The right to vote and the opportunity it provides for an individual to contribute to social change is a very simple, powerful tool in the democratic process, and we in South Africa have waited long and suffered much to secure this right.
For this reason alone we should all discharge our responsibility as voting citizens with due care and informed thought. In so doing we must take cognisance of the impact of HIV/Aids on our lives as seriously as we do with equally pressing issues such as unemployment, the economy, poverty alleviation, food security, education, public health services and rampant crime.
That being said, assessing the contesting political parties according to their approach to solving the Aids crisis is quite an undertaking. Am I justified in being disposed towards doubt, and even cynicism, in my response to these approaches?
None, in my view, has presented a comprehensive, credible, and forward-looking programme to address this HIV/Aids crisis, whether now or in the near future. I do not see imagination and foresight at work, nor any articulation of the critical need for an exploration of the boundaries between pragmatism and possibilities.
Without wishing to minimise the impact of malaria, tubercu-losis, cardiovascular disorders, trauma and other major killers of humankind, it must be said that the HIV/Aids pandemic in our country is like no other, and therefore requires the utmost and immediate efforts to stem its spread and to treat those suffering from infection.
We have to live with the fact that politicians everywhere tend to inflate the benefits they promise to bring to the nation if elected, so that we should take all such campaign assurances on HIV/Aids with a large measure of salt, or suspended belief.
As HIV/Aids is accepted by most people to be an unprecedented catastrophe in South Africa, is there a likelihood that politicians will pay lip-service to its dimensions merely to win votes? Although I have a strong suspicion that some do, this is entirely subjective and I do not believe this applies to the majority of the parties.
Most, I sense, are serious about the problem and wish to respond coherently. In their manifestos the African National Congress, the Democratic Alliance, the Inkatha Freedom Party, the United Democratic Movement and Independent Democrats place high priority on HIV/Aids. The DA proposes to establish an entire ministry for HIV/Aids, the IFP calling the problem a ”national priority”, and the UDM is devising ”a national plan of action”.
Many of the parties seek to mobilise a broad collective to subdue the pandemic: for example, the ANC calls for ”stronger partnerships across all sectors”, the ID wish to work across and with a very large number of institutions and sectors, and the New National Party pinpoints churches (not speaking of other faith-based institutions), people’s forums and other organisations.
None tackle the question of passing the leadership and management of the HIV/Aids national programme (with final accountability to the state, of course) to any person or institution outside of the government, whether these be NGOs, the corporate sector, or health professionals and scientists.
Unsurprisingly, almost all political parties promise anti-retrovirals (ARVs) — with the ANC already committed to a public programme, the NNP to provision of free ARVs, the UDM to ”universal treatment”, and the DA to a ”national programme”. The Freedom Front (FF) and the Azanian People’s Organisation (Azapo) are silent on this, although the latter speaks of ”necessary treatment”.
However, there are many complexities to ARV provision on a national scale, with massive benefits but also huge risks. Little thought appears to have been given to finding the safest route between a better quality of life arising from ARV treatment, and the sustainability of the programme, taking into account possible resistance of the virus to drugs, prevention and treatment of opportunistic infections like tuberculosis, and the management of drug toxicities.
One suggestion for assessing the parties’ proposed HIV/Aids programmes and their likelihood of success is to base one’s decisions on the party’s past achievements and on trust. Naturally, this is only possible with regard to the ruling party, which does have a track record and, demonstrably, a blemished past with respect to HIV/Aids.
The present programme of the ANC is full of promise but the future is highly uncertain. The province with the finest track record is the Western Cape — but having noted this, is the province’s success attributable to the NNP’s governance, or due to the availability of the best health-services infrastructure, resources, and the lowest prevalence of HIV in this country?
KwaZulu-Natal has been governed by an ANC minister of health in an IFP government. It has relatively inadequate resources, a troubled public health service, and the highest number of people living with HIV/Aids in any one region in the world.
