World Aids Day provides an annual landing place to review what has been achieved, and what still needs to be done, in confronting what is the preeminent threat facing world security. We have, inevitably, a mix of the positive and the negative. In the negative scale is the fact that this year saw an estimated 5-million new infections world-wide. Half the new infections last year affected young people, posing a threat to the future of entire nations. (01-DEC-05)
This article, written by Tim Trengove Jones, first appeared in today’s edition of the South African newspaper Business Day. It has been edited for republication here.
This is daunting. But the positives are also impressive. Today we have more knowledge of the structural, medical and sociological causes of the pandemic than ever before. There is more funding from national governments and international sources like the Global Fund. Political will is increasingly harnessed at local and global levels. At the World Summit in New York in September, the international community adopted the goal of universal access to treatment, prevention and care by 2010. And the G-8 summit at Gleneagles in July saw the world’s richest countries commit themselves to universal access to treatment, though not, sadly, to universal access to prevention.
-For the first time, the goal of reversing the pandemic is within grasp
All this means that, as UNAIDS director Peter Piot said recently, ‘for the first time the goal (of reversing the pandemic globally) is within grasp’. But the sad truth is that the latest UNAIDS figures show that SA still has the largest number of people living with HIV/AIDS in the world. Even in Zimbabwe the number of new infections has declined noticeably. That our infection rates rise while those in Zimbabwe decline is especially disturbing when we consider that within sub-Saharan Africa SA is a special case. We are far richer. Our infrastructure is more advanced and extensive. We have a constitution that guarantees human rights, among these is the right to the progressive access to health care. These facts should make us better able to confront HIV/AIDS. Yet, the statistics suggest we lag further behind.
-We’re stll in denial
One reason is that, while Africa as ‘the dark continent’ still tends to be viewed through prejudicial lenses, the pandemic has fostered new forms of prejudice within the highest echelons of our society. Ironically this has arisen at a time when the official rhetoric of our nation-building has rightly been dedicated to ending discrimination of all kinds. The new prejudice assumes two related forms: stigma and denialism. Denialism is a cause and symptom of stigma. It has inhibited the rollout of national programmes of prevention and especially of treatment. It has permeated the highest centres of power in our country. It is evidenced by the fact that while President Thabo Mbeki has never explicitly denied that HIV causes AIDS, he has, in times of confusion, never said that it does. Denialism is also present in the president’s claim that he knows no one who has died of AIDS. It is there, too, in the continued refusal of both the president and the health minister to state, unambiguously, that antiretrovirals make HIV/AIDS a medically manageable condition. It is there in the health minister’s flirting with vitamin entrepreneur Matthias Rath and his internationally debunked ‘vitamin cure’.
-Access to treatment is a social, political and economic imperative
It is now widely accepted that one approach to HIV prevention is the entrenchment of human rights. Our constitution outlaws all forms of negative discrimination and our history makes this project imperative. But, as the roll-out takes its all-too-slow course, we see there are huge differences in the number of people on treatment, depending on where they live. This points to differences in the levels of political will, and of a new and grotesque form of discrimination consequent on discrepancies in will. We should be alert to ugly new forms of prejudice in parts of our national life: stigma against those living with HIV/AIDS, and stigma against the very medications that will help those infected to live longer, more productive lives. We should acknowledge that treatment regimens require us to think in the long term as never before. The demand for sustainable funding represented by programmes of antiretroviral treatment is unprecedented in world economic history. But in order to muster the logistics, one has to accept that universal access to treatment is not just desirable but a social, political, economic imperative.
-Instead of prejudice and stigma, we need insight and compassion
We are blessed with great role models in this country. In January Nelson Mandela withstood great family pressure to announce that his son, Makgatho, had died of AIDS-related illness. In doing so, he joined his wife Graça Machel, Kenneth Kaunda and Mangosuthu Buthelezi as African leaders willing to acknowledge that their families have been affected by HIV/AIDS. This is in starkly exemplary contrast to Mbeki’s claim of knowing no one who has died of the disease. In combating stigma against HIV/AIDS and its therapies, we need to revisit our commitment to fighting prejudices of all kinds. It is a truism that marginal groups are more vulnerable to HIV. All of us need to oppose discrimination against women, children, sex workers and sexual minorities. It is not just ‘the government’s problem, or ‘their problem,’ with ‘their’ referring to ways of life that ‘we’ find unacceptable. Rather than judgmentalism and rejection, we need compassion and insight. Our own futures depend on it.
-We must demand greater levels of political will from our leaders
To understand this is to see that AIDS is not just another public health problem but is, as Piot has said, ‘a make-or-break issue of our times’. Faced yet again this December 1 with the dismal fact that SA is lagging behind in the fight against the disease, we must once more confront the structural realities and cultural principles that have led us to this position. UNAIDS African envoy, Stephen Lewis, recently reviled by the health minister for his comments about her, has said that ‘every one of us has to speak out on the issues with clarity and courage’. That is our democratic duty. And today we can start realising this duty by challenging stigma and demanding greater levels of political will from our leadership.
-Trengove Jones, a senior lecturer at Wits University, has written widely on the politics of HIV/AIDS.
