six years after the elections the huge upswell in confidence has dissipated considerably. The post-apartheid government inherited a multitude of major problems - massive unemployment, huge inequalities, rampant crime, poor services, inept bureaucracies and poverty being the most stark. In the late 1990s another issue emerged as probably the most daunting threat yet to South Africa's social fabric post-apartheid, HIV/AIDS.
It is estimated that about 20 to 25% of South Africa's adult population are HIV positive. In addition there are thousands of children who have the virus. The rate of daily transmissions is approximately 1 500 --the highest in the world. In some parts of the country as many as 60% of all pregnant mothers were found to be HIV positive. It is estimated that by 2005 about a million South African children under the age of 15 would have lost their mother to AIDS. A large proportion of these children would have lost both parents.
For the first couple of years of the ANC's rule, HIV/AIDS was not presented as an issue by government. Rarely was it mentioned in official speeches. President Mandela hardly mentioned AIDS and negligible amounts were budgeted to fight the threat. In the 1994/95 budget about US$6 million was allocated for HIV/AIDS research and education. Health workers were, however, warning that South Africa was on the verge of mimicking its neighbours and entering into an HIV crisis. The figures were already alarming. Thus, between 1990 and 1994 the proportion of pregnant women who were HIV positive virtually doubled from year to year. In 1989 HIV did not appear to be present in the population. In 1990 0.76% of pregnant women were HIV positive. In 1991 the figure was 1.49%, in 1992 it was 2.69% and in 1993 it was 4.7%. By the end of 1998 it was about 20%.
Instead of embarking on a massive education campaign from the moment it took office the ANC virtually ignored the threat. This was despite South Africa having all the conditions for the HIV virus becoming a fact of life for a large part of the population: the virus was spread mainly through heterosexual contact, condom usage was minimal, promiscuity was rampant, sex workers operated in large numbers, especially in areas where migrant workers, usually single males, were located and sexual violence was widespread. South Africa's neighbours were already in the throes of an HIV epidemic and the movement of people in the region was substantial. In addition, the high levels of unemployment amongst young people meant that thousands were roaming the streets. Many sought solace by engaging in sexual activity. Single and married men usually had multiple partners.
By November 1998 the HIV/AIDS crisis had become too evident to ignore and the first major government campaign against AIDS was launched. It was estimated that at this point up to 22% of the adult population was HIV positive or about 3.2 million people and South Africa had the distinction of having more people infected with the HIV virus than any other country in the world, except India. At the end of 1998 the Minister for Welfare, Geraldine Fraser, estimated that 250 000 South Africans would die of AIDS over the next three years. The 1999 Aids Epidemic Update, a joint report by the United Nations Programme on AIDS and the World Health Organisation, has estimated that in southern Africa life expectancy which climbed from 44 in the early 1950s to 59 in the early 1990s could decline to 47 by 2005.
Although the government had now recognised the gravity of the problem, its response remained shoddy. In 1998/99 only US$ 20million was allocated for AIDS education. The replacement of President Mandela by Thabo Mbeki represented a new phase in the South African government's approach towards HIV/AIDS. Instead of confronting the issue head on, Mbeki spent a great deal of time questioning the ethics of the drug companies, the efficacy of anti-retroviral drugs and most bizarrely whether there is a link between HIV and AIDS. The first line of attack has a great deal of legitimacy but the latter two have had disastrous implications. It has led to a half-hearted and confused education campaign around the prevention of HIV/AIDS and has contributed to the South African government's refusal to countenance the use of anti-retroviral drugs for HIV positive mothers. This is despite Glaxo-Wellcome's offer to supply the drug at a greatly reduced fee. It is accepted amongst researchers in the field that the administration of a short course of anti-retroviral drugs to expectant mothers cuts down the risk of transmission of the HIV virus to the new-born by one-half to two-thirds. In the South African context this means - to quote Justice Edwin Cameron, who is HIV positive and one of South Africa's most eminent critics of Mbeki's policies on HIV/AIDS - that every month in South Africa `5000 babies are born, unnecessarily and avoidably, with HIV'. Despite the overwhelming evidence to the contrary, the Ministry of Health premised its refusal of Glaxo-Wellcome's offer on the basis that there is not enough evidence that the drug works.
