African AIDS activists see new government effort
South Africa -- President Thabo Mbeki's dramatic reversal on AIDS policy
last month appears to be a genuine shift from the government's
oft-criticized detachment toward the disease in the past, AIDS activists
cabinet announced in mid-April that it was tripling its AIDS budget and
halting opposition to treating rape victims and newborns for the AIDS
virus, activists say they have encountered a new attitude among public
think the cabinet's change was a cynical ploy to reduce pressure on the
government," said Mark Haywood, head of the AIDS Law Project in
Johannesburg and a frequent government critic. "But people we know at
public hospitals say the atmosphere has changed in government, that more
drugs are being made available and there are fewer obstacles. Things are
rollout of a program to treat newborns with the antiretroviral Nevirapine,
which is shown to reduce transmission from HIV-positive mothers, is still
in the planning stages. And the government still has no plans to provide
antiretrovirals to adult patients.
believes a fundamental change is under way. "Our feeling is that once
you publish the change in a cabinet statement, it's hard to reverse
course," he said.
The shift in
attitude comes none too soon for South Africa, where about one in eight
adults - 4.7 million people - is believed to be HIV positive.
The South African
government has been widely perceived to be insensitive to the AIDS
pandemic. The health ministry balked at authorizing treatment on technical
grounds, citing the severe side effects caused by antiretrovirals. And
Mbeki's government appeared to be immobilized by fears about the potential
cost of AIDS, preferring to treat no one rather than provide inequitable
even worse was Mbeki's embrace of discredited AIDS dissidents, who deny
that HIV causes the disease and who say the AIDS crisis is nothing but a
fabrication - a racist Western conspiracy designed to frighten Africa.
mixed messages buttressed impressions among the populace that AIDS was no
threat - even rumors that antiretrovirals caused, rather than treated,
reacted defensively to criticism. When former President Nelson Mandela and
Anglican archbishop Desmond Tutu suggested AIDS should be attacked more
aggressively, Mbeki reportedly declined to return Mandela's telephone
calls for a month.
escalating international pressure, the government's turnaround appears to
be a response to an erosion of support among key domestic constituencies,
particularly labor unions. While they are close allies of the ANC, the
unions increasingly had been supportive of those suing the government to
provide AIDS drugs. In addition, some provincial governments found
themselves compelled to defy Pretoria by allowing greater access to
courts repeatedly sided with AIDS activists and ordered the government to
treat newborns with Nevirapine, most recently last month when a
Constitutional Court ruling said the government is constitutionally
obliged to try to save children's lives.
That led to one
more burst of defiance from Mbeki - then, less than two weeks later, the
about-face by his government. Officials reportedly disassociated
