Aids, Poverty and Ignorance in South Africa
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Twenty years after the first clinical evidence of Acquired Immunodeficiency Syndrome (AIDS) was reported, it has become the most devastating disease humankind has ever faced. Since the epidemic began, more than 60 million people have been infected with the virus worldwide. Data shows an estimated 57,520,805 infected people around the world with that number increasing by approximately 1,400 people per day (redribbon.co.za). AIDS is now the leading cause of death in sub-Saharan Africa. Worldwide, it is the fourth-biggest killer. At the end of 2003, an estimated 46 million people globally were living with AIDS. In many parts of the developing world, the majority of new infections occur in young adults, with young women especially vulnerable. About one-third of those currently living with AIDS are aged 15–24. Most of them do not know they carry the virus. Millions more know nothing or too little about AIDS to protect themselves against it. Dr. Malegaparu Makgoba, President of the Medical Research Council of South Africa, warns that “as Africa faces the challenges of its renewal or renaissance, there is no greater potential barrier to the attainment of this vision than the specter of the HIV/AIDS epidemic” (mrc.ac.za).
The most affected part of the world has been Sub-Saharan Africa, in particular South Africa. The groundbreaking article released at the end of 2002 by the Medical Research Council of South Africa, the “Impact of HIV/Aids on adult mortality in South Africa” report is the first comprehensive examination of mortality statistics from the AIDS era. In a strongly worded introduction to the report, Dr. Makgoba states that as a consequence of early beliefs that AIDS was a disease exclusively due to homosexuality and that “many Africans promoted the notion that homosexual practices were ‘unAfrican’, thus sowing the seeds for denial to justify why AIDS would not be prevalent in their communities” (mrc.ac.za). He believes that “this denial was compounded by stigmatization, chauvinism, the distortion of scientific evidence, and ignorance” (mrc.ac.za). The report shows data proving that AIDS is the biggest killer in South Africa—with an estimated 40% of adult deaths during 2003 were caused by AIDS.
According to the researchers of the ‘Impact of HIV/AIDS on Adult Mortality in South Africa’, AIDS will continue to be a growing problem in South Africa.
With a higher AIDS count than any other country in the world, in the next ten years the number of AIDS related deaths will rise “to more than double the number of deaths due to all other causes, resulting with between five and seven million cumulative Aids deaths in South Africa by 2010.” The statistics show that one in nine South Africans, and one in four adult South Africans has the dreaded disease and because of that statistic it is estimated that the average life expectancy is only 47 years of age, instead of 66, as it would be if AIDS were not a factor. In addition to this report, Dr. Makgoba believes that “there is no precedent for this in our history. We have a situation where the younger females, who are supposed to be healthy and productive, are dying in greater numbers than their mothers” which doesn’t bode well for the future of South Africa (mrc.ac.za).
AIDS killed 2.4 million African people in 2003. The estimated 3.4 million new AIDS infections in sub-Saharan Africa in that year means that approximately 28.2 million Africans were living with this deadly virus. (See attached graphs). And if history is anything to go by those estimates are even higher for 2004. Without adequate treatment and care, most of them will not survive the next decade. Greater and more effective prevention, treatment and care efforts need to be brought to bear.
International Programs to Combat AIDS
During 2001, the resolve to search for a more effective and useful treatment and prevention for AIDS became stronger than ever. The United Nations General Assembly Special Session on Aids in June 2001 initiated conformity for national and international accountability in the struggle against this epidemic. Each government pledged to pursue a series of many benchmark targets relating to prevention, care, support and treatment of AIDS. The aim of these governments is to:
• Reduce HIV infection in the 15–24 age group of affected countries by 25% by 2005
and, globally, by 2010;
• Reduce the proportion of infants infected with HIV by 20% by 2005 and 50% by
• Develop national strategies to strengthen health-care systems and address
factors affecting the provision of HIV-related drugs, including affordability
• Make every effort to provide the highest attainable standard of treatment for
AIDS, including antiretroviral therapy in a careful and monitored manner to
reduce the risk of developing resistance;
• Develop and implement national strategies to provide a supportive environment
for orphans and children infected and affected by AIDS.
