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AIDS Reform in South Africa:  Policy and Positions[ird]

“Acquired immunodeficiency syndrome (AIDS) is a complicated illness that may involve several phases. It is caused by the human immunodeficiency virus (HIV), which can be passed from person to person. AIDS impairs the human body's immune system—the system responsible for warding off disease—and leaves the victim susceptible to various infections.  HIV is spread from person to person through direct contamination of the bloodstream with body fluids containing the virus. Such fluids include blood, semen, vaginal fluid, and breast milk. The virus is usually transmitted through sexual intercourse and the sharing of contaminated intravenous needles. Infected women can pass HIV to their babies during pregnancy or delivery or during nursing.” [2ird]

“AIDS is now listed by the United Nations as the leading cause of death in Africa, and the fourth leading cause in the world.”[3ird]  It is the biggest killer of girls and women under the age of forty in South Africa.  With about “six hundred people each day in South Africa dying from AIDS-related diseases each day,”[4ird] something must be done.  “South Africa has more people living with the AIDS virus than any other country in the world, 4.7 million people are infected.  That means one-tenth of the world’s population of AIDS infected people are in South Africa.”[5ird] 

You would think that everyone in South Africa, the government, the labor unions, the employers, and the people, would want some kind of policy implemented that provides drugs and other support to the AIDS infected population.  The policy would benefit everyone, though costly (“It costs about 1,500 rand, or $190, to treat one person for one month – about half an average family’s income[6ird]); it would supply much needed help to the people who need it most.  This however is not the case in South Africa.  The government, President Mbeki and the ANC (African National Congress), have taken the opposing position to both COSATU (Congress of South African Trade Unions) and the majority of employers in South Africa.

The government of South Africa is not supportive of any programs that will provide drugs and other support to the people that need help.  It would be understandable if they cited money as the main problem of getting the aid that they need.  Yet, that is not entirely the case.  “South Africa is best equipped in terms of medical infrastructure”[7ird] to make medication available than the other African nations that have been stricken by this epidemic.  They were also granted monies from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) by the United Nations General Assembly.  President and ANC member, Thabo Mbeki, questions the link between HIV and AIDS.  This is where all of the problems begin.  He believes that “a virus cannot cause a syndrome.”[8ird]  They have “linked AIDS to poverty and nutritional deficiencies.”[9ird]  The government has gone as far as to appoint a consultant that not only disputes the link, but also believes that the “anti-retroviral drugs that are available induce rather than treat AIDS.”[10ird]  It is thought that President Mbeki would rather believe that poverty was the cause of AIDS rather than tie the epidemic to sexual behavior.  Mbeki also doubts the safety of the drugs, because studies on the first drug that was invented to combat AIDS, AZT (azidothymidine) was highly toxic, and did not help many patients.    

            This decision to limit government actions was handed down by President Mbeki, but the person catching all of the flack from the public is his Minister of Health, Manto Tshabalala-Msimang.  According to her department, the government has taken this stance because “just giving out pills to the poor, uneducated people is not the solution; if the patients do not follow the correct treatment regimen, the drugs quickly become ineffective.”  In an effort to show that the ANC led government shows some compassion for the millions of people suffering from AIDS, they are quick “to point out that they spend large amounts of money on AIDS education and prevention.”[11ird]  Though education and prevention are a step in the right direction, without the proper treatments to extend the lives of the people that are already stricken with the disease, and allowing them to lead functional lives as opposed to the ones they are living now, where most people have to be taken care of by family members.  She was quoted in a local newspaper as saying that South Africa cannot afford to provide antiretrovirals for the people who need them because they need money for weapons to protect themselves from the United States.  Tshabalala-Msimang has responded to this statement, saying she was misquoted, but the damage had been done.  Is the real reason they won't approve this new plan money?  It is possible that Mbeki's reluctance to implement policy that provides treatment to the many HIV and AIDS infected people in South Africa comes from a fear of wasting money.  The cost of providing these drugs for the 4.7 million people that are infected is very high.  President Mbeki is not exempt from the criticism though Dr. Tshabalala-Msimang is fielding the brunt of the opposition.  Mbeki’s assertion that HIV does not exist, along with similar “statements made by senior ANC spokespersons, such as Parks Mankahlana and Peter Mokaba, who later died of AIDS-related illnesses, are seen as the biggest blunders of his career.”[12ird]  This may be one of the reasons he is so reluctant to talk about AIDS, AIDS related issues, and policies that would make anti-retroviral drugs available through public health services, and not private ones.

