There is something bizarrely, tragically and profoundly wrong in the way our government is thinking about the nation’s health in the light of the HIV/Aids crisis. Heaven knows this point has been made to government leaders often enough before now – with evidence provided – by us and very many others better qualified to do so. The proceedings of the recent World Aids Conference in Durban drove home the point again, not that further argument would have been necessary for a government attentive to reality and to the cataclysm in our midst.
In this edition we tell a story that throws into perhaps the sharpest relief yet the cruel absurdity that is government policy (if “policy” is not too dignified a term for it) on HIV/Aids. It is this. About 131 000 young South African children are dying of Aids each year although as many as 99E000 of them could be saved if the state was willing to provide anti-retroviral drugs and milk formula to all HIV-positive pregnant women. Anti-retrovirals prevent mother-to-child transmission of the fatal disease. The state justifies withholding these drugs from infected pregnant women sometimes on the grounds that it fears their side effects but, more commonly, on the grounds that it cannot afford to supply them. To deal with the first justification first: an HIV-positive mother is (in the absence of a cure for Aids or chronic treatment with anti-retrovirals) doomed to die; in these circumstances side effects from anti-retrovirals are likely to be among her lesser problems. But it is with the second justification that our story is mainly concerned. We show that it is actually costing the state much more money in terms of hospital and other costs to let these 131E000 children die each year than it would cost the state to give anti- retroviral therapy to their mothers. We report that the cost of doing nothing is about R800-million a year more than it would otherwise have been, according to a comprehensive study at the University of Cape Town. Professor Nicoli Nattrass, who supervised the research by economist Jolene Skordis at that institution, is exercising extreme restraint when she suggests that “the state should stop its unconvincing mantra that we cannot afford to save the children” of HIV- positive mothers. For any number of reasons – moral, financial and political – we cannot afford not to save these young lives. Moreover, if our government any longer hesitates and prevaricates on the issue of providing anti-retrovirals to HIV- positive pregnant women, it should not be surprised to hear charges of genocide directed at it. For to fail to act right now against the HIV/Aids pandemic on the basis of best-available science and with all the resources we can muster will have genocidal results. Whether that outcome is the result of malevolence, of incompetence, of panic- induced denial, or of pig-headed obduracy among senior members of the government will scarcely matter. For they will have been warned often enough. Yes, history will then judge them harshly, as former president Nelson Mandela said in a closing speech to the World Aids Conference in Durban last week. But, before history has its turn, the rest of us will have a go at them – and our judgment will not be generous. President Thabo Mbeki and his entire government must either get their act together in combating the HIV/Aids catastrophe – now – or get out of government. Matters are as simple – and as serious – as that. A divorce settlement? Camp David has gathered together the threads of failed promise, disappointed expectations and the hope of a breakthrough in a drama that ought to be compelling. Yet excitement is lacking. There is a strong sense that we are reading yesterday’s news. The reason is that Israelis and Palestinians already have a peace – they recognise each other’s existence, work together in various ways, conspire constantly to gain advantage, have moments of amity but mainly dislike each other, and usually stop short of violence. Peace cannot be more fundamental than this as long as Israel sees itself as an exclusively Jewish state that happens to include some Arabs. Peace between Palestinians and Israelis, one Israeli commentator said years ago, was not about getting married, but about getting divorced.
It is the divorce papers that are being discussed at Camp David. Much of what they will contain is known in advance. Israel will keep Jerusalem, keep its main settlements, and get its way on water and roads. The Palestinian state will be at best weak, at worst unworkable. Why is it so difficult to give formal expression to what in a way has already been agreed? For the Palestinians, a piece of paper would make clear how much they have been forced to give away, and would be a political liability for all those who sign it. For many in the Israeli ruling class, reluctance to settle is not grounded on concrete objections to territorial changes or to the establishment of a Palestinian official presence on the fringes of Jerusalem. No, they fear instead the loss of the issue itself – the loss of the threat which has given Israeli society coherence and which at the same time has given certain narrow groups such disproportionate power. Palestinian public life would be similarly changed. Once the national struggle in its old form is over, the purpose of politics would have to be redefined, and a Palestinian state might be very ill-equipped to undertake that task. So, after all, it has to be concluded that Camp David is exciting, not in the substance of the discussions but in the implications if a deal is struck. At that moment a new politics will begin for both societies.