• Implement strategies that begin to address the factors that make individuals
particularly vulnerable to HIV infection, including under-development, economic
insecurity, poverty, lack of education, social exclusion, illiteracy,
discrimination, lack of information and/or commodities for self-protection, and
all types of sexual exploitation of women, girls and boys;
• Develop multi-sectored strategies to address the impact of the HIV/AIDS epidemic
at the individual, family, community and national levels. (unaids.org)
The Joint United Nations Program on HIV/AIDS, known as UNAIDS, recently estimated that the minimum amount of resources necessary to help curb the spread of AIDS in low and middle income countries is between seven and ten billion dollars per year. This global fund called for by United Nations Secretary General Kofi Annan has at present attracted almost $1,500,000,000 in pledges. The World Bank offered major loans in 2002 and 2003 for HIV/Aids, with a grant equivalency of over $400,000,000 per year. All the while, more countries are boosting their national budget allocations towards AIDS responses. Some of the most under developed countries of the world have received, or are due to receive, some sort of national debt relief that could help them increase their spending on HIV/AIDS (unaids.org). Thus, the only apparent challenge should have been moving from commitment to actions, showing that it’s not easier said than done.
South Africa’s Primary Problem: Mbeki on AIDS
For a few months at the beginning of 2001 it looked as if the South African Government had finally come to realize and treat the AIDS epidemic with the seriousness it deserves. After years of ignoring—then underestimating—the dilemma surrounding AIDS, a new sense of urgency seemed to be taking effect within the South African government. Money that had been poured into Virodene, the ‘miracle cure’ that turned out to be nothing more than an industrial solvent, seemed to have been better allocated to more beneficial programs. Just when things appeared to be on the rise, everything took a major turn for the worse thanks to one person. Even with statistics that prove that some 40% percent of the population is presently infected with AIDS, recently re-elected South African President Thabo Mbeki was adamant that the AIDS ‘epidemic’ was by no means a crisis in his country.
Mr. Mbeki’s antics brought a storm of protest when he questioned the Medical Research Councils report that found AIDS to be the single biggest killer of South Africans. He used an outdated study by the World Health Organization to argue that AIDS is only the 12th leading killer in South Africa (lancet.com). Mr. Mbeki then proceeded to ask health officials to reassess their budget according to this World Health Organization report, thus making the budget reassessments as outdated as the report.
Mr. Mbeki clung to his much-criticized stance of denying a direct link between HIV and AIDS in an interview with Time magazine shortly thereafter. “No, I am saying that you cannot attribute immune deficiency solely and exclusively to a virus,” he responded when asked whether he was prepared to acknowledge that there was a link between the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (time.com). He later appointed scientists to government panels who share his foolish mindset that HIV does not have a role in the cause of AIDS. His doubts about this link presented much confusion within the South African public. Doctors and Trade Unionists had to deal with all sorts of questions from patients and members who are convinced that they no longer need to use condoms. According to a doctor at Baragwanath Hospital, “a few irresponsible remarks have undermined years of hard work” (Nytimes.com).
President Mbeki then further squandered his image and brought about a barrage of criticism when he exaggerated the toxicity of Nevirapine, the only anti-retroviral known to stunt the spread and transferal abilities of HIV/AIDS. “There exists a large volume of scientific literature alleging, among other things, the toxicity of this drug is such that it is in fact a danger to health,” he told the National Council of the Provinces, Parliament’s second chamber. His plans for the future were thus based upon this theory and so he “has therefore asked the Minister of Health to go into all these matters so that we ourselves, including our country's medical authorities, are certain of where the truth lies.” He continued by warning Parliament that anti-retro-virals are “as dangerous as the disease they are meant to treat” (Virusmyth.net).
Even after being President of one of Africa’s top countries for 5 years there are many times when the rest of the country questions decisions made by Mr. Mbeki. Although for the most part those questionable decisions do not turn out to be as deadly as his mishap over the AIDS crisis. It is possible to think that being president; he is after all still human, and thus bound to make mistakes. But being having as many right-hand men as he does and being as informed as he could be, his dubious decisions are some times unforgivable.
Mr. Mbeki’s road to become the head political figure in the country was not an easy one. He only found himself at the top after a lifetime of fighting the oppressive white rule of apartheid in South Africa. President Mbeki’s misunderstanding of the seriousness of the situation has been reportedly rooted in defensiveness about race. He has been quoted as saying that those advocating AIDS treatment viewed black people as “germ carriers and humans of a lower order” (nytimes.com). His views, therefore, seem to be based on a retaliation of the Apartheid Era; and he seemed to be trying to show that he will determine the major decisions and won’t be influenced by the majority of white doctors and scientists. It is difficult to imagine a more immoral inequality than apartheid, but AIDS has already built up a higher death toll. And the South African government seemed to have no immediate plans to make anti retro-viral drugs available, using arguments that they are toxic, that there is a lack of infrastructure in the country to ensure correct administration and monitoring of the drug, and that they are simply too expensive. The extremely high mortality will therefore continue to rise at an unbearable rate.
