The odds stacked against the plan look something like this: AIDS-related deaths claimed over 345 000 people last year; more than 1 in 10 South Africans are already HIV positive; 30percent of pregnant women at government facilities countrywide were HIV positive by 2005.
Now, hospitals in Durban and Pietermaritzburg report that well over half their pregnant patients are testing HIV positive, while social workers report that in many families around Durban, three generations are infected. Officially, over 35 thousand people are on waiting lists to receive antiretroviral drugs, but only a quarter of the 5,5million South Africans with HIV even know that they are infected.
The ‘Abstain, Be faithful, Condomise’ efforts aimed at getting South Africans to change their behaviour have had a limited impact in youth under the age of 19 where the HIV infection rate is slowing slightly, but have had little or no impact on the older groups.
Deputy President Phumzile Mlambo-Ngcuka, Deputy Health Minister Nozizwe Madlala-Routledge and acting Health Minister Jeff Radebe have brought an until-now unheard of vigour to addressing the epidemic by driving the adoption of the National Strategic Plan for 2007/2011. But the success of the plan relies on unity within government as well as a strong alliance between government and civil society organisations.
Ironically, the spat over presidential succession provided two opportunities for this new energy. First, it saw the removal from office of Jacob Zuma, who was head of the dysfunctional SA National AIDS Council (SANAC). In contrast, his replacement, Mlambo-Ngcuka, has made HIV/AIDS one of the defining issues of her office.
The second opportunity has developed because Mbeki’s weakened grip on the ANC has meant that fewer party officials feel obliged to keep quiet about HIV/AIDS, as they did in the past when virtually every cabinet minister refused to publicly state that HIV causes AIDS.
Those who are opposed to Mbeki, such as the ANC Youth League and the Young Communist League, have suddenly, opportunistically, remembered that their youth constituency is one of those most affected by the disease and have mentioned HIV/AIDS in speeches and press releases. Zuma himself took a public HIV/AIDS test earlier this year ‘ an admirable act that unfortunately looks rather like one-upmanship in the current climate.
The National Strategic Plan has recently been adopted by both Cabinet and the restructured and revived SANAC. Before its adoption, there was extensive consultation with a wide range of stakeholders including government’s previous nemesis, the Treatment Action Campaign.
Essentially, the plan has two main aims:
‘¢ To halve the rate of new HIV infections by 2011 through a number of innovative and conventional prevention strategies;
‘¢ To treat, care for and support 80 percent of those already living with HIV/AIDS and their families.
Legalising commercial sex work, programmes against alcohol and drug abuse (which both encourage risky sexual behaviour and inhibit people’s ability to take their ARVs), subsidies for people who adopt orphans and food support for HIV positive mothers who breastfeed exclusively, are some of the innovative new interventions proposed in the plan. It also proposes a public awareness campaign involving high profile people taking HIV tests every month for the next five years, to encourage citizens to follow their example.
The plan’s implementation will be costly. It may exceed the entire health budget by 20percent’ and cost up to R45 billion. By far the biggest cost is antiretroviral drugs (40%) followed by support for orphans and children affected by AIDS (7%).
Implementation relies on efficient systems and political will ‘ both of which are shaky in parts. A number of the weaker provinces have not even been able to spend their current AIDS budgets, due to a lack of doctors, nurses and pharmacists to implement the plan.
Political will relies on unity of purpose. But here is the tricky part: Is the AIDS denialism that has undermined government’s anti-HIV efforts a thing of the past? Officially, of course, no one will now admit to denying that HIV causes AIDS ‘ not even Mbeki, despite the fact that he stood up in Parliament and said that a virus could not cause a syndrome.
Unofficially however, those who dispute the links between HIV and AIDS, those who believe that the pharmaceutical industry has manufactured the ‘hype’ about AIDS to sell their products, those who believe antiretroviral drugs are a dangerous killer and those who believe African traditional remedies and nutritional products are the best option to fight ‘immune deficiency’ have been in a loose alliance for some years now ‘ united in their determination to undermine the roll-out of antiretroviral drugs.
This alliance has thrived on the patronage of Mbeki’s close ally, Health Minister Manto Tshabalalala-Msimang, and her Director-General, Thami Mseleku. In a bid to counter the TAC’s mobilisation in favour of ARVs and against bogus AIDS cures, government has worked closely with elements of the National Association of People with HIV/AIDS (Napwa) and the Traditional Healers Association (THA). Napwa and the THA have organised marches and demonstrations in support of Tshabalala- Msimang. Napwa has continued to receive grants from the health department despite being unable to account for money spent and allegations from staff themselves that the organisation’s director, Nkululeko Nxesi, is corrupt. (See Financial Mail, 30 March)
While Tshabalala-Msimang is sick, she is by no means out of the picture. She was briefed regularly about the NSP and apparently demanded some lastminute changes. Mseleku is one of the cheerleaders for African traditional medicine and vitamins as weapons against immune deficiency ‘ even when these remedies have not yet been scientifically proven to work. As long as these two officials wield control over the department of health, it will continue to be plagued by high levels of disunity and staff insecurity as far as HIV/AIDS policy and implementation is concerned.
Tshabalala-Msimang’s high-handed approach to staff is legendary while Mseleku is much the same. Last April, he tried to prevent the TAC and the AIDS Law Project from attending the UN General Assembly Special Session on AIDS (UNGASS) meeting. Last August, Mseleku ordered all provincial heads of department to refuse media interviews on HIV/AIDS in the wake of the health minister’s humiliation at the Toronto AIDS conference and a possible visit to the country by UN AIDS envoy Stephen Lewis. Last November, he forbade departmental officials to attend a meeting convened by the Nelson Mandela Foundation aimed at encouraging dialogue between government and HIV/AIDS scientists.
Also last November, Herbert Vilakazi was appointed as chairperson of a presidential task team on traditional medicines, along with lawyer Christine Qunta. Vilakazi has substantial business interests in uBhejane, a concoction that Zeblon Gwala, its truckdriver maker, claims can cure AIDS ‘ as long as it is taken without ARVs. Qunta represents Dr Matthias Rath, a vitamin seller who also claims that his concoctions can reverse AIDS.
Among the things the task team will be advising government on, according to Mseleku, is whether African traditional medicines should be required to pass the rigour of clinical trials before registration, or be subjected to an alternative testing.
Gwala, Rath and Tshabalala-Msimang’s one-time advisor Tine van der Maas, continue to promote, distribute and (in Gwala’s case) sell for a fortune, their ‘immune-boosting’ concoctions to the sick and the desperate. All explicitly advise patients not to take ARVs.
They have been able to peddle their products without submitting them to the Medicines Control Council, which has so aggravated the TAC that it has launched a court application aimed at forcing the health department to prevent Rath from operating. The case is due to start in the next few weeks and in an ominous curtain-raiser, the department supported Rath’s appeal to accept his replying affidavit that was submitted 13 months over deadline. Rath’s affidavit applauds government’s resistance to ARVS and its willingness to embrace ‘alternative remedies’.
This web of denialists and opportunists is not going to be dismantled overnight. It relies on the protection offered to its members by senior government officials, exploits the divisions created by AIDS denial and has well-established networks to distribute its goods.
Madlala-Routledge has courageously stated that politicians in powerful positions who promote untested AIDS ‘remedies’ are ‘irresponsible in the extreme’, and that Vilakazi should not chair the task team on traditional medicine. But so far, she is a lone voice. Unless government is prepared to act against those who peddle their goods as AIDS remedies and directly undermine the NSP, there will be no unity and the plan will flounder.