The fact is that, with the exception of the ANC, it is very difficult to draw inferences about the political capacity for wise leadership and sound practical implementation for the control of the HIV/Aids pandemic in South Africa. The decision as to where to place one’s trust is as difficult for an individual voter casting the ballot in April 2004 as it is for one to determine whether, in the face of HIV/Aids, sex with another human being is ever really ”safe” without protection.
As far as voting this year is concerned, it will be an exercise in probabilities to discern which party would be least likely to stray from its election promises and in so doing, to betray one’s trust in its HIV/Aids programmes. If one is focused on the pandemic as a deciding factor, one may as well close one’s eyes and make one’s mark. Controlling, reversing and conquering this pandemic will be a monumental task. Those at the helm of this country will have to deal with multiple complex public health issues simultaneously.
For example, while ARVs and other treatment and care initiatives are being phased in, prevention programmes will have to be escalated, otherwise treated persons may become complacent because they feel healthy — as has transpired in industrialised countries — and may resume or increase risky sexual practices.
New messages to change risky sexual behaviour will have to be devised and conveyed to people, while mega-scale provision of female and male condoms and substantial improvements to health services for the management of sexually transmitted diseases will be needed. Upscaled access to antenatal clinics will have to be provided for mothers with their infants and children, and an overall rehabilitation of our public health services set in motion.
It turns out that most of the political parties understand the rudiments of the concept that prevention and care are synchronous, not dichotomous, and that the two are often interdependent. The FF and Azapo are silent on this, while the IFP, ID, NNP and African Christian Democratic Party are explicit.
The dangers of unscientific medicine, the promotion of so-called ”cures” for HIV/Aids, and the uncritical use of untested substances and practices have exacerbated the pandemic in this country. The people in power must safeguard us from these hazards.
While Azapo and the ACDP appear to have a worrying tendency to ride on the back of the widespread preoccupation with immune-boosting nutrition supplements and unproven diets, the IFP comes out strongly for the use of scientifically acceptable medicines.
There are wider contexts for the control of HIV/Aids, and we should expect political parties to have formulated credible programmes to deal with these. Poverty renders the poor even more vulnerable to HIV/Aids in numerous ways.
How will this be dealt with? Is it inevitable that approximately a third of the current work force is unemployed and a barely modest rate of growth achieved? These conditions bear terrible consequences for social stability and the rule of law.
Who will we trust with providing the widest safety net for all those who fall through the cracks of our hugely unequal society?
Is it intrinsically impossible for us to attain the astonishing growth-rates of some of our neighbours and other developing countries? Are we being duped by the Washington Consensus and its market fundamentalists? Only an honest government can be transparent and decline to trade on its citizens’ unfamiliarity with the minutiae of these critical elements in our national fabric.
We need a government with enough courage to tackle the difficult task of mitigating the harmful impact of migration, an important risk factor for HIV/Aids. We require brave women and men to expose, discuss and find solutions for the continuing abuse of women and children, the practice of which is not only morally deplorable, but also drives the spread of HIV.
Inevitably, many of the answers to these questions will not be provided by the politicians who seek our support. This is because they do not have such answers, but are too immodest or politically ambitious to say so, and are willing to economise on the truth, leaving only confusion in their wake.
Which political party should we entrust with handling one of the worst human crises ever to confront modern men and women? We already know the steps required to halt this epidemic, and I believe any one of the parties, once in power, could develop the mechanics of an effective programme.
As such, the litmus test for assessment is more than this: decide which party enjoys the confidence of the largest number of citizens, so that state intervention initiatives for behaviour change can meet with success, and that urgent measures to safeguard women and children from the predatory practices of men can be effectively implemented.
In the medium to long term, it will take courageous and committed leadership to tackle the complex social, economic, cultural and political conditions that underpin the contagion in our midst. These transformations and interventions, even more than any putative HIV vaccines, are the only hope for a sustainable solution to HIV/Aids in South Africa.
Hoosen Coovadia the Victor Daitz professor of HIV/Aids Research at the Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban; scientific director of the Doris Duke Medical Research Institute; and biomedical director at the Centre for HIV/Aids Networking.