            There are several groups that have conflicting opinions of how this pandemic should be handled.  The most well known AIDS lobby group is that of the Treatment Action Campaign (TAC), led by Zackie Achmat.  “He is HIV-positive, but refuses to take the anti-viral drugs on principal, until they are available free through the national health system.”[13ird]  The protesters he is leading are fighting because the government has not delivered the drugs to the millions of HIV-positive people in South Africa.  They have gone as far as “suing the Health Minister, Dr. Manto Tshabalala-Msimang, and the Trade Minister, Alec Erwin, for culpable homicide, and vow to continue this until the government reverses its stance on AIDS-busting drugs.”[14ird] The ANC has refused to budge despite the lawsuit the two ministers are facing. The TAC’s plan is to lead a nationwide civil disobedience campaign until their demands are met.  Achmat and his supporters believe treatment is key “not only in keeping people alive, but in also removing the stigma and denial that surround the disease, and encouraging people to come forward for HIV tests.”[15ird]  These protests are widespread, and going on day after day in the attempt to gain more support, be noticed by the government as a force, and eventually have their demands met.  Because of the actions of the TAC, and also the continued support of the two major trade unions, the Congress of South African Trade Unions (COSATU) and the Federation of Unions of South Africa (FEDUSA), and many companies that are losing their workforce to the disease the government has said that the “ministries of health and finance are now assessing the feasibility of a comprehensive drug-treatment plan.”[16ird]  They also have the continued support of the United Nations and the head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the examples of Malawi and Uganda, who are already offering anti-retrovirals through public health services.

            COSATU has put pressure on the government and businesses to agree on a national AIDS treatment plan.  The pressure they exert comes in many forms.  COSATU's mere involvement is a threat to the ANC, because it allows the public to see  the division between the allied parties very clearly.  The labor unions' involvement in protests with TAC, and the existence of capital that can be used to fund even more campaigns are also threats to the ANC.  In this plan they want the same funding for the anti-retroviral drugs that TAC is fighting for.  When a meeting with “government and business representatives at the NEDLAC (National Economic Development and Labor Council) offices did not produce a signed agreement to implement the provision of the medicine, members of COSATU staged a sit in along with TAC members and AIDS patients.”[17ird]  NEDLAC is made up of representatives from government, business and labor. They meet in order to negotiate and approve legislation.  They did not sign the plan that TAC and COSATU members presented them with during the sit-in.  Their efforts were in vain. Though there was a misunderstanding between the labor union and the government, in the end a task force was created that contained members of the “government, labor and business, and together they drafted a deal on the treatment and prevention of HIV and AIDS.”[18ird]  It is plain to see that COSATU and FEDUSA are involved in this battle, and have taken the side of TAC because their main interest is to protect their members, and this reform will help them enormously.  It is also in the best interest of employers to also support the TAC in their efforts.

            Businesses are beginning to come around, and realize that though the new policy may cost them money, they will find themselves at an even greater loss if they lose their labor force.  Of the people afflicted with AIDS and stricken with AIDS related diseases, the majority of the numbers are those prime laborers that are needed to keep businesses going.  When family members are sick and/or dying people must leave their jobs in order to take care of the family.  When children are orphaned by the loss of their parents to AIDS-related illnesses, someone has to take care of them, and most likely it will be someone that should be in the workforce.  Because people in the family are not working, or are spending the majority of their money taking care of the sick, the children who should have been in training to join the labor force (school) have to resort to begging and other odd jobs to contribute to the household expenses.  AIDS contributes to this loss any way you look at it.  Employers are directly hit by this epidemic; “about one quarter is thought to be HIV-positive.  A growing number of companies are beginning to offer free anti-retrovirals to their employees with AIDS-related diseases.  They have devised plans that would allow them to provide antiretrovirals to their workers.    This is an expensive response to the problem, but it serves to keep productive workers alive.”[19ird]   It is mostly the larger, wealthier companies like AngloGold, De Beers, and Heineken, that have realized the impact that HIV/AIDS can and will have on their population of workers.  

            If not only people with AIDS and their advocates are in agreement with the implementation of this new policy of providing anti-retroviral medication through public health resources, government should take heed.  Trade unions, employers, the United Nations, and also the world has taken notice of this disease that is wreaking havoc on the population of the country.  Denying that HIV exists, or that it is the cause of AIDS is detrimental to the health of the whole nation.  President Mbeki needs to swallow his pride, admit he was wrong, and help the people he was appointed to protect.  The longer he stays in denial, the more people die, and the elimination of a population of people will be far more expensive in ways other than financially.

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