South Africa Gets Real on AIDS Crisis

(Nov. 4) -- After failing for years to face up to its tragic status as the country most ravaged by HIV/AIDS, South Africa is taking a dramatic new approach to the epidemic that experts say could stop a hemorrhage of unnecessary death.

AIDS causes about 350,000 deaths per year in South Africa, which has 5.7 million HIV-infected people -- more than any other nation in the world. And yet instead of declaring war on the disease, former President Thabo Mbeki spent much of the past decade denying it. Under Mbeki, the South African government delayed the launch of lifesaving drug treatment programs, advocated useless herbal cures, and scorned the medically established link between AIDS and the virus. Critics say those decisions cost hundreds of thousands of South African lives.

But in a landmark speech to parliament late last week, President Jacob Zuma rejected his predecessor's stance. "Knowledge will help us to confront denials and the stigma attached to the epidemic," said Zuma, who took office in May. He ordered a "massive mobilization campaign" to educate the country about HIV/AIDS transmission. "All South Africans must know that they are at risk and must take informed decisions to reduce their vulnerability to infection or, if infected, to slow the advance of the disease," Zuma said. He claimed the campaign would help cut the rate of new infections by 50 percent by 2011 and would be accompanied by an extension of anti-retroviral drug (ARVs) treatment to 80 percent of those who need it.

The president made the need for action brutally clear, noting that the number of deaths in the country could soon outnumber births. "If we do not respond with urgency and resolve, we may well find our vision of a thriving nation slipping from our grasp," he said.

Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa, agrees that the "high mortality rate from HIV" is the "biggest challenge facing our democracy, our health and our future prosperity. We can't put our country on track until we seriously deal with HIV/AIDS."

AIDS scientists and activists applauded Zuma's call to action. "It's a breath of fresh air, as we have lacked this level of leadership on AIDS from government for 15 years," said Vuyiseka Dubula, general secretary of Treatment Action Campaign, the country's leading HIV/AIDS group.

Abdool Karim, meanwhile, likened the speech to the end of apartheid. "This is a smaller equivalent of [South Africa's first democratic election in] April 1994, where we put away the negatives of apartheid and started to focus on the future," he said. "Now that AIDS denialism is in the past, we can face the challenges ahead of us."

The move should also quell doubts over Zuma's own beliefs on HIV/AIDS. In 2006, he caused outrage among AIDS campaigners when, during a trial for rape -- of which he was found not guilty -- he admitted that he had had unprotected sex with his HIV-positive accuser. Zuma also told the court that he had taken a shower after intercourse, as a precaution against catching the disease.

Following the trial, Zuma publicly apologized for not using a condom and said his original comments had been taken out of context. Abdool Karim said Zuma should be judged on his actions from this point, and not past indiscretions. "Our politicians aren't flawless," he said. "What's important is that they show us they've learned from their mistakes and don't repeat them."

Nokhwezi Hoboyi, a Treatment Action Campaign spokeswoman, said the president's followers are likely to heed his new advice. "People look up to him," she said. "Zuma has a massive number of followers, and whatever he says, they believe. If he repeats this new message when he visits communities, and asks people to be tested for HIV/AIDS early, he will make a very big impact."

Unfortunately for many South Africans, this new approach arrives too late. According to a study released this spring by Harvard University, more than 330,000 South Africans died prematurely from HIV/AIDS from 2000 to 2005 because of restrictions and delays the Mbeki government placed on life-saving ARV treatments. In addition, the Harvard team said, an estimated 35,000 babies were born with HIV infections that could have been prevented.

The deaths from this era of denialism are likely to continue for many years yet. It will be a struggle, for example, to re-educate people who took to heart the misguided advice of Mbeki's former Health Minister Manto Tshabalala-Msimang, who advocated treating AIDS with lemons, beetroot and garlic. "The seeds of doubt over ARVs have been sewn," said Nicoli Nattrass, director of the AIDS and Society Research Unit at the University of Cape Town. "Not everybody will be willing to take the medication; they'd rather go for the alternatives and end up dying."