What a difference a year makes. A collective sigh of relief was heard throughout South Africa on April 17 last year when the Cabinet at last acknowledged its programmes would be based on the premise that HIV causes Aids and promised to introduce a national treatment and prevention programme.
Health providers throughout South Africa believe the government has failed to keep this promise.
The government’s position on HIV/Aids over the past year has been ”nothing short of bizarre, irrational, ill-informed and pathetic”, says Clive Evian, a doctor with Johannesburg consulting group Aids Management and Support.
Caregivers say the government has moved at a snail’s pace to quell the rise in HIV infections and that it has failed to introduce a national anti-retroviral programme, the most important part of any treatment regimen.
The Cabinet was forced to release its statement last year because of pressure from civil society, ministers and the African National Congress’s own health committee members who do not hold President Thabo Mbeki’s position, says Jerry Coovadia, a professor in Aids policy and treatment at the University of Natal.
The Cabinet’s statement appeared to break the government’s apparent alliance with Aids dissidents. The move was welcomed by Aids organisations for recognising that anti-retroviral drugs improve the quality of life of people with Aids.
”Because these drugs are costly and can cause harm if incorrectly used or if health systems are inadequate, we will continue working to lower the cost of anti-retrovirals, including having discussions with the producers of the main drugs and investigation into possible production of generic drugs,” last year’s government statement said.
However, the government has still failed to provide licences for companies to produce generic Aids drugs in South Africa.
Speculation was rife last year that the government’s turnaround was directly linked to achieving Mbeki’s dream for the New Partnership for Africa’s Development.
The Cabinet statement committed the government to implementing a Constitutional Court order that it administer nevirapine at hospitals and clinics throughout South Africa to prevent mother-to-child transmission of the HI virus. Nevirapine is being widely provided in most provinces except Mpumalanga.
In the second week of March Parliament heard that the government’s legal battles against the provision of anti-retrovirals to HIV-positive pregnant women has cost taxpayers R2,88-million.
Other achievements include the provision of anti-retrovirals to victims of sexual assault, improving nutrition programmes for people with HIV and extending home-based care programmes.
Despite the Cabinet’s statement last year, many believe that Mbeki and Minister of Health Manto Tshabalala-Msimang still flirt with Aids dissidents. Tshabalala-Msimang recently confirmed this view by appointing controversial Aids dissident Roberto Giraldo as her nutritional adviser.
”It is almost impossible to explain why Mbeki and Tshabalala-Msimang take the position they do and why they continue to defy medical science, South African HIV/Aids specialists, clinicians, university departments and economists,” says Evian.
One possible explanation could be their obsessive rejection of a Western explanation for the epidemic.
”Of course it is not really a Western notion at all, it is simply the fact of the matter, and the quicker our president and his [health] minister accept this, the better. I think their greatest fault is in trying to make clinical decisions and then basing their policy on these decisions. Mbeki is totally unqualified to do so and Tshabalala-Msimang is both inexperienced in HIV care and completely overpowered and dominated by Mbeki,” Evian says.
He says the government’s reluctance to provide anti-retroviral treatment is understandable, because the cost and the delivery of proper care are real issues. ”However, they are using every kind of nonsense to avoid the issue. They keep tying themselves in knots and getting entangled in confusion and developing irrational anger with the people. If it is unaffordable, then they should just say so and do as best they can.”
Cati Vawda, director of the Children’s Rights Centre, says the government’s policy is at odds with itself, with many government officials working towards treatment. ”We need to have strong, courageous voices that will stand up and lead.”
Mbeki and Tshabalala-Msimang do not represent the government’s general view or the progress in HIV/Aids policy, says Coovadia.
He warns that the programme to prevent mother-to-child transmission of HIV had been difficult to get off the ground. An anti-retroviral programme would be even more difficult to implement, but he is confident that the government will introduce a national treatment programme.
Last year the government and Aids activists were beginning to reconcile around the idea that South Africa should respond to the HIV/Aids crisis with prevention and treatment.
The relationship crumbled late last year after the government refused to sign a treatment plan. The government faces its first civil disobedience campaign from Aids lobby groups.