She failed to understand the logic of investing in people’s education, but then refusing to treat them for HIV/AIDS because you did not want to take out a loan, says Dr Mamphela Ramphele, outspoken managing director of the World Bank.

Ramphele said that South Africa needed to offer treatment to mothers living with HIV/AIDS because the country could not afford to face an even larger AIDS orphan burden.

She said that South Africa needed a comprehensive approach to tackling HIV/AIDS that should include the prevention of mother to child transmission, sustained messages that include talking unashamedly about sex, condom use and drug treatment (anti-retrovirals) “There is a window of opportunity now that this whole issue of intellectual property rights have been demystified so there is a greater willingness from the pharmaceutical industry to work with countries with a variety of offers,” said Ramphele, who joined the World Bank last year after serving as vice-chancellor at the University of Cape Town.

Ramphele, who was in Cape Town last week to receive an honorary doctorate from her alma mater, is responsible for social development, health, information technology and education at the World Bank.

She said a variety of treatment options were being looked at. This included continuing the treatment of the mother “so that you don’t end up with a larger burden of AIDS orphans.

“In this continent alone there are about 13 million AIDS orphans. No society can survive with kids who grow up without support. Second, it is better to keep people alive that we have invested a lot of money in terms of training and here the private sector is leading the way.”

Ramphele acknowledged that despite the World Bank being involved with HIV/AIDS since the mid ’80s, the “big push” has only come over the past 18 months.

She said the institution had already given “soft” loans (loan at a low interest rate coupled with a substantial grant) worth U$1,7-billion (about R13,6-billion).

“Is it moral to give loans for an epidemic such as HIV/AIDS? The issue of morality is important, but the question is, what options remain? There is an option to do nothing or do something with soft loans which are in effect a two-third grant and a one-third loan at low interest rate (well below 7,5%) and a repayment period of up to 40 years,” Ramphele argued.

She said any country that was serious about its future would not overlook such an option. “Also, the whole argument of loan morality is an excuse for people to do nothing. Here you are talking about the future, about young people, people you have invested in and you say you’ll continue to educate then and they will die because you refuse to take a loan. I don’t understand that logic.”

Returning to the critical issue of orphans, Ramphele said the world had to stop expecting impoverished households to carry the largest problems associated with the epidemic.

She said there were no models out there, but there needed to be interventions that took the burden off women and young children.  

She said countries needed to look at strengthening certain institutions such as boarding schools.

“If the teenagers could be in a boarding school and come home to a family that is also supported somehow and then it becomes a burden that is lighter.  

But if they are simply left in the villages and townships we are going to see a sociological disaster.”  

Asked whether she thought South Africa has a clear AIDS plan, Ramphele was forthright: “If we are clear, it would be obvious to everybody.”  

She said her understanding was that there was a plan that had been developed to match the best in the world. “What will need to be done for the world to know is for that plan to be articulated, not just by the Minister of Health, but by all the ministers, including the president.

“Until the world hears us, they will always wonder what it is that we’re doing.”

As a South African planning to return to the country of her birth in the future and a medical doctor, what is Ramphele’s assessment of South Africa’s response to HIV/AIDS?

“As a South African, obviously I am concerned. I love this country and I am a resident of this country. I’m also an educator and concerned about the young people we are producing who are dying. I have two sons. I wouldn’t want them to come back to a country where they will be at risk at every level. I have a material interest as a South African and hope now that we have won the case against the international pharmaceutical industry and with all of the offers that are out there, the country will start implementing.”