Since his 2001 debacle about AIDS, Thabo Mbeki has managed to get himself re-elected to president. It is now his duty to ensure the safety of his citizens for the next five years. At the outset it seems that he has not made any steps forwards, but as recently as the 21st of May 2004 at his State of the Nation address to the joint sitting of the Houses of Parliament, he pledged that government would be providing 53 000 people with treatment for HIV/AIDS by March 2005. He added that 113 health facilities would be fully operation by March next year. But will this be enough to sustain a healthy country. The severity and ruthlessness that comes with AIDS is somehow still misunderstood within the South African Government (dwaf.gov.za). And although he recently seems to have shifted his position slightly by agreeing to set out a plan for provincial governments to issue nevirapine to infected pregnant women and rape victims, it is far too late for far to many South Africans (economist.com).
The Response: Inform the Misinformed
There is certainly something to be said for Mbeki's vigorous intellectual independence and conviction. He won’t be told what to do by anyone. But even Mbeki’s supporters fear that his stubbornness on dealing with the AIDS epidemic may be increasing the risks to his fellow countrymen. Pressure is growing for him to re-evaluate his conflicting stance on HIV/AIDS and although he was forced to allow a limited amount anti retro-viral treatment for a select few pregnant women, it needs to be more readily available to everyone. One man in particular that Mbeki can’t easily refuse has repeatedly endorsed this demand; that man is Nelson Mandela.
Former president of South Africa, and Nobel Peace Prize winner, Nelson Mandela has continually called for an end to the debate on the link between HIV and AIDS within his former political party, the African National Congress (ANC). It has on many a time caused rifts from within the delegation that could pose greater problems for the unity of both the ANC and South Africa. Mandela has said that the government and South Africans should focus on fighting the ‘war’ against the disease, according and article in the Sunday Times, a national weekly newspaper in South Africa. In an interview with the newspaper, Mandela issued a strong attack on the government’s lack of urgency in the fight against AIDS. Mandela stated: “This is a war. It has killed more people than has been the case in all previous wars and in all previous natural disasters. We must not continue to be debating, to be arguing, when people are dying” (sundaytimes.co.za). The report said that while stopping short of directly criticizing President Thabo Mbeki and the African National Congress, Mandela said he was talking to the ruling party about its position on AIDS and believed it would listen to sound advice. “I have no doubt that we have a reasonable and intelligent government, and that if we intensify this debate inside, they will be able to resolve it.” He said it was only when he had done “everything in [his] power” and exhausted all channels within the African National Congress to reach an understanding that he could and would “come out and criticize them” (Sundaytimes.co.za).
In reaction to Mr. Mbeki’s seemingly unintelligent thoughts on the AIDS epidemic, Mr. Mandela believes that “doctors and sick people should be the ones to decide on the anti retro-viral drugs, not the politicians.” He is very supportive of the idea to move forward on the treatment of AIDS but remains very involved in South African politics and the African National Congress itself. Therefore, he is very sensitive to the insecurities in the Mbeki camp. On the eve of President Mbeki's State of the Nation address in April 2003, Mr. Mandela stressed the importance of preventing mother-to-child transmission of AIDS by allowing the anti retro-viral drugs to be dispersed and used “beyond argument or doubt.” He said that the debate on this killer disease “unfortunately continues to rage in manners that detract attention from what needs to be our core concern” (Sundaytimes.co.za)
The South African Medical Journal has also launched a scathing attack on President Thabo Mbeki for his “therapeutic paralysis” on the treatment and assistance for people with HIV/AIDS. The editor of the authoritative journal, Professor Daniel Ncayiyana, says in an editorial that there can be no excuse for their current stance on the matter. Ncayiyana said that there are real constraints at present to the rolling out of a comprehensive anti retro-viral program for the whole country. However, “sitting back and waiting until everything is perfect is not” an option. The government was quite “foolish, and perhaps even undemocratic,” he said, to maintain “stubborn inflexibility in the face of such enormous public demand for anti retro-viral drugs.” The government had to provide and allow the use of anti retro-viral drugs on the basis of some key principles primarily to alleviate suffering and to prolong lives. Ncayiyana believes that the there is a real risk of resistance to the drugs developing fairly quickly which the medical profession was prepared to accept, even if it meant that post-exposure prophylaxis would be rendered useless (samedical.org)
Many others have joined the dispute against President Mbeki and his party’s views on the seriousness of and necessity for the treatment to this disease. Another South African Nobel Peace Prize winner, Arch Bishop Desmond Tutu, has expressed his concern by complaining that the governments “dithering” over important issues is causing untold amounts of deaths due “to the enemy, the new apartheid,” called AIDS. Another voice among the dissenters of the government is that of Edwin Cameron, a Constitutional Court acting judge. He used one of the first sessions at the XIII International AIDS Conference to deliver a powerful lecture slamming the South African Government to an audience comprised of over 1,000 delegates from around the world. In his momentous speech, which received a standing ovation, Judge Cameron accused the government of mismanaging the HIV epidemic “almost at every conceivable turn” and declared his disappointment of President Thabo Mbeki and his decisions (virusmyth.net).
