In the euphoria that followed President Jacob Zuma's AIDS Day speech, finally nailing down the coffin lid on government AIDS denialism, the memories of fifteen wasted years could almost be pushed aside, says Virginia van der Vliet, the well-known author of AIDSAlert.
In a news letter, she says it's about time South Africa got serious. "While UNAIDS could announce that new infections in sub-Saharan Africa were down 15%, South Africa's figures have shown no such decline. One reason for this failure is undoubtedly the delinquent policies of Zuma's predecessors, and the confusion, doubt and denial they sowed".
Van der Vliet says Zuma announced a number of important changes, to be implemented from April 2010: HIV-infected children of under a year of age will be given antiretroviral (ARV) treatment; patients with HIV/TB co-infections will receive ARVs if their CD4 counts drop to 350 or less rather than the current 200; all pregnant women with CD4 counts of 350 or less, or with an AIDS-related illness, regardless of CD4 count, will be put on ARVs at 14 weeks of pregnancy to protect the baby. ARV testing and treatment would now be available at all healthcare facilities, not just accredited ARV centres.
Zuma also announced a massive testing campaign - "Every South African should know his or her HIV status." Zuma himself was arranging to be tested, though he said he had been tested before and knew his status. He emphasized that better treatment did NOT mean people could now be sexually irresponsible. Rather they should join the "struggle for the health and prosperity of our nation."
The speech was welcomed by all those who had fought for better treatment policies, although the Treatment Action Campaign (TAC) noted that the 350 CD4 guideline should apply to all HIV-positive people as recommended by the World Health Organisation.
More important, perhaps, are doubts about the capacity of our creaking health system to deliver on these ambitious goals, given the kind of crises we have seen with even the current modest goals in, for instance, the Free State. As a Business Day editorial (3 December 2009) concluded: "So, while we welcome the break from denialism, we also urge the government to ensure a practical, not just rhetorical, victory against the deadly virus."
It is not just a matter of capacity; the new policies will be expensive to implement. Given that, according to leading HIV clinician Dr Francois Venter, treating a patient currently costs between R6000 and R8000 a year, the new, extended plans will not come cheap.
Donor help will be critical, says Van der Vliet. The US has already pledged an additional R900 million over 2 years, following a direct request from Zuma, in addition to the R4.2 billion contribution it has budgeted for HIV/AIDS efforts in South Africa for the 2010 fiscal year.
US officials say Zuma's new approach will mean "a new era of co-operation' on HIV/AIDS between the two countries . The government's new approach coincides with a rising clamour for former President Thabo Mbeki to be called to book for his handling of the epidemic, which saw hundreds of thousands of unnecessary deaths, and untold suffering, happen on his watch. The issue, like everything about HIV/AIDS, has immediately become politically charged, even provoking in-fighting between the ANC and its alliance partners.
Before the elections this year, stories circulated that the ANC planned a post-election apology to the nation for the disastrous AIDS policies under Mbeki, and the deputy speaker, Nozizwe Madlala-Routledge, called for an enquiry, akin to the Truth and Reconciliation Commission (TRC) into the government's role, in order to prevent "something like this happening again." Little more was said. Then new health minister, Dr Aaron Motsoaledi, admitted in a parliamentary media briefing in November 2009, that the "shocking" rise in HIV and in AIDS mortality, were a direct result of the previous administration's denial and neglect - "our attitude towards HIV/AIDS put us here where we are."
Of late, the calls for Mbeki to be made answerable have heated up. The Congress of South African Trade Unions (COSATU) has called for him to apologise to the nation for his failure to fight an epidemic it blames for "destroying more lives than any invading army in history." (New York Times December 2009). However, as COSATU general secretary Zwelinzima Vavi pointed out, the chances of such an apology are slim, as Mbeki has denied "ever saying that he questioned the link between HIV and AIDS," and "that the government did not have a plan to deal with AIDS." (Business Day 1 December 2009)
The idea of a TRC for HIV/AIDS, first suggested by the TAC's Zackie Achmat in 2008 ( after the release of the Harvard study, which claimed 365 000 people had died as a result of government policies under Mbeki), was re-floated, by Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa, at the University of KwaZulu-Natal, in the online Science and Development Network in October 2009.
While Karim welcomed Zuma's new approach, he asked: "Should we simply forget the past and accept that it was unfortunate - but there is nothing we can do about it now? To simply ignore the actions that led to hundreds of thousands of avoidable deaths would be to condone them and lay South Africa open to history repeating itself." In order to prevent this and to "rebuild trust among all those working against HIV/AIDS in South Africa," we need to know exactly what happened (including detailed estimates of how many people died), and why the government and other decision makers allowed these "damaging policies" to take hold in a democracy, "where government should be accountable to the public for its actions."
Some calls go even further; they demand that Mbeki and his (recently deceased) lieutenant, Health Minister Dr Manto Tshabalala-Msimang, be hauled before courts and charged with genocide. HIV/AIDS has certainly been allowed to cut a devastating swathe through South Africa. The SA Institute of Race Relations (SAIRR, November 2009), estimated that so far 2.9 million have fallen to the disease. The number...is undoubtedly awful enough to qualify as "a crime against humanity." Genocide, which implies an intent to kill, directed at a particular category of people, would almost certainly not stand up as a charge in court.
The call has been made by Buti Manamela, national secretary of the Young Communist League (December 2, 2009)...The president of the ANC Youth League, Julius Malema, immediately attacked Manamela's position, saying that Mbeki "might have made mistakes, but we can never charge him," and that "we must never surrender our leaders."
In a thoughtful piece by Frans Conje, deputy CEO of the SAIRR, he writes (20 November 2009) that "it was presumably not Thabo Mbeki's intention to kill hundreds of thousands of people, but in this case the absence of intent does not alter the fact that the consequence of his negligence and indifference were foreseeable." He suggests that an alternative to charging Mbeki with genocide might be for the victims of the disastrous HIV/AIDS policies to pursue class-action type claims against the government and the ANC "for loss of breadwinner support and the like that resulted from the death of family members." However, he comments: "incredibly, many of the victims remain among the most loyal and steadfast supporters of the ANC and are unlikely to initiate any action against their leaders..."
Why did Mbeki get away with it for all those years? Why did other leaders and followers collude in what was patently a disastrous course of action (or inaction)? Myriad reasons suggest themselves...they were scared to take him on, perhaps remembering how former president Nelson Mandela himself was savaged for daring to put the case for AIDS treatment...
Van der Vliet concludes: So who was ultimately responsible for the AIDS disaster?...Throughout the time that Mr Mbeki foisted his AIDS policy on South Africa, Parliament had the legal, and the ANC the political, power to remove him from office." With a few honourable exceptions, like Nozizwe Madlala-Routledge and Barbara Hogan, who did raise concerns on the issue, they did nothing to stop the carnage.
To single Mbeki out as the scapegoat for the AIDS catastrophe is as ludicrous as blaming apartheid on a handful of deluded white leaders.
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