Health-e (Cape Town)

South Africa: Citizens Must Take Responsibility for Their Actions

opinion

Challenging "political correctness" inevitably sparks heated reaction from those with vested interests. But seldom have I seen such distortion and manipulation as the article by Gavin Silber and Nathan Geffen ("Zille's HIV claims just a sick joke" Argus November 15).

The article focuses almost entirely on rebutting a statement I never made. It invents a position, falsely ascribes it to me - and then seeks to challenge it. That qualifies as a "sick joke".

It is totally ludicrous to say that I suggested withdrawing treatment from those who contract AIDS "irresponsibly". How would one know? I have never suggested that the public health system stop treating any person (let alone category of people) with HIV.

On the contrary, I specifically emphasised, in my talk at the health summit, that the Province would "continue to provide the most comprehensive HIV/AIDS treatment in the country" -- acknowledged as one of the best in the world. This service was started by the DA during our short period in power in 2000. And we take pride in the fact that it has repeatedly won international acclaim.

I repeatedly emphasised our commitment to comprehensive treatment, because I know how opportunists manipulate emotive issues in their own interests. Geffen and Silber's article perpetuates the myth that underlies so much of our social pathology. They take the patronising view that South Africans are passive victims, unable to take responsibility for their decisions and actions.

The authors consider it discriminatory, intrusive and unconstitutional to require people to take personal responsibility for ensuring that they do not pass a chronic illness on to others. They take the view that the HIV-negative partner is equally guilty. The authors seem to be unaware that most women have little choice in their sexual encounters and cannot ask men to wear condoms.

South Africa will remain in denial until we acknowledge that the root cause of our AIDS pandemic (and many other social problems) is the widespread practice of inter-generational sex with multiple concurrent partners. This is not merely a "moral" issue. Nor is it a private matter. It is a serious public health issue. It is a critical social issue. It destroys families, oppresses women, results in teenage pregnancies, spreads disease, entrenches poverty and costs the state billions each year.

This type of behaviour should be stigmatised, not condoned, or patronisingly justified in the name of "culture". It is worthwhile reminding ourselves that the history of social progress is the story of cultural change to eradicate destructive practices. Intergenerational sex with multiple concurrent partners is a profoundly destructive practice, and it is time we said so unambiguously. No amount of political correctness will stop me from doing so.

Geffen and Silber compare the sexual transmission of HIV to smoking and poor eating habits that also cause ill health. The difference, of course, is that the smoker injures himself. When HIV-positive people have unprotected sex, they potentially pass on a debilitating and incurable disease to others.

No-one can be assumed to have consented to unprotected sex if they did not know that their partner was HIV positive. Yet Geffen and Silber justify this on the grounds of sex being a sensitive and complex matter. So is alcoholism. But no-one condones drunk driving, precisely because it poses such a risk to others. And most citizens expect the state to intervene to protect people from harm, not merely treat them afterwards.

Geffen and Silber are correct to quote the constitution which says that "everyone has the right to have access to health care services" and that "the state must, within its available resources, realise that right". The operative words here are "within available resources". We do not have enough. Every time the state funds something preventable, something else loses out. If rational adults would merely take responsibility for their lives, there would be so much more left for unpreventable conditions. And we need to say so, loudly, clearly and often.

This week I attended the 10th anniversary celebration of the Smile Foundation -- with remarkable donors and dedicated doctors who ensure that children born with facial deformities have the chance of a normal life. The public health system should prioritise these terrible afflictions and not continue to make excuses for destructive sexual practices with devastating public consequences.

I believe, in this context, it is entirely appropriate to require people:

1. To know their HIV status by regular testing which the state should provide, free.

2. To end the practice of intergenerational sex with multiple concurrent partners.

3. To require people to inform a prospective sexual partner if they are HIV positive.

4. To use condoms during sex.

5. To empower women to say No, and to ensure men accept No to sexual advances.

There is absolutely nothing wrong with society requiring people to know their status, and acting appropriately on the basis of that knowledge - or face the appropriate criminal sanctions. Other countries expect their adult citizens to act responsibly. Why can't we?

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