The refusal to sponsor the purchase of the anti-retroviral drugs for expectant mothers has had a dire impact on the credibility of the ANC-led government. It could be argued that the government's stance has resulted in the unnecessary deaths and suffering of thousands of children. Children who should have had the right to live healthy lives have been condemned to die because of the intransigence of the ANC leader and the refusal of his fellow cabinet ministers to challenge him.
The recent international AIDS conference held in Durban, South Africa, once more threw into sharp relief the crisis facing South Africa and other sub-Saharan African countries. Conference participants were damning of Mbeki's stance. In response to Mbeki's questioning of the link between the HIV virus and AIDS and his recent convening of an HIV/AIDS advisory panel which included a number of dissident scientists propagating this dangerous view, 5000 physicians and researchers signed "The Durban Declaration" which was subsequently published in the journal, Nature. It briefly summarised the evidence that HIV does indeed cause AIDS, the way the virus is transmitted, what needs to be done to prevent its spread and emphasised the need to develop new, less expensive and more effective drugs to fight the virus.
A government spokesperson accused the originators of "The Declaration" of attacking the president and dismissed it. A scheduled press conference in Durban to be addressed by the originators of the document was unexpectedly cancelled. No official reason was given.
Mbeki's speech opening the conference was met with dismay. Hundreds of delegates walked out and its conclusion was met with muted hand clapping. Instead of using the occasion to directly address the issue of HIV and AIDS and announce a major new offensive, Mbeki chose to emphasise the importance of poverty in Africa and how it has contributed to the prevalence of HIV/AIDS. A plan of action was not addressed. Mbeki also defended his fraternising with dissident views and called for tolerance in the debate so `as to allow all voices to be heard'.
A far more appropriate demand from the South African government and other poor nations is that the drug companies involved in the manufacture of anti-retroviral drugs make these drugs affordable to victims in poorer countries. The current cost of the drugs means that almost all of the 24 million Africans in sub-Saharan Africa who are at present HIV positive are destined to die because they do not have the means to acquire the necessary drugs. The only way that this can be resolved is if the drug companies involved donate the relevant drugs to governments or alternatively if the drugs are bought by wealthier countries or agencies like the World Bank and then donated to the governments concerned. Of course, the mere presence of the drugs is just the start. Structures and processes then have to be put into place so as to ensure that people affected are educated to take the cocktail of drugs in the correct fashion.
The question that emerges is why the South African government has responded in such a clumsy, ad hoc, ineffective and ultimately callous fashion to the HIV/AIDS crisis. There is no easy answer to this question. Perhaps it is being driven by a genuine concern that the value of anti-retroviral treatment is questionable and that the cost at present does not warrant its use. This argument is more appropriate in the context of the average person who has the HIV virus. Even at a greatly reduced price, the cost of the drugs is about $100 a month per person. The South African government would find it difficult to finance anti-retroviral treatment for all. However, the cost factor is not an issue in the case of expectant mothers where, as mentioned, a very short course of AZT is sufficient to dramatically reduce the risk of mother-child transmission. Furthermore, the cost of supporting sick HIV positive infants in hospitals is extremely high and far outweighs the cost of the anti-retroviral drugs. In the case of expectant mothers and children one could accuse the ANC of adopting an inexplicable policy position that has had the direst consequences. Of late, there does appear to be a slight softening of the government's hardline position on the giving of anti-retroviral drugs to expectant mothers and there are indications that it may alter its stance in the coming months.
One thing is clear. In the next decade the social fabric of South Africa's society is going to be dramatically transformed by HIV/AIDS. Hundreds of thousands of people are going to die of AIDS and millions will be stricken with HIV-related maladies. What is less clear is what the impact of this unfolding human tragedy will be on the society. Africa's beacon of hope faces a very testing start to the 21st century.
Alan Morris is a visiting fellow in the School of Sociology at the University of New South Wales.