Mbeki’s AIDS denial – Grace or folly? Part V

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.

Mbeki’s strategists blamed Tshabalala-Msimang for previous failures, and she was quickly sidelined. Although government strategists grudgingly conceded that the health minister had become identified with the abysmal failure to manage the disease, Mbeki still refrained from firing her. Ironically,it would take Tshabalala- Msimang falling seriously ill in late 2006 for Mlambo-Ngcuka, with the help of Madlala-Routledge,to finally wrest control of government’s AIDS policy from the health minister. Mlambo-Ngcuka was assigned to lead the new AIDS approach, and was appointed as head of South Africa’s National AIDS Council. Some of Tshabalala-Msimang’s responsibilities were transferred to her deputy, who had previously been excluded from making decisions on AIDS policy. Mlambo-Ngcuka promised to consult non-governmental groups and outsiders on government’s future AIDS policy. However, Tshabalala-Msimang has tried to fight back in-between bouts of illness, attacking both Madlala-Routledge and Mlambo-Ngcuka: ‘The incident of my illness was portrayed as an opportunity to turn others into champions ofa campaign to rid our government of the so-called “HIV and AIDS denial at the highest level.”

Nevertheless,Mlambo-Ngcuka and Madlala-Routledge – with Mbeki’s backing – have revitalised the moribund battle against the pandemic and have deservedly been showered with praise by HIV/AIDS experts and civil society groups. However, some long-suffering AIDS veterans remain sceptical: they have been here before and have seen many false dawns.

Practical considerations aside, there is much work yet to be done, by govern- ment, the TAC and other civil society organisations, to destigmatise the disease. Gugu Dlamini was stoned to death by a mob near Durban after she disclosed her HIV-positive status on radio. The veil of secrecy surrounding the deaths of Peter Mokaba and Parks Mankahlana show how pervasive the stigma is.

The Sisulu family proved a rare exception when they went public after a family member died of AIDS. Buthelezi, an arch-traditionalist, also broke the silence by acknowledging that both a son and a daughter had died of AIDS within months of one another in 2004, and publicly speaking of the devastation the disease has caused within the family circle. And when Nelson Mandela announced that his son, Makgatho, had died of AIDS in January 2005, it was a move aimed at breaking one of the most stubborn taboos surrounding the pandemic.

It is true that there are cultural taboos against speaking about death, but the continual denials perpetuate the terrible stigma surrounding AIDS in South Africa. The vast majority of the population still see the disease as something that happens to ‘other’ people – prostitutes, migrant workers and moral lepers. Only those who have done something bad, behaved immorally or been sexually promiscuous get AIDS, and ‘decent’ folk are right to treat them as outcasts. Sex, too, is something that polite people don’t discuss in public. It happens, but one does not talk about it, hence Zuma’s mind-boggling statement that those who dare to mention oral sex are ‘un-African’.

The fact that Mbeki has never led the way in talking openly about AIDS, as President Yoweri Museveni did in Uganda, has seriously undermined all government efforts to combat the disease. Mbeki’s refusal to acknowledge that HIV is sexually transmitted is a major obstacle to facilitating behaviour modification and greatly diminishes the dedicated attempts of sex educators to protect another generation from wholesale infection. A more enlightened leader such as Chandrababu Naidu, chief minister of the Indian state of Andhra Pradesh, for example, insisted that all his ministers should make mention of AIDS in their public addresses, no matter what the topic.

Mbeki’s role is crucial. Though South Africa has the most progressive Constitution and Bill of Rights in the world, with women’s rights firmly entrenched, gender relations are far from being democratised. Age-old perceptions of women as ‘possessions’ run deep, and in November 2003,a South African Medical Research Council study offered conclusive evidence of links between gender-based power inequalities and the risk of South African women contracting AIDS.

The study recommended that reducing gender inequalities and making men more respectful of women are crucial weapons in the fight against AIDS, and in building a society in which women have the right to live free from violence. The most recent research shows that women aged between fifteen and twenty-nine are three to four times more likely to be infected than males. As the country’s president and leading male role model, Mbeki could be extremely influential in changing attitudes towards women.

Recent official surveys show a high level of HIV infection – 20 per cent – among young people between the ages of fifteen and twenty-four. In addition,1.5 million children under the age of eighteen are maternal orphans, who have lost either a mother or both parents, and 66 per cent of them have been orphaned as a result of HIV/AIDS. In all, 1.8 million AIDS-related deaths have occurred in South Africa since the start of the pandemic.

Mbeki’s handling of the AIDS issue has reinforced his image as a lone, remote intellectual and contrarian battling against the world. It has also illustrated the president’s Don Quixote side, which caused his mentor, Oliver Tambo, many headaches. Tambo once told an associate: ‘That Thabo is such a clever young man, but I always have to keep a close eye on him,because he tends to wander off[on intellectual pursuits].He would cause my death,if I am not careful.’

In dealing with AIDS, Mbeki may have wandered off on a deadly diversion that has helped place an entire nation in denial and needlessly taken the lives of millions of its citizens.

*William Gumede is the author of Thabo Mbeki and the Battle for the Soul of the ANC - Published by Zed Books (http://zedbooks.co.uk). His latest book, 'The Democracy Gap - Africa's Wasted Years', will be published later this year.

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