World Aids Day: a time to celebrate and to lament

2007-12-01 00:00

As we observe World Aids Day (WAD) this year we mark the 26th anniversary of the isolation of the HI virus.

Our attitudes to the pandemic cannot but be mixed ones. There is much to celebrate and much to regret. In South Africa we once more achieve a bad eminence: the UNAids 2007 Global Report indicates that we are “the country with the largest number of HIV infections in the world”. We have more people on ARVs than any other country. But we still lag behind the government’s own treatment goals.

We’ve adopted the new National Strategic Plan 2007-2011 (NSP). Described by UNAids director Peter Piot as “ambitious and credible”, it is the product of broad-based consultation, sets goals, and specifies those most at risk: women, sex workers and men who have sex with men. Regrettably, former deputy health minister Nosizwe Madlala-Routledge, who last November injected a new commitment into our Aids drive, urging us to “do whatever we can to save lives,” was sacked in August.

We have fine policies, many committed personnel. The slogan for WAD this year is: “Fight Aids: Keep the Promise.” These words urge us all to make Aids a political priority and to ensure that our leaders deliver on the programmes we have in place. After the many unseemly spats we’ve had at the highest political level, we must ensure we are fighting Aids and not each other.

That said, we need to reiterate the importance of effective political leadership. As the ANC leadership race hots up, we should recall the time and lives lost through dithering and obscurantism at the highest level. This is not carping. One cause of what I have termed second generation denialism is the attempt to misrepresent aspects of our recent history in the hope of exonerating our leaders from catastrophic errors of judgment. We know that President Thabo Mbeki asked Parliament, “How can a virus cause a syndrome?” Published this year, Nicoli Nattrass’s book, Mortal Combat, should, like the NSP, be essential reading. Her cautious estimate of 343 389 lives lost unnecessarily between 1999-2007 bears heavily on succession debates.

Last week, Jacob Zuma, much-favoured for the ANC presidency, conceded that “we could have done more” on HIV/Aids. But this is the former head of the National Aids Council who spoke of the need for “moral regeneration”, espoused the ABC prevention message, and yet had unprotected sex with an HIV-positive woman who was not his wife. It is, perhaps, our most dramatic instance to date of the insufficiency of the broad advice to Abstain, Be faithful, and Condomise. It is also a chilling example of the fallibility of our political leadership.

As the NSP indicates, our prevention programs must become more targeted. UNAids insists that countries “know their epidemic”. Though the vaccine trials have been suspended, we know a great deal about the biology of HIV/Aids. We know much less of its sociology. For prevention programmes to work, we need a huge increase in targeted research amongst our various populations to establish more clearly the precise nature of the drivers of this epidemic. Our biomedical model runs ahead of our cultural and socio-economic understandings. But we do know we have not one, but several epidemics running in tandem.

We must note the increasing feminisation of the pandemic: it’s no coincidence that WAD falls within the 16 Days of Activism Against Gender Violence. Sixty percent of HIV-infected adults in sub-Saharan Africa are women. UN special envoy on Aids in Africa, Elizabeth Mataka, has vowed to speak “honestly about the cultural practices that are harmful to women”. She cites the requirement that daughters be “submissive and obedient” and opposition to divorce even in marriages “with high risk and abuse” as problematic.

That men who have sex with men (MSM) constitute a high risk group remains difficult. To date we have no meaningful data on the epidemic among this group, yet we know that in Canada, the U.S. and Britain new infections among MSM are key drivers. Given the levels of homophobia in South Africa — something placing MSM who might have HIV in a doubly stigmatised position — we must break the silence on this issue.

Speaking in Geneva this November, Judge Edwin Cameron insisted that “stigma lies at the heart of the experience of every person living with HIV”. Elsewhere he insists we must “stop stigma”, and this means “stopping blame, moralism, condemnation”. We must understand more clearly the drivers of stigma, and oppose them promptly.

We must insist that HIV is a medically manageable condition, while also urging prevention. We must retain the political exceptionality of Aids while defusing stigma-fuelled fear. Psychologists and anthropologists are as vital to us now as scientists. In the media we must know that rehearsing statistics is useless. We need insight, not mere data.

In June Deputy President Phumzile Mlambo-Ngcuka urged that “if we are united like we were when we fought apartheid we can conquer [HIV/Aids]”. Apartheid was about stigma, exploitation, marginalisation and abuse of power. HIV/Aids is too. As with apartheid, we have the resources and we know what to do. Keep the Promise.

• Tim Trengove Jones lectures at Wits University and has written widely on culture and politics in South Africa.

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