South Africa's 4th AIDS conference: The politics of HIV in South Africa.

Apr 92009

On a dark Durban night in June 2000, two of South Africa’s leading HIV/AIDS researchers were unexpectedly called to a meeting in a plush room at the city’s Hilton Hotel. “The minister wants to see you! Now!” a government official had simply barked at Professors Salim Abdool Karim and Jerry Coovadia, who were both in the process of releasing groundbreaking studies at the International AIDS Conference.

Both men had previously been critical of their government’s response to the epidemic which was at the time killing thousands of their compatriots. Karim and Coovadia had been outspoken in their condemnation of then President Thabo Mbeki’s statement doubting that HIV caused AIDS.

But Karim and Coovadia weren’t particularly worried – after all, theirs was a country praised internationally for its freedom of speech laws. 

The scientists remember the short walk across a bricked quad from the International Convention Centre to the hotel. Dour security officials escorted them into a lavish top floor suite. As the door opened, they were immediately met with a stolid, emotionless gaze from South Africa’s then health minister, Manto Tshabalala-Msimang.

Seated on chairs around the room surrounding the minister, were the nine provincial ministers for health, and assorted officials and bodyguards.

Karim and Coovadia recall being nervous, but not overly concerned. These were people that the two scientists knew well. They had all been comrades in the struggle against apartheid. Both Karim and Coovadia are former leading lights in the United Democratic Front, which played a central role in ending white minority rule in their homeland.  

Coovadia remembers greeting the unsmiling assembly, but being met with a few cursory murmurs.

Then, Tshabalala-Msimang began speaking. She immediately lashed out at them for “continuously criticizing” the president and government. Karim and Coovadia were shocked by the vehemence of her outburst.  

Nevertheless, both Karim and Coovadia attempted to respond to the minister’s diatribe. But Tshabalala-Msimang told them to “shut up and listen.”

For the next 45 minutes, the only voice heard was that of the health minister. She slammed Karim and Coovadia as “irresponsible” for their promotion of “poisonous” antiretroviral drugs, the medicines that have been scientifically proven to prolong the lives of HIV-positive people, and to prevent mother-to-child transmission of the virus.

“But what really hurt,” said Karim, “was that we were called unpatriotic.”

Coovadia added, “the two of us, who had faced extreme intimidation from the apartheid state in our efforts to get true democracy in South Africa, were labelled enemies of the new South Africa. Enemies of our own people. It hurt. It really hurt. It still hurts.”

Tshabalala-Msimang, shaking with anger, slammed the researchers for “darkening” South Africa’s name in the international community, and ordered them to “stop” or “consequences” would follow.

Even though the former health minister was absent from the 4th South African AIDS Conference at the ICC in Durban last week, her ghost was omnipresent.

Coovadia’s and Karim’s recollections of the events of the night almost nine years ago offer fascinating insight into the machinations that took place during a period in which an estimated 350,000 South Africans died from AIDS-related deaths, as a direct result of Mbeki’s and Tshabalala-Msimang’s resistance to a rapid roll-out of antiretroviral therapy in South Africa. 

Mbeki and his ex-health minister are now gone…and, because of that, this year’s SA AIDS conference was unlike any of the previous ones. There was only one protest – this time not against unscientific statements by a health minister, but rather to put pressure on government to provide more money for HIV treatment. According to the AIDS lobby group, the Treatment Action Campaign, the government has budgeted one billion rand too little for anti-retroviral treatment.

It was also the first conference in which a very high ranking government official – in this case deputy-president Beleka Mbete – publicly acknowledged that “without the political and financial commitment of the state, AIDS will not be combated in the country.” These were commitments that were seriously lacking during the Mbeki era administration.  

The ruling party, the African National Congress (ANC), has given a strong indication that it’s going to issue a public apology for the previous government’s AIDS “dissident comments” and “failure” of said government to address AIDS effectively over the past decade. In addition to this, the former deputy health minister, Noziswe Routledge-Madlala, has called for an AIDS truth commission. Routledge-Madlala, now the deputy-speaker of the National Assembly, was fired by Mbeki in August 2007 after publicly criticizing the way in which health care was handled in the country.

South Africa’s current health minister, Barbara Hogan, closed the conference by acknowledging that the authorities need to “plan more carefully” as regards HIV treatment and must urgently investigate why some provinces run out of money for this before the end of the financial year. The country’s Free State province recently had to halt putting any new people with HIV on anti-retroviral therapy as the provincial budget had dried up. 

People like Mbete and Hogan provide hope for South Africa’s response to HIV. Hope that the epidemic will be addressed comprehensively and that treatment will be expanded. While the man who is most likely to become South Africa’s new president, Jacob Zuma, has a terrible AIDS track record himself  - he is infamous for his statement that he believed a shower after he’d engaged in unprotected sexual intercourse with an HIV-positive woman would prevent him from becoming infected. He does, however, appear to be far more open to addressing the HIV epidemic in his country than Mbeki was.

But activists say they will only believe in Zuma if he retains Hogan after South Africa’s elections later this month, following which Zuma will likely form his government. 

Hogan is the darling of both the country’s health and human rights communities, after her criticism of South Africa’s past and present response to HIV/AIDS, and her lambasting of her government’s decision to bar the Tibetan spiritual leader and peace activist, the Dalai Lama, from attending a conference in the country – apparently following pressure from China.

If Hogan is axed, say activists, leaving the struggle against HIV/AIDS in South Africa once again directionless, the country may well open yet another dark chapter in its troubled history.