William Gumede
8 May 2008
opinion
Pambazuka News brings you the last part of William Gumede's chapter on Mbeki and the controversies surrounding his AIDS policies. This is from his book 'Thabo Mbeki and the Battle for the Soul of the ANC'.
In the end, economics rather than compassion would force Mbeki's hand on HIV/AIDS. Members of his international investment council warned him at roughly the same time as the NEC meeting that investors found the confusion over the government's approach to the disease unsettling, if not downright frightening. Mbeki's association with the AIDS dissidents was fuelling negative perceptions about South Africa as a potential investment opportunity, and unless a clear and unambiguous change in policy could be discerned, his meeting with the G8 in June to discuss NEPAD could be blown off course.
Trevor Manuel and Reserve Bank governor Tito Mboweni were also starting to feel the pinch as foreign investors probed them on government's AIDS policy, and they, too, began dropping cautious hints to the president of looming economic consequences.
When the cabinet met in April 2002, Mbeki proposed that ARVs be made available to pregnant women and rape survivors without further delay, pointing out that despite the absence of conclusive evidence that they worked, they were already being routinely used by medical staff who suffered puncture wounds sustained from hypodermic syringes.
It was a landmark decision and a radical departure from Mbeki's position to date. He followed through by starting to distance himself from the AIDS dissidents, and gave cabinet an undertaking that no longer would the dissidents or Mokaba be allowed to speak on his behalf regarding the disease.
In an interview with the Star, Mbeki denied that there was a lack of govern- ment leadership on AIDS. 'Perhaps we are not communicating that message loud enough, 'he said. 'But I think there's been very strong leadership on the matter. It is critically important that I communicate correct messages.'
Since then, like many other developing countries, South Africa has increasingly channelled funds into AIDS programmes, albeit at the cost of poverty alleviation or opening up their markets to trade with poorer countries. Development funding is now earmarked almost exclusively to halt the infection rate and treat the victims.
But in fairness, the business community has not been a partner to govern- ment in this battle. The South African Business Coalition on HIV/AIDS surveyed 1006 companies throughout the country on the impact of the disease in commerce and industry, and found that only 25 per cent of them had implemented a formal HIV/AIDS policy. Less than 20 per cent had introduced voluntary counselling and testing programmes, or provided care, treatment and support to infected workers.
Having previously announced with great fanfare that it would make ARVs available to employees free of charge, mining giant Anglo American subsequently withdrew the offer, saying it would be far too costly.[68]Incredulously, trade minister Alec Erwin would claim as late as April 2002 that AIDS had 'no impact on the South African economy or workforce'.
The harsh reality is that South Africa is now faced with creating the largest AIDS treatment programme in the world. The ARV roll-out in the public sector will require a major upgrading ofthe existing health-care infrastructure,recruitment and training of a vast corps of health workers, and a well-coordinated national programme for HIV tests and counselling.
It is a daunting prospect, to be sure, but it can be done. In the mid-1980s,the picture looked equally grim in Thailand, but thanks to a dedicated monitoring programme, concentration on high-risk groups, general AIDS education combined with 100 per cent condom use and vigorous efforts to dispel the stigma attached to the disease, the situation has been brought under control and infection rates appear to have stabilised. The secret ingredient to success, however, has been large doses of political will.
Worryingly, Mbeki still firmly believes that those who contract the disease should assume individual responsibility for their care and not simply expect the state to pick up the tab. He remains unconvinced that HIV causes AIDS, and many senior ANC leaders share his view. Said Smuts Ngonyama, the party's official spokesperson and one of Mbeki's closest associates: 'It's based on a scientific assumption, and like all assumptions, it can be disproved.'
Small wonder, then, that Mbeki could tell the world, without blinking an eye, 'I don't know anybody who died of AIDS' in an interview with the Washington Post in September 2003.
Cynics have no doubt that the only reason the government backed down on the ARV roll-out was to deny opposition parties the chance to use the issue as a vote-catcher in the 2004 elections. Many claimed that the ANC still lacked the political will to tackle AIDS head-on, and predicted that the issue would be moved to the back burner again once the election was over.
In August 2004, Tshabalala-Msimang confirmed that the government would not meet its target of supplying ARVs to a paltry 53 000 people by March 2005. After all, she sighed, 'we are just a developing country'. Somewhat tellingly, she added: 'If you say to the nation that you are providing ARVs then you will wipe out all the gains made in the promotion ofa healthy lifestyle and prevention.'
Government's AIDS policy soon regressed to such an extent that, at the Make Poverty History rally in 2005, Nelson Mandela urged Mbeki to 'recognise that the world is hungry for action, not words'.
Although by the end of 2006 there was a noticeable increase in government's delivery of ARVs, with about 200000 patients receiving the drugs through the public health system, making it one of the world's largest ARV treatment pro- grammes, a further 800000 were in desperate need of them. In many other respects, government rapidly returned to doing things the old way. The AIDS plan was heavily undermined when Jacob Zuma said during his rape trial that, after having unprotected sex with an HIV-positive family friend, he had taken a shower to prevent infection. His testimony showed that AIDS denial was endemic within the highest echelons of government and the ANC. Zuma was the former head of the country's National AIDS Council.
At the World AIDS Conference in Toronto in August 2006, international activists, medical doctors and the media accused South Africa of 'lunatic' negligence regarding HIV/AIDS. The official South African stand prominently displayed lemons and garlic, along with condoms and ARVs, as ways to deal with AIDS. At the start of the conference, the display had also included apples, nectarines and grapes, but these were quickly eaten by passing delegates. Such was the inter- national criticism that investor perceptions of South Africa slumped, which spurred Mbeki into action. The AIDS issue again became part of a political football game. A day after being acquitted of rape in May 2006,Zuma publicly apologised for the irresponsible statements he had made during his trial. Cynical as this apology was, his position was immediately contrasted with that of Mbeki, who had elected to maintain a stony silence on the topic of AIDS. In addition, the SACP and COSATU rained fresh hammer blows on Mbeki over the government's approach. AIDS activists stepped up their criticism and embarked on a strategy to shame government, particularly at prestigious international forums.
In September 2006, the TAC was joined by eighty-one leading scientists to demand the sacking of Tshabalala-Msimang.This was particularly effective, as Mbeki and his cabinet are super-sensitive when it comes to international, and especially business, perceptions of government. Deputy health minister Nozizwe Madlala-Routledge broke ranks with her superiors in October and admitted that government was failing to fight the pandemic. 'Our country is in pain. We are all in pain,' Madlala-Routledge said. She later demanded that all government leaders - including Mbeki - should take public AIDS tests, but backtracked quickly after being reprimanded by senior officials in the presidency and denied that she had singled out the president. On World Aids Day at the end of November, the government announced it would cobble together a new five-year plan to expand treatment and prevent new HIV infections. Mlambo-Ngcuka and Madlala-Routledge became the first government leaders to meet with civil society groups and activists such as Zackie Achmat, previously shunned like the plague. The new plan would make those aged between fifteen and twenty-four a priority, halve the rate of new infections and provide treatment for 750000 adults and children by 2011.'This is a sea change, 'exclaimed Mark Heywood, a leading AIDS activist. 'We' re not across the ocean yet, but now the government is sailing in the right direction.
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