Our Aids debate has been characterised by evasion, political correctness and inconsistencies. The Constitutional Court judgement on the issue of mother-to-child transmission of HIV and nevirapine has highlighted some of the issues.
One welcome element in President Thabo Mbeki’s controversial speech at Fort Hare on October 12 last year was his admission of the usually unmentionable reality that HIV/Aids is a pandemic among black South Africans but not as serious among whites, Indians and coloureds. Much of South African society, not just Mbeki, has been confused and in denial over the disease.
The “apartheid legacy” around HIV/Aids is that a campaign in the 1980s and early 1990s, when it could have had maximum impact, would have been seen as the apartheid government trying to stigmatise blacks and reduce their population growth. The African National Congress/United Democratic Front would probably have opposed the campaign. Our present responses have often been simplistic and opportunistic such as the Sarafina debacle, the loveLife campaign and a superficial “condomise for safe sex” solution.
HIV/Aids is primarily a sexually transmitted disease (STD). There are tried-and-tested public health principles for responding to STDs. These include the history of the patient and the centuries-old medical tradition of circumspection and respect for a patient’s privacy within the medical necessity of dealing with a condition such as an STD. HIV/Aids, however, has acquired a human rights dimension, which is not explained by HIV/Aids being a terminal disease.
To understand why, one must appreciate the influence of the northern hemisphere and its “gay lobby” on the medically marginal problem that HIV/Aids is there. The book Defiant Desire: Gay and Lesbian Lives in South Africa, edited by Mark Gevisser and Edwin Cameron, notes: “[In North America and in Western Europe] there was an appropriate gay political movement in place to lead the fight against Aids, but [in South Africa] this fight could actually be used as a mobilising tool, to further buttress and strengthen the gay movement itself.” Those concerns are irrelevant, and even dangerous, in our society, which is threatened with a viral genocide from an STD that is heterosexually transmitted. The human rights baggage that HIV/Aids has acquired should be re-evaluated so that South Africa can deal with the crisis untrammeled by special pleading.
Many contradictions have been exposed in the important campaign around mother-to-child transmission and nevirapine, which ended up in the Constitutional Court. A problematic element is that Zacki Achmat, who led the Treatment Action Campaign (TAC), is on record in writing about his sex life. In Defiant Desire he writes: “I had sex at the toilets every day, sometimes twice or three times a day. I had sex with anyone who wanted to: old, young, black or white, fat or thin, it did not matter.”
In establishing and leading the TAC maybe Achmat is seeking atonement and justification because nowhere has he apologised for a promiscuous lifestyle that has been the key factor in spreading the HIV/Aids whirlwind in South Africa.
A second problem, which government advocates argued in the case, is that the Constitutional Court was treading on ground that is rightly that of the executive. Decisions on “second generation rights” — the social and economic rights in the Bill of Rights — have the potential to turn the Constitutional Court judges into executive lawmakers. This issue is likely to be a constitutional “chestnut” in the future, apart from the controversial nature of second generation rights in themselves.
A third conundrum is the court’s robust defence of the rights of unborn children of HIV-positive mothers. This, however, conflicts with their support for abortion on demand.
Another puzzling implication of the judgement is that, if the state is to be fair to all the unborn children of HIV-positive mothers, then the testing of pregnant women must surely be mandatory. Government planning for physical infrastructure, budgeting for health and education, human resource management in the Public Service and a responsible attitude to the rights of HIV-negative South Africans requires that nobody be immune from testing. The demand for corporations listed on the Johannesburg Securities Exchange to disclose the effects of HIV/Aids on their operations must require knowledge of the HIV status of the workforce. Risk management for investment decisions, protecting the savings of HIV-negative clients and appropriate human resource management, including planning and costing palliative treatment, all require testing. The Constitutional Court clings to a fundamentalist view, that mandatory testing is unconstitutional. It is time it became realistic rather than fundamentalist.
Another issue is that the Constitutional Court has now effectively involved itself in the breastfeeding debate. To provide medicine to address mother-to-child transmission is not sufficient if one doesn’t address the issue of transmission of HIV through breast milk. If milk substitutes are used, they pose another set of health problems around clean water, clean bottles and teats. Such are the pitfalls of “second generation rights”.
South Africans need to get real about the horror we are facing. We are in a war with millions of casualties. We act as though there is a minor insurgency. Political correctness will take us nowhere. We must be honest in exposing cant, and think rationally, realistically and radically if we are to properly address the HIV/Aids nightmare.
Graham McIntosh is a Democratic Alliance MP from KwaZulu-Natal who writes here in his personal capacity. As a farmer he has been closely involved with his farm workers and their families when some of them have died of diseases complicated by Aids