Khadija Magardie
The South African National Defence Force’s (SANDF) skewed policy on HIV/Aids has once again come under the spotlight, after an HIV-positive soldier in Durban sought legal assistance after threats to discontinue his anti-retroviral therapy.
Following a letter from the soldier’s lawyer, the SANDF backed down, stating that it would continue treating patients already on the programme, but refusing to take on any new cases. But the case raises the question of who, according to government policy, may or may not be provided with free anti-Aids drugs.
According to unofficial statistics and a Metropolitan Life survey, 40% of the SANDF is HIV-positive, a figure the defence force says is inflated. Despite this, the South African Medical Health Services, the umbrella body for SANDF medical services, claims its position on the provision of treatment is in line with the occupational exposure policy of the Department of Health.
Occupational exposure refers to situations where people are exposed to HIV in the execution of their jobs. Nurses fall within this category. According to government policy, provided employees follow the correct notification procedure as prescribed by legislation, they are eligible to receive post-exposure prophylaxis – the “starter pack” cocktail of Retrova and AZT – and, failing this, free anti-retroviral medication.
The SANDF has confirmed that, except in cases of occupational exposure, and where rape charges have been filed, soldiers are not treated for the virus.
In the case of rape, it appears that the SANDF policy contradicts the official line toed by the health department – namely that the supply of anti-Aids starter kits to rape survivors in public hospitals is too costly. This is not the only contradiction of SANDF policy.
The can of worms was opened by Major Esme Cataka, a retired military practitioner who, up to June this year, was stationed at the Durban base. A professional nurse, social worker and Aids counsellor, Cataka was an ex-Umkhonto weSizwe soldier. Working as a health educator for sexually transmitted diseases and HIV/Aids in African National Congress camps in exile, she was also one of the pioneers in the formation of a HIV/Aids treatment clinic on the Durban military base in 1995.
Cataka claims that, when inquiring about the availability of two anti-retrovirals to treat HIV-positive soldiers, she discovered that the drugs were already being supplied, via the chief pharmacist, to soldiers stationed in Pretoria and in the Western Cape. This, despite official statements at the time saying treatment was too expensive.
One of the patients, a civilian working in administration, is alleged to be the brother of a prominent officer managing the defence force’s HIV/Aids programme.
The pharmaceutical company, which is the only known manufacturer of the drugs, refused to confirm the quantities of anti- retroviral drugs being sold to the SANDF, nor the period during which they were supplied. It did confirm that at least one of the drugs was on the SANDF’s “shopping list”, but said “no significant purchases” of anti-retrovirals were being supplied.
According to Cataka, there is discrimination within the SANDF in deciding who gets treated with anti-retroviral drugs. The defence force’s policy requires that in all cases, the member should test HIV-negative at the time of the alleged incident of occupational exposure or rape.
In early 1999, following Caktaka’s complaint regarding selectivity in treatment for HIV/Aids at SANDF bases, a batch of the drugs was ordered for Durban- based patients. Following her resignation in June, the HIV-positive soldiers on the treatment were told it would be discontinued. It was at this stage that legal advice was sought.
Mark Haywood of the Aids Law Project at the University of the Witwatersrand says it may appear unfair that certain soldiers are treated and others not, but he cautioned against what he called “pitting one sufferer against another”.
Acknowledging the moral obligation of government bodies to provide treatment in cases of occupational exposure, he said the focus should rather be on seeking means to provide treatment to all sufferers, regardless of how the virus was contracted. In the case of rape, he said, there is “a legal obligation on a government that cannot protect its female population from rape to make available access to effective treatment”.
The health department has been criticised for its refusal to provide the drugs in public health facilities, particularly to rape survivors and pregnant women.
For Haywood, part of the problem is “the lack of a holistic HIV/Aids policy” in the SANDF. An example of this is the issue of pre-employment testing. A recruit who tests HIV-positive cannot be admitted into the SANDF. This is misleading because the so- called “window period” means that one could test negative and later have the virus. There is at present no follow-up testing.
In late 1997, the Department of Defence, with the Department of Health, launched the South African Civil Military Alliance to Combat HIV/Aids. The aim of the project was to raise HIV awareness among soldiers.
According to a defence force internal circular, soldiers would be educated about treatment options. But for some of the soldiers at Natal Command, who were diagnosed after joining the SANDF, the measure may be too little, too late.