Nelson Mandela ended the 13thInternational Aids Conference by urging delegates to rise above their differences Tim Trengrove-Jones The 13th International Aids Conference began with exasperation and ended in muted hope. The exasperation sprang from the opening address given by President Thabo Mbeki. The hope came from the careful, principled closing address of his predecessor, Nelson Mandela. The shift between these two poles can stand as emblems of the realignment in thinking which the conference – despite its many obstacles – managed to effect. Mbeki reiterated his contention – one he’s rammed home since at least late last year – that poverty is the great imperative and stumbling block. In the presence of about 1E500 journalists from around the world, he doggedly refused to make the one simple statement we’d all prayed he would: HIV is a specific virological intervention present in all cases of Aids. The president bloody-mindedly (I use the term designedly) rejected a golden opportunity for a simple act of damage control. If that was not disappointment enough, he seemed keen to diminish the conference before it had even started. “Perhaps in thinking your conference will help us to overcome our problems as Africans, we overestimate what [it] can do,” he said. This remark is an anagram for the rest of the president’s address. It insisted that international visitors understand their provisional status as outsiders and, in so doing, underscored differences between Africa and the West. Despite this unpromising start, I am pleased to report that the conference will “help us” – this is, after all, a fairly modest, interim goal. And one reason it will is because of the lead given by Mandela in his closing address. Through effective and strategic lobbying, the conference managed to ensure that global views of HIV/Aids will never again be purely medical. It made it clear that the pandemic is both a development and human rights issue, as well as a scientific- medical affair. In so doing, it demonstrated the interdisciplinary, cross- border thinking required for any effective interventions. If such a view adds greatly to the complexities of our understanding, it also adds to the potential efficacy of our interventions. Much of this was at least implicit in Mandela’s address. As such, it served as an encouraging summary of what had been achieved.
Where Mbeki stressed division, Mandela reached for synthesis. Where Mbeki failed to offer any policy initiatives or undertakings, Mandela twice insisted on the need for “large-scale actions to prevent mother-to-child transmissions.” Although a protest march and many speakers highlighted the need for this very intervention, Mbeki did not rise to the occasion by committing our government to it. The former president ensured that we ended the week where we began, that is, with our minds clearly focused on what is not only possible but a political, economic and ethical imperative. But Mandela did more than that. His speech was exemplary in that he did what he could to right an earlier oversight. During his own presidency, the government’s HIV/Aids policy stumbled from error to error. To my knowledge, Mandela himself devoted only two speeches to what was daily becoming a more severe crisis. Now, in stressing the need “to move from rhetoric to action”, and in insisting on the need for treatment to contain mother-to-child transmission (MTCT), the former president gave yet another example of diplomacy and humility.
He showed us it is possible to atone for past mistakes and to do so with dignity, earning a nation’s thanks and praise. The contrast with Mbeki’s characteristically intransigent opening speech could not be starker.
Mandela also insisted on the need to “rise above our differences … to save our people”. The acrimony and mistrust that have developed between the government, pharmaceutical companies and Aids activists is dismaying but unsurprising. The pandemic draws into stark relief virtually every major point of potential conflict: wealth, culture and gender, both within and between nations. The conference underscored what has long been apparent: in an increasingly globalised world, HIV/Aids highlights the tensions between the local and the international.
Easy talk of a “globalised world” or a “global village” cannot begin to bridge the gap between, for instance, the plight of a young, rural South African woman and a New York teenager. It follows, that to “rise above our differences” and “save our people”, we need to redefine what we understand by “our”. The currently exclusive nuance of the term needs to be extended to an inclusive one. To effect such a change in perspective within the fractured space that is the current South African cultural domain is itself a huge task. To attempt to achieve this internationally is even huger. But the conference showed signs of moving to help “us” work towards this attitudinal shift.
For the moment, we need to concentrate on destroying one crucial divide: the perceived gap between prevention and treatment. As Judge Edwin Cameron has emphasised, treatment is prevention. This is especially true of prophylaxis to prevent MTCT. But it also applies to post- exposure prophylaxis in the treatment of rape victims. Furthermore, treatment is a major social incentive. If people know they can get treatment, they are more likely to take advantage of voluntary testing and counselling services. This, too, will help stem the spread of the illness. As Judge Cameron insisted at an address at Wits last Friday: “Once we break the dread equation between Aids and death, we break the hold it has over our minds.” We now know that another drug, Nevirapine, can reduce MTCT by 30%. Its manufacturers have offered the drug for free for a five-year period for this specific application. Now, with grim predictability, our government stalls again. Now, it is the issue of possible resistance. Informed medical opinion tells us that we should proceed to make this therapy available. It seems “we” are determined not to allow even our own medical scientists to help “us.” Informed opinion recognises the need for collaboration both intra- and internationally. We also see the need to “rise above our differences”, but not if these are obstructive. If our government does not, as a first step, commit itself to MTCT therapy immediately, it needs to be told that it risks no longer being considered “ours”. Increasingly, commentators resort to an idiom of warfare when talking about HIV/Aids. It is now clear that the president’s strategy is larger than cheaper pharmaceuticals. He is using the pandemic as a weapon to right colonial economic and political wrongs. In this light, we need to understand that every preventable infection of a baby in this country casts that child as, at best, a strategic casualty. When the president resorts to the language of ethics, we should remember this fact. Remember, too, that underlying the language of ethics, economics and politics, is the the fact that we come to the wealthier countries as supplicants. HIV/Aids has shown itself to be hugely divisive. But precisely because of the personal and economic imperatives informing the need to “be well”, it could emerge as an issue around which we can all unite. In transcending the imperatives of current party politics, it provides the basis for a new set of political imperatives in terms of which every party in this country must know it will be carefully judged. Any credible politics in South Africa today must now be a politics of health. Political players need to know they don’t only ignore this at their peril, but ours. Aids 2000 should teach us this lesson and, again, Mandela has begun to show us a way forward and given us muted hope.