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SA is winning on Aids, Zuma – now help the rest of Africa do it too

A googling of Charlize Theron's name on Tuesday morning reveals that her bangs – or her "fringe", as they're better known to South Africans – are growing out at an acceptable pace. As Huffington Post noted, this is no easy feat "for a woman". 

The more dedicated fan of the Oscar-winning actor might discover, upon a more thorough Google search, that she met with President Jacob Zuma and a delegation from the United Nations's specialised HIV and Aids arm, UNAids, on Monday.

And behind that photo-op was a closed-doors meeting where a personal call was made to Zuma by a UNAids head, telling Zuma that he must pin his own political legacy to the advancement of the rights of women, especially young women, and to make it his personal project to elevate this to the political agendas of African leaders.

As UNAids executive director, Michel Sidibe met with Zuma in 2009. Sidibe is also the UN's under-secretary general, and has a long history of working on the African continent with various organisations, including Unicef.

At the Sandton-based hotel where we meet, Sidibe says Theron's enthusiasm and commitment to HIV education is infectious. It's people like her, he says, that allow people like him to take their message to parts of society, "where bureaucrats don't reach, but HIV does".

Plenty will
Sidibe met the Mail & Guardian after he and Theron's talks with Zuma.

"From [Malawi's President Joyce Banda] to Tanzania, there is willingness to take a multi-sectoral approach to combatting HIV and Aids," he said.

But the challenge is immense.

"There are countries where talking about, for example, drug users or women's sexuality are problematic in and of themselves. And now you want leaders to talk about them in the context of HIV? It's very, very difficult. We asked Zuma to make this his legacy project."

"In essence, we said to him: as South Africa, you are winning in this fight [against HIV]. But if you leave the rest of the continent behind, that is no victory at all."

No more dependency
UNAids believes Africa must become independent from international HIV financing programmes. This is an area in which South Africa succeeds, Sidibe said.

"We said to Zuma that South Africa must produce more of the drugs that Africa needs. Zuma needs to use his ties on the rest of the continent to ensure that South Africa leads the continent in weaning itself off of its dependency on international aid for antiretroviral drugs."

Sidibe explained that 85% of people on anti-retroviral treatment in Africa today are taking medicines produced outside of Africa. Political leadership from South Africa on this issue is vital, he said.

Said Sidibe: "The second thing is that the leadership of South Africa on a continental level is critical. For us, South Africa is starting to produce medicine for less than it costs in India, for example, and medicine that is among the best quality."

Thus, South Africa must become a "hub of excellence" in anti-retroviral production, and this requires that the South African government partner with pharmaceutical companies.

UNAids raised the issue with Zuma.

"We asked him to start thinking about how we can start funding medication beyond sources outside of the continent, and to do this we need to promote the concept of shared responsibilities.

"This is a very, very critical aspect, because South Africa now has the second largest national investment in HIV and Aids treatment in the world. They [South Africa] came from being almost completely dependent on outside funding several years ago to being almost completely independent from HIV financing."

Catherine Sozi, UNAids's country co-ordinator, added: "I said to President Zuma: you have 20-million Africans who need anti-retroviral treatment today, right this minute. And only 7.2-million of those are actually on treatment. And these 20-million will need to be on treatment for the rest of their lives."

Nearly two million of these are being treated in South Africa, where just about every HIV infection indicator is down since 2009, according to UNAids: people dying from Aids-related illnesses; mother-to-child transmission rates; HIV infection rates in children; HIV infection rates in general; and the number of children under five dying of Aids.

Except for life expectancy at birth, which has gone up, and is now at 60 in South Africa, exceeding the country's 2014 targets.

South Africa's relative success in the HIV arena was hard-won. Take KwaZulu-Natal, for example, where Gugu Dlamini was stoned to death in 1998 for revealing her HIV status.

Writing in 2008 for Sterling Publishing's collection of photo essays, What matters, HIV researcher Dr Helen Epstein described that province in 2005 as "where the hush surrounding the epidemic was so spooky that it surprised even me".

"As we went from one homestead to another and sat with dying patients and their families, no one, not once, said the word Aids. Patients told us they were suffering from ulcers or tuberculosis or pneumonia. Aids orphans said their parents had been bewitched by a jealous neighbour. Many Aids patients died in their houses, cared for with compassion but in silence, their conditions shrouded in euphimisms."

By 2008, attitudes were beginning to change, Epstein noted. But the misconceptions that underlie the stigma around HIV have long been misdiagnosed as inferior value systems, that are un-Western and therefore unsolvable.

In fact, Uganda designed its own HIV prevention programme in 1986, "long before rich donors like the United States or the UN". And the premise for it was based on the fact that the reasons for high HIV rates in that region were surprising: Ugandans were not overwhelmingly engaging in what Aids researchers consider high-risk sexual behaviour.

In fact, Epstein wrote, research showed that many Ugandans supported a long-term wife and a long-term girlfriend. And it was this network of stable, life-long partnerships, that was forming an HIV "superhighway" in the region.

Complexities of Aids
Back in KwaZulu-Natal, a multisectoral approach to HIV called War on Poverty, or Operation Sukuma Sakhe, has been adopted. Once the province with the highest HIV infection rates in the country, UNAids now considers the model for this programme to be international best practice.

This is because it isn't just about Aids: it seeks to target the various complexities of the disease – poverty, promoting behavioral change, environmental care, and supporting job growth.

Sidibe asked Zuma to take this model to the Southern African Development Community, because countries in the region cannot reduce HIV rates if they operated in silos.

"We are seeing progress but still the metaphor for the disease is inequality. We are not reaching younger women and we still have difficulty in breaking the conspiracy of silence and in stopping violence against younger women. We wanted to really engage the president on two major aspects of the response that is now needed: one is a new target – for zero preventable deaths. Medicine is available and we can scale up our testing programmes even more. Secondly, to make sure the president can really take on, as part of his legacy, zero tolerance for violence against young women and zero new infections among them.

"Lastly, we wanted to show Zuma that HIV is not about health only: it's about equity, social justice, inclusiveness, and a political legacy that can help us to put the poorest segment in society at the centre of our social response … We are moving from despair to hope in South Africa. There was a period where there was a conspiracy to keep Aids quiet, which was very difficult. Today we must talk about removing discrimination; engaging every corner of society in integrated programmes," he said.

"Let us not forget that this is happening at the right moment: South Africa's Phumzile Mlambo-Ngcuka was just appointed as head of the gender equality body, UN Women … It's a huge opportunity for us. There's a new momentum for addressing those difficult issues related to young women in South Africa and in Africa, like how young women on the continent can negotiate the terms of their own sexuality," Sidibe said.

"This is what we are saying to African leaders: inclusive, tolerant societies, are the new starting point for how we deal with Aids. This is what Aids has taught me: saving lives is a political agenda, because when we exclude minorities, or the poor, or any segment of a society from our approach, we destabilise that society. And then we lose."

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Sarah Evans
Sarah Evans

Sarah Evans interned at the Diamond Fields Advertiser in Kimberley for three years before completing an internship at the Mail & Guardian Centre for Investigative Journalism (amaBhungane). She went on to work as a Mail & Guardian news reporter with areas of interest including crime, law, governance and the nexus between business and politics. 

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