Mark Heywood
At the beginning of March 1998, the Minister of Health released the results of the 1997 survey of HIV infection among women attending ante-natal clinics in South Africa. The survey revealed that a staggering 16% of women are already infected with HIV. In KwaZulu-Natal, one in four ante-natal attendees are estimated to have HIV. Nationally, nearly three million South Africans have HIV or Aids.
Minister of Health Dr Nkosazana Zuma told Parliament that South Africa now has the fastest growing HIV epidemic in the world. She did not explain why there is still no serious mobilisation to prevent it.
How, concerned observers might ask, would the government of the United States or Germany respond if close to 20% of its labour force had a terminal illness? Or if more than 15% of women of child-bearing age were living with a virus that is a risk to themselves and their children?
What are the implications of this fact for labour productivity, the health services and the most cherished ideals of the new South Africa: the rights to equality and life?
When an inexplicable illness that caused Acquired Immune Deficiency Syndrome (Aids) was first reported in the United States in the early 1980s, the initial response of public and private institutions was to stay silent and then to release a wave of prejudice against those believed to be the “carriers” -gay men. Countering this required a huge movement led by the gay and lesbian community, which eventually, in the words of The Economist, also “helped to mobilise a massive scientific campaign against Aids”.
Aids activists such as Larry Kramer succeeded in catalysing a public response that reflected outrage and shock at seeing young, mainly white, men die in their 20s and 30s -in a society where, for the middle-class, a life expectancy stretching into the 70s had become a norm. Angry protests were held. Names and histories were attached to those who died. Candles were lit. Quilts were sewn.
It is ironic that in South Africa, which not long ago expressed its outrage at the lost human potential of countless victims of apartheid, there is no equivalent anger about Aids.
Why? Perhaps the answer is in our history and, if we are to galvanise a response, needs to be better understood.
Apartheid lasted for so long because most white people, particularly the rich and politically powerful, developed a callous disregard for black life and potential. African life was considered dispensable, less valuable, more hurtable but less hurting, somewhat animal.
As John Pilger has argued, apartheid may have ended, but that indifference certainly has not. It has simply spread to the relative handful of black people who now have hands on the reins of power and affluence.
This attitude extends far beyond South Africa. It probably originates in the colonial attitude that life in “the tropics” was dispensable. Not too much has changed when you consider President BillClinton’s African visit during which he heralded the “African renaissance” while making no public mention of the huge social problem presented by HIV infection?
There is a degree of continuity between the obliviousness of captains of the Chamber of Mines to the effect of the migrant labour system on their workforce and their obliviousness to the effects of Aids. In the past, those dying of tuberculosis or silicosis, or irredeemably crippled in accidents, were shunted off to the rural areas. The same is happening again.
In 1986 mining was the first industry to begin to calculate the possible impact of Aids on its business. Twelve years later, one large mine (unnameable) reports 100 Aids-related deaths a month. Mine bosses and trade union leaders mirror each others’ silence on this tragedy.
One mine, 100 deaths: no comment. We might be forgiven for thinking that public expressions of loss about Aids-related deaths are reserved for white people. The stigma and discrimination around HIV and Aids seem now to be as socially disabling as apartheid. Look at it this way: in each newly HIV-infected person there is a potential Hector Peterson, Steven Biko, Solomon Mahlangu. To each life lost, or blighted, there is a history, a family, a story.
Ironically, medical breakthroughs in the developed world and a decline in Aids-related mortality have added to our problems. Among the first cadre of Aids activists, particularly in North America, there is a sense that the battle is over. There is little solidarity with the more than 22-million Africans infected with HIV. Of course, there are many social and scientific factors inhibiting the emergence of an effective response to Aids in South Africa. But the first thing that needs to change is the mindset of the rich and powerful. If the value the upper classes (black and white) attach to their own lives could be extended to the poor, we’d be halfway there.
Then, at least, we could act on what we know. From Uganda we know that visible political commitment at the highest level creates greater awareness and consciousness about the reality of HIV. From science we know there are interventions (routine in the US and Europe for several years) that can make the risk of mother to child transmission of HIV almost negligible. We know that active prevention of discrimination encourages greater openness about HIV infection.
I have a courageous friend. A modern black woman with modern aspirations and a new South African’s zest for life. She is living with HIV – most times positively, but in her quieter times, less so. Two years ago, her 2-year-old daughter died of Aids. A death unreported, but of a kind increasingly common among adults and children all over South Africa.
I am reminded of Charles Dickens’s indignation at the rich classes’ callous indifference to the loss of poor people’s lives. This is how he lamented the death of Joe, the street sweeper: “Dead, your majesty. Dead, my lords and gentlemen. Dead, right reverends and wrong reverends of every order. Dead men and women born with heavenly compassion in your hearts. And dying thus around us every day!”
Such indignation and a little bit of outrage would be apt today.
Mark Heywood is project head at the Centre for Applied Legal Studies’ Aids Law Project.
ENDS