The Cabinet’s April 17 statement on HIV/Aids policy — widely hailed as a crucial change of heart — is looking increasingly threadbare. Was it, as some maintain, merely a tactical manoeuvre to deflect international condemnation in advance of the G8 meeting in Canada due to consider the New Partnership for Africa’s Development?
The Cabinet’s clearest concession was on state provision of anti-retroviral drugs to rape victims. There may be a theoretical commitment to this, and it appears to be happening in some provinces, including Gauteng, KwaZulu-Natal and the Western Cape. But, as we report this week, the necessary drugs are either lacking or only sporadically available in two regions with a high rate of infection and pitiful Aids treatment records, Mpumalanga and Limpopo.
On prevention of mother-to-child transmission of HIV, the Cabinet insisted universal roll-out of nevirapine could not begin before the end of the year, while the Department of Health would complete a roll-out plan “as soon as possible”. Why eight months was needed to introduce a relatively simple drug regime is unclear — specialists insist preparations should have taken a few weeks at most. What is really worrying, however, is the persistence of technical obstruction and foot-dragging by certain provincial health officials — in apparent defiance of a Constitutional Court order. In Mpumalanga doctors dispensing nevirapine — which they must source privately — still face dismissal. In Limpopo only two pilot sites serving their immediate catchment areas have access to the drug. The Northern Cape says it plans to begin roll-out only in December. Angry doctors — who ought to know –reject official claims that nothing can be done because of logistical unreadiness.
What is now moving to centre stage is the question of a national treatment plan for the estimated six million South Africans already infected with HIV, more than 400 000 in the last stage of the illness. On this, the Cabinet’s April 17 statement was virtually silent, and nothing visible is happening in the state sector.
Moral pressure on the government to act is mounting. This week the admirable South African Medical Associationboss Kgosi Letlape announced a plan, backed by former president Nelson Mandela, to give free anti-retroviral treatment to those who cannot afford the drugs. A range of private corporations, including Anglo American, BMW and Siemens, as well as the parastatal Transnet, have announced treatment schemes for workers. Treatment Action Campaign leader Zackie Achmat, himself HIV-infected, has sought to dramatise the drive for a national plan by refusing anti-retrovirals until they are available to all.
The bottleneck is not in the national health department — Aids specialists are unanimous in their praise of director general Ayanda Ntsaluba and the head of the department’s Aids programme, Nono Simelela, both transparently keen to move matters forward. But they are functionaries, at the mercy of their political chiefs. The problem, as always, lies with the Cabinet itself.
Since the April 17 statement, Minister of Health Manto Tshabalala-Msimang has complained she is being forced “to poison my people” by providing anti-retrovirals. She attacked Anglo American over its treatment programme at the same time as Parliament’s health committee praised it. She has defended the government’s blocking of a R600-million grant by the United Nations to KwaZulu-Natal — for a project that apparently included anti-retroviral treatment — on grounds that it was “unprocedural”. One can reasonably assume that she would not act and speak in this way if her principal, President Thabo Mbeki, disapproved.
The treatment regime for HIV-positive people is a complex one requiring continuous monitoring and testing, and South Africa clearly cannot afford to treat everyone. Drug treatment without a broad educational campaign to break down the Aids stigma will not succeed. But to argue from this that no one should be treated now is a fallacy.
A good start would be the immediate launch of state pilot sites, of the kind that now administer nevirapine, and state support for private anti-retroviral schemes. And to show that they are no longer prey to dissident fantasies, the health minister and her Cabinet colleagues should consider submitting to Aids tests and publicising the results.
Case for confidence
We applaud the government’s decision to investigate the twists and turns that have occurred in attempts to bring to book the murderer of Martin Whitaker, an East London shopkeeper.
A former Azanian People’s Liberation Army cadre, Dumisani Ncamazana, pardoned by President Thabo Mbeki just two weeks before Whitaker’s murder, was initially brought to court in connection with the fatal shooting, but discharged at his bail hearing. This gave rise to fears that there had been either a grossly inept investigation into the crime or that an official might have intervened to prevent what he feared would be embarrassment to Mbeki over Ncamazana’s pardon.
This week, however, Ncamazana was back in court in connection with Whitaker’s death — and the killing of a taxi driver.
Joe Matthews, Deputy Minister of Safety and Security, has taken a personal interest in the case. We look to him to ensure the public hears the relevant facts. Frank disclosure of what went wrong in this case is necessary to sustain the public’s confidence in our criminal justice system.