South Africa’s peaceful democratic transition confounds Afro-pessimistic views that the continent is doomed. Yet the “Rainbow Nation” is still struggling to come to terms with the HIV/Aids epidemic — a crisis with long-term consequences for its political economy and the sustainability of Africa’s states and societies.
Five million South Africans are infected by the pandemic and Tshwane has launched the world’s most ambitious treatment programme that could play an important role in realising the African renaissance. But South Africa’s leadership in Africa is compromised by how the government has related to its own HIV/Aids crisis and stands in stark contrast to the leadership demonstrated by countries such as Senegal and Uganda.
In 1991 the ANC health secretariat and the De Klerk government’s department of national health and population development formed the National Aids Convention of South Africa, the strategy of which was endorsed by then-president Nelson Mandela after the 1994 election. However, what followed was a disillusioning experience for many who had hoped South Africa would become a model for other countries.
The history of government equivocation on HIV/Aids is familiar to most South Africans: Sarafina II, the virodene debacle, President Thabo Mbeki’s dealings with the HIV/Aids dissidents, his arguments that conventional HIV discourses are inherently racist and that antiretrovirals (ARVs) are unsafe and toxic. The August 2003 decision to roll out ARVs was driven more by international pressure than newfound clarity over the deaths and suffering among ordinary South Africans.
Issues of race, sex, dissent and denial explain, in part, the government’s equivocation. Colonial and apartheid medicine had indeed argued that black people could not control their “insatiable sexual drives”.
Throughout the 1980s and 1990s most African leaders neglected the HIV/Aids epidemic. Bucking this trend, Senegal’s president at the time, Abdou Diouf, and Uganda’s leader, Yoweri Museveni, addressed the challenges of HIV/Aids decisively. The epidemics in these countries took remarkably different trajectories. Senegal’s national HIV rate was contained to less than 1%. Uganda’s overall HIV prevalence rate fell from 13% in the early 1990s to 4,1% by 2003.
Mbeki, in contrast, “removed himself” from the HIV/Aids debate in 2002. His Health Minister, Manto Tshabalala-Msimang, continued with the rhetoric that many felt undermined key public health messages and South Africa had to relegate leadership on African HIV/Aids issues to other actors and institutions.
In August 2006 South Africa was acutely embarrassed at the Toronto International Aids Conference, when, among other incidents, Stephen Lewis, UN Special Envoy for HIV/Aids in Africa, noted that South Africa’s HIV/Aids policies were the worst on the African continent.
The ensuing furore and protests in South Africa had a significant effect on the government. Just before World Aids Day on December 1 last year, Tshwane announced, after broad consultation, a new strategic plan for dealing with HIV/Aids and STIs (sexually transmitted infections). The Treatment Action Campaign observed notably that “the eight-year struggle to end government HIV denialism and confusion has ended”.
Will this reluctant shift at national level be reflected in South Africa’s African leadership?
In 2001 Africa’s leaders pledged to lead the HIV/Aids response from the front during the Abuja summit on HIV/Aids, tuberculosis and malaria in Nigeria. Continental leaders agreed that HIV/Aids, TB and malaria should be “top priorities” and committed 15% of their national budgets to health.
The mid-term review of the Abuja Declaration took place in Abuja in May last year. Only Botswana has met the 15% health expenditure target. Gambia, Ghana, Tanzania, Uganda and Zimbabwe are making progress towards this goal. But governments such as South Africa argued that the Abuja health targets were too broad, and Tshabalala-Msimang went as far as seeking to reopen the debate on the 15% target — which South Africa has yet to meet.
In June 2001 proposals from African leaders had seen the establishment of the Global Fund to Fight HIV/Aids, Tuberculosis and Malaria. African leaders urged donors to put $10-billion into the fund. Yet, between 2002 and 2005, only $1-billion had been disbursed. Africa, and South Africa, has also failed to implement a meaningful advocacy strategy for replenishing the fund.
Mbeki is a member of the AU’s Aids Watch Africa, a group of continental heads of state mandated to advance Africa’s response to the pandemic, but his visible engagement has been negligible.
The UN has emphasised repeatedly the importance of the state in dealing with HIV/Aids and other non-traditional security threats. But it is unlikely that the South African government will be leading more robust state responses in Africa.
Eight years after the birth of the idea of an “African century”; 11 years after Thabo Mbeki’s famous “I am an African” speech; and 25 years after the onset of humanity’s most tragic recent outbreak of disease, South Africa has failed decisively to halt its own HIV/Aids epidemic and deferred the dream of an African renaissance.
Angela Ndinga-Muvumba is a senior researcher at the Centre for Conflict Resolution in Cape Town. Shauna Mottiar is a researcher at the Centre for Policy Studies in Jo’burg