World Aids Day dawned this week on two different epidemics. Epidemic one, in the developed world, sees an Aids plague that has not spread as fast or as fiercely as first predicted. There are fewer people dying, fewer people catching Aids, fewer reported HIV infections. These reductions should be celebrated. Preventive health campaigns as well as the new anti- retroviral drug combinations are working. Even people with HIV are living longer.
But epidemic two, in the developing world, is spreading on an almost unimaginable global scale. Last week’s report from the joint United Nations Programme on HIV/Aids and the World Health Organisation set out the grim facts: there are 30-million people worldwide with HIV or Aids – which includes between two million and three million South Africans, and an estimated 2,3-million people will die from the virus this year – marking an increase of 50% on last year’s figures.
In a little more than a decade, all the gains health workers have achieved through clean water projects, better sanitation and wider immunisation programmes are being wiped out. African countries that have added 20 years to life expectancy since independence have suffered a brutal reversal of this progress. Poor countries have become even poorer, while the better- off are better off.
The number of people in the United States dying from Aids dropped last year for the first time since records began in 1981. Aids cases in Western Europe are expected to drop by 30% this year. Warnings need to be heeded, however: the new combined drug therapy is not easy. Some 30% find themselves unable to survive the rigours of the regime. The fall in the number of infections is unlikely to be as dramatic next year. The successful new drug combination could easily suffer a reverse as new resistances emerge.
But it is the Third World where despair sets in. Even if a vaccine is discovered, the developing world’s problem will not be over. Traditional vaccines are no use in developing countries because they are unable to store them (lacking fridges in the villages), distribute them or even afford them. The new combination drugs cost $17 000 per patient per year. Many developing nations spend less than $10 per patient per year.
Yet there are lessons to be learned. Even in the West, prevention has been more important than cure. Local health promotion campaigns have worked in countries such as Uganda. More investment in traditional health programmes – immunisation, clean water, better sanitation – will produce a population more resistant to the virus, as will a focus on sexually transmitted diseases.
New research programmes among Africans with natural immunity may achieve a breakthrough, although the gap between identifying a remedy and “bottling” it remains wide. The French are right to push for a worldwide fund to combat Aids. Ironically, the biggest threat to the Third World could be the retreat of Aids in the West and the complacency it would almost certainly breed.
In South Africa we need to prepare for this by pitching our relatively hi-tech resources into a Third-World scientific initiative to combat Aids and not by authorising quacks to experiment on unsuspecting sufferers.
Open arms trade
A Human Rights Watch discovery that yet again South African arms have been sidetracked into another bloody African conflict – this time Burundi – prompts the obvious question whether Africa needs South Africa’s arms industry.
Time and again, in Angola, the two Congos, Rwanda and Sudan, weapons of war sourced from South Africa have turned up, undermining the government’s claim that peacekeeping is a cornerstone of our foreign policy.
One might even ask whether foreign policy has been hijacked to serve the aims of the arms industry. Arms deals increasingly accompany high-profile presidential visits abroad.
But can we ignore the national and international political repercussions of arms trading with countries with fragile democracies, dictatorships or poor human- rights records, particularly given the South African arms industry’s notorious past?
What does President Nelson Mandela’s recent visit to Saudi Arabia say about his government’s priorities internationally? Why is he happy to sell arms to Indonesia?
What makes the sales more intriguing is the secrecy with which elements in the government, the clients in the deal and the arms industry want to shroud the deals.
This makes it difficult for Parliament and the general public to hold the government accountable for deals which have an impact on South Africa’s standing internationally.
The South African sale of arms to Rwanda, in which the government claims to be using sales to pursue goals of regional stability, raises the question: who is to say when the fine line will be crossed, and South African weapons are used not for consolidating peace, but for selective attacks?
The problem is always that a legal trade is accompanied by an illegal trade, as we are seeing in the Burundi and other African wars.
It is important for the government to acknowledge openly the importance of arms sales in their foreign relations and to allow these sales to undergo public and parliamentary scrutiny, in a way that, at the moment, they are not.