Fight against Aids must also be a fight against inequality
Why has it been possible to deliver ARVs but not quality education, asks Mark Heywood
TEN years ago, on November 19 2003, the late Dr Manto Tshabalala-Msimang made public South Africa’s first plan to treat people with HIV using antiretroviral (ARV) medicines. The plan was the result of a persistent campaign led by the Treatment Action Campaign (TAC) and its allies.
Aids had darkened the world of many South Africans. An estimated 1 000 people a day were dying of HIV-related illnesses. The rate of HIV transmission from a pregnant mother to her child was more than 20%. Although the Constitutional Court had ordered in 2002 that a programme to prevent mother-tochild transmission of HIV be progressively implemented, it was being done so grudgingly by Tshabalala-Msimang.
As a result of this crisis of death and the denialist response of thenpresident Thabo Mbeki, there was a deep and polarising conflict between civil society, health workers and researchers, and the government. Most people with political power chose public silence.
But there were some exceptions. Judge Edwin Cameron, for example, spoke out against Mbeki by contrasting the foundations of Aids denialism with that of holocaust denialism. But, for the most part, civil society, particularly the TAC, was left to fight the battle alone. That was then. Today we are at another World Aids Day, the 25th since December 1 1988 when the date was given that title.
In South Africa, as we reflect on the 10 years since the start of the ARV treatment plan, it is clear that a revolution of sorts has been effected in the response to Aids. As a result, the story of Aids today is very different from what it was.
There are more than two million people on ARV treatment. Life expectancy is rising again, rather than declining;
Mother-to-child transmission has been massively reduced. Less than 3% of pregnancies in women living with HIV result in HIV transmission. The baleful pictures of emaciated and dying infants have become a thing of the past. The once infamous Cotlands has closed its hospice and now devotes its attention to early childhood development. Children live with HIV, rather than die, as in the tragic case of youngster Nkosi Johnson; and
Most notably, in the person of Dr Aaron Motsoaledi, we have political leadership, energy and commitment.
It is clear that Aids is one of the few post-apartheid social challenges that have elicited a collective national response, cutting across race and class. It is the only issue that has rallied business, community organisations, trade unions and churches in a common purpose.
As we approach the 20th anniversary of freedom and another general election, it should be acknowledged that the response to HIV is one of the few social challenges on which our government, after a bad start, can clearly be seen to have delivered to the poor.
There are lessons to be learnt from this. What are they?
Although it is frequently said that HIV does not discriminate, the truth is that it does. The vast ma-
HIV remains a deadly virus, but its eradication means we must also confront the school in Limpopo where there are no toilets
jority of people with HIV are poor, black and women. These are the same people the government has generally left behind when it comes to housing, education and employment. Why has it been possible to deliver ARVs but not a quality education system? What about Aids was different?
I would argue that the government eventually delivered on HIV because the people organised the power that they have under the constitution and demanded a proper response based on their rights.
It delivered because people shamed the government’s own inaction with evidence of their own action, rather than just griping. Thousands of societal initiatives to prevent HIV and support people with Aids were organised across the country.
Is this mobilisation now unnecessary? I would say not. The message we must convey on World Aids Day 2013 is that although we have made progress, we cannot afford complacency. Aids is most definitely not over and it still needs an exceptional effort to control it. There are still more that 200 000 HIV-related deaths every year; there are still abnormally high rates of HIV infection, particularly in girls and young women; there is still stigma and individualised denial.
Some who should know better, like UNAIDS, argue that the end of Aids is in sight and we must now normalise the response to HIV. But we cannot afford a “normalising” of HIV if that, in effect, means a dumbing down of the response to the level of service that poor people receive in every other area of health and life.
We are also approaching the 20th anniversary of the Reconstruction and Development Programme. The RDP once envisaged an exceptional mobilisation of resources to confront social inequality, the main legacy of apartheid. But, tragically, given its transformative intent, it died in the surgery of Gear and lingers on most closely in the association with an “RDP house”— something synonymous with a small, poor-quality dwelling for the poor. It might be argued that we also have an RDP health service and RDP school system. But we must not accept an RDP response to Aids.
In this context, it is also essential now to understand that Aids is not just about the virus called HIV, which breaks down our immune systems, but also about the syndrome of social inequalities that facilitates its transmission and determines who lives or dies once infected.
In the early days, HIV made many people confront their own prejudice about “normal” sexuality and accept homosexuality. In order to confront stigma, you had to confront your own instincts to stigmatise. Better people and institutions emerged as a result.
Today, if we are to tackle HIV effectively, we must once more look deeper into our souls and our society and question, in particular, our tolerance of inequality.
Today, HIV remains a deadly virus, but its eradication means we must also confront the school in Limpopo where there are no toilets.
Today, HIV remains a virus, but it means we must also find solutions for the 14-year-old girl who stays away from school one week every month during menstruation because the school has no toilets, water or privacy — and while she is away, leaves herself vulnerable to men, to other children, to herself . . . vulnerable to HIV.
Today, HIV is still a virus and it remains the 15-year-old boy who is denied access to condoms at school — despite our knowledge that they remain the most efficacious means of HIV prevention.
Today, HIV is still a virus, but it is also the crisis of teenage pregnancy that, according to Motsoaledi, is the major cause of mortality among young women: 8% of pregnancies occur in girls under 18, but they account for 36% of about 3 200 maternal deaths every year.
Today, HIV is still a virus, but it is also the government’s failure to budget for school infrastructure and minimum norms and standards for our public schools.
Basic Education Minister Angie Motshekga has as much responsibility for HIV as Motsoaledi.
This World Aids Day, it should strike people concerned about HIV that demanding that the government fixes the public schools should be at the heart of a renewed, reinvigorated response to Aids. And in keeping with the lessons of the past decade, if this does not happen, there should be an uprising to demand it.
Heywood is the executive director of Section 27