The run-up to the International Aids 2000 conference starting in Durban on July 9 has been dogged by controversy
Timothy Trengove-Jones
If asked to name a single issue that drew into unambiguous focus the most pressing dilemmas facing this country today, one would have to answer HIV/Aids.
But, immediately upon giving that answer, one would need to redefine the question, if only because HIV/Aids is not a single issue, but cuts across economic, cultural, political and medical domains.
The tentacles of the problem make debate so fraught, answers so difficult and a multidisciplinary approach imperative.
From July 9 about 10E000 delegates will gather in Durban to attend the International AIDS 2000 conference. The run-up to the conference has been dogged by controversy, largely caused by the often contradictory, sometimes incomprehensible utterances about HIV/Aids made by President Thabo Mbeki.
The president is to open the conference and all South Africans will be looking to hear a message of hope, based upon clearly articulated goals for the management of the pandemic in this country.
Such a message would not only offer hope to the approximately four million people living with Aids in South Africa and spur on our increasingly exhausted and disenchanted Aids workers. It would say something reassuring about the very nature of our new democracy.
For, alongside the (often maudlin) recent debates about the science of HIV/Aids in this country, has been a much less-remarked-upon index of the nature of political power and its implementation.
What has emerged from government policy is a top-down form of decision-making in which expert opinion has been thwarted or silenced. Remember now the ill-fated Virodene saga.
While Mbeki welcomed this witches’ brew, the Medicines Control Council was replaced for its refusal to endorse the product and, only after a considerable delay, did Professor Malegapuru Makgoba, head of the Medical Research Council (a body charged largely with confronting the pandemic) speak out against it.
It is completely inadequate to talk, as commentators have done, of the sad “interference” of politics in medicine. Given the nature of the pandemic, the issue not only requires political intervention but precise and canny political leadership of the highest order. Rather, what is at issue is a hollowing out of proper democratic structures: it seems that people are prevented or intimidated from speaking their minds.
It is, therefore, a pointed irony that Aids 2000 should take as its theme “Breaking the silence”. When I asked the organisers what this motto’s specific reference might be, I was referred to the conference website. I found, if you like, a silence.
In another irony, we remember that the president’s panel of international experts, gathered in Pretoria in May, was the occasion for many, intense mouthings about free intellectual enquiry.
Critics of the government’s actions were branded as members of the “thought police” by presidential representative Parks Mankahlana.
Perhaps most worrying were the remarks made by Makgoba after the Committee of 33’s meeting. He said, on a series of experiments with Aids dissident Peter Duesberg, “that will in all probability disprove his theories, or may prove him right”.
It is difficult to underestimate the potential damage in a remark such as this. That a medical scientist of Makgoba’s calibre should feel it necessary to be drawn into what, to some of us, looks like a cynical game in order to humour the state president is further evidence of what I’ve called the erosion of democracy in this country.
Looked at through a different lens, what some hailed as Makgoba’s statesmanlike behaviour might appear as weak-kneed toadying to a president who will brook no contradiction even from a man of science whom he has himself appointed.
The more we hear the government extolling the virtues of free and open debate, the more virulent become the attacks on all those who criticise it.
For, looking at the evidence of HIV/Aids (mis)management in this country, it seems clear that the personal journey of the president in relation to the illness is bedevilling and stalling this country’s hopes of effective policies. All indications imply that the president’s own views of the matter take precedence, requiring loyalty and even subservience.
Discourse surrounding HIV/Aids is currently the surest barometer of our national health. Besides the president, we have a Minister of Health, Manto Tshabalala-Msimang, who, inter alia, insists that on the matter of treatment she will “not play God” by deciding who will or will not die. Rather than an abuse of authority, this is an abdication from it. If the task seems too great, the minister should abdicate altogether and resign.
Mbeki has insisted that issues of poverty should be linked to Aids in Africa. Unfortunately, the issue has been reported as one suggesting that poverty causes Aids and the socio-economic has been muddled with the medical. However, if a government’s duty is to provide for its citizens, and given that South Africa is reported to have the highest rate of HIV infection in the world, we have another problem.
Why does the newly democratic government in what Organisation of African Unity leader Kofi Annan has called the “economic powerhouse of Africa” have soaring unemployment and rocketing HIV- infection rates? It is not just the issue of a failure to provide basic health care that suggests that economically our new democracy is not delivering. HIV/Aids is a dangerous issue because it forces this uncomfortable recognition.
If the new democracy has a duty to educate its citizens then, again, HIV- infection rates tell a sorry tale. The government’s new five-year plan stresses the importance of awareness programmes targeted at the youth. Yet researchers report high awareness and high infection rates.
The kind of education vital to simply keeping our population alive is a failure. And this is no surprise when the latest plan itemises as a primary goal the promotion of “safe and healthy sexual behaviour”. The document’s very language itself fails to understand the crucial truth that there is no such thing as “safe” sex.
And, finally, if the new democracy undertakes to provide free health care to children under seven and to pregnant mothers then, at the moment, we face another failure.
The persistent refusal to offer prophylactic treatment for pregnant HIV- positive women is a dangerous and glaring contradiction of the government’s own policy. Despite the insistence that HIV/Aids is a national crisis, there are still no protocols in place for its treatment.
In March Tshabalala-Msimang insisted that the government “was intensifying [its] fight against HIV/Aids”.
No matter how jaded one might be, one does not question the government’s commitment. One retains – following the president – one’s democratic right to question and finds that the issue is a searching one. It is to do with democracy and competent government within that democracy.
Timothy Trengove-Jones is an Aids researcher and academic