The new health minister launches a massive Aids programme to deal with the looming crisis. Mark Gevisser reports
AFTER years of official foot-dragging and negligence, the government has finally endorsed an Aids programme that could see as much as R256-million allocated to Aids prevention and care in the next two years.
In the most important official acknowledgement yet of the looming Aids crisis, Minister of Health Nkosazana Zuma yesterday endorsed the National Aids Plan, which was developed by Nacosa (the National Aids Convention of South Africa), and undertook to launch a multisectoral National Aids Control Programme that will begin almost immediately.
Zuma plans to spend at least R100-million on Aids prevention programming this year alone. The current Aids budget is R20-million a year, but Zuma believes she can find at least R40-million from within her health budget this year, and that this can be supplemented with another R60-million from international sources like the European Union and USAid.
Zuma’s job immediately prior to assuming the health portfolio was chairman of Nacosa’s strategy subcommittee. “As Nacosa,” she said, “it was obvious that Aids was going to be one of this country’s greatest crises — in terms of health and the economy — and that the government was not going to get around to doing anything unless prompted. So we felt that we needed to present it with a plan they could use as the basis for strategy.”
Now, as the minister primarily responsible for Aids programming, she is on the receiving end of a plan she developed. “In principle, the government accepts the plan, but that doesn’t mean we’ll implement it word for word.”
Top priorities, she says, are to start developing mandatory sexuality education curricula in schools; to embark on a mass information campaign; to improve the treatment of sexually-transmitted diseases; to distribute condoms more effectively; and to fight discrimination of people with HIV by setting in place national policies and changing discriminatory legislation.
On this last score she believes “the most important thing is to counter the stigma of Aids. If people deal with it secretively, it just reinforces the culture of fear and ignorance, and makes it impossible to control. People need to see Aids as a disease like any other, to demystify it . We have to outlaw discrimination against people with Aids.”
The plan calls for a national manager based in President Nelson Mandela’s office, and regional authorities working out of the nine premiers’ offices. But Zuma believes the programme would be better managed as part of the Reconstruction and Development Plan, and intends to keep it as a function of the Health Department.
She stressed, however, that the co-operation of other ministries (Education and Welfare) is critical, and her next step will be to present the plan to the cabinet’s RDP committee. She has held preliminary talks with RDP chief Jay Naidoo who “understands the implications of Aids in the workplace”.
Johannesburg Aids chief Clive Evian, one of the architects of the plan, said “the most vital aspect of kickstarting a programme like this is the political will of the government”. But while he believes “we have a major ally in Zuma, there hasn’t been any real demonstration of political will from the other heavies up there, except for Mandela, who has highlighted the issue from time to time”.
Zuma will have to battle it out with the other funding priorities facing the new government, and she stressed that the programme cannot work without private sector involvement.
Malcolm Steinberg, head of the Medical Research Council’s Aids programme, believes that many in government are still “looking for a quick fix. But what we need to do is tackle the whole value system of this society, and the morality which continues to see Aids as divine retribution for sin”.
Zuma acknowledged that this, perhaps, is the major challenge facing her. Previous Aids programmes in schools have failed because of the unwillingness of authorities to deal explicitly and openly with sexuality. “In the long-term perhaps we do need to change the values of this society, so that it can be more acceptable for young people not to be sexually active. But in the short term, let’s face it, condoms are useful.”
Does this mean she is on a collision course with the churches? “Absolutely not. Clerical leaders must deal with it in a way that they feel is most effective within their own communities.”
The plan puts an emphasis on Aids prevention and education (53 percent of the budget), and allocates 38 percent to counselling, care and support for people with HIV and Aids. Most of this funding — about R100-million — will go towards improving the primary health care system. Despite a high HIV-infection rate (550 000), there is not yet an undue strain on health-care services: currently, there are only 10 000 people with Aids needing medical treatment, as opposed, for example, to 11 000 killed on the roads each year. But, notes Evian, “the crunch will come in five to seven years’ time”.
Most encouraging about the plan, is it was developed by people working in the Aids field. “This gives us a fighting chance. The last government did try, but it had a history of controlling peoples’ lives, so people saw Aids prevention as another form of control. I don’t think it’s going to be easy for us, but we stand a better chance.”