The Solution: Put Country before Presidency
“This is war,” according to Mr. Mandela, “it has killed more people than has been the case in all previous wars and all previous natural disasters. We must not continue to be debating, to be arguing, when people are dying.” With this in mind, one glimmer of hope came through the words of Trevor Manuel, South Africa’s finance minister addressing parliament, who acknowledged the extent of the mortality of AIDS. He publicized that an “extra R357, 000,000 ($55,000,000) would be spent over the next three years on the fight against AIDS.” He conveyed his thoughts that “the budget contains significant measures to strengthen the national HIV/AIDS program.” In addition to this monetary assignment, R86,000,000 ($13,000,000) is to be allocated, during the next financial year, for the distribution of condoms throughout South Africa. Also, there will be an increased effort on forming the basis of the AIDS education and counseling programs, and the care of AIDS sufferers and pregnant women with AIDS (allafrica.com).
A German pharmaceutical Company, Boehringer – Ingelheim, has been offering, unsuccessfully until recently in South Africa, but successfully to all other developing countries since July 2000, its drug Nevirapine for the prevention of mother-to-child transmissions of HIV/AIDS. The drug prevents the newborn from being infected with HIV at birth in a high percentage of cases. “It was made for the world, as it still is now. Rejection won’t make us change that policy; we still would want to provide the medicine” (allafrica.com) With the limited amount of Nevirapine that is now in use it is hoped that studies will show the necessity for a greater use of this ‘miracle drug’ (allafrica.com).
Mandela knows Best
In his closing remarks at the XIII International Aids Conference held in Durban, South Africa, Nelson Mandela reiterated the devastating impact HIV/AIDS is having on families, communities, societies and economies around the world. Decades have been chopped from life expectancies. AIDS is clearly a disaster. The most frightening thing is that all of these new infections and the human suffering could have been and many more still can be prevented. Something drastic needs to be done.
Mandela then went on to tell the world what everyone should already know:
• “With nearly two decades of dealing with the epidemic, we should have some
experience of what works. The challenge now is to move from rhetoric to action;
action at an unprecedented intensity and scale. There is a need for us to focus
on what we know works.
• We need to break the silence, banish stigma and discrimination, and ensure total
inclusiveness within the struggle against AIDS;
• We need bold initiatives to prevent new infections among young people, and large-
scale actions to prevent mother-to-child transmission, and at the same time we
need to continue the international effort of searching for appropriate vaccines;
• We need to aggressively treat opportunistic infections; and
• We need to work with families and communities to care for children and young
people to protect them from violence and abuse, and to ensure that they grow up
in a safe and supportive environment” (virusmyth.net)
The former President concluded by pleading for everyone’s help to combat this enemy. “For this we need to be focused, to act strategically, to mobilize all of our resources and alliances, and to sustain the effort until this war is won. We need, and there is increasing evidence of, African resolve to fight this war. Others will not save us if we do not primarily commit ourselves. Let us, however, not underestimate the resources required to conduct this battle. Partnership with the international community is vital. A constant theme in all of our messages has been that in this inter-dependent and globalized world, we have indeed again become the keepers of our brother and sister. That cannot be more graphically the case than in the common fight against HIV/AIDS” (virusmyth.net).
In comparison to his 2001 nightmare, President Thabo Mbeki has made some major steps towards righting an incredible wrong that is taking a firm grip on South Africa. Now in 2004, there seems to be some hope for those AIDS victims. But even with those major strides there is still an immense amount of work and support needed to fix the AIDS epidemic. With the presidential elections only a few months behind us, a question on every South African’s mind is ‘what is Mbeki going to do to help us?’ Is there something out there to make us prosper? Mandela made some profound and accurate statements concerning AIDS and South Africa’s viewpoint on the killer disease. It is time that Mbeki take some of his advice and save our great country. And if he could put as much support and effort in to the HIV/AIDS problems as he did into the 2010 Football World Cup Bid over the last 4 years, then there doesn’t seem like there should be anything to fear. However, seeing him do that is another question altogether.
www.virusmyth.net/aids/index/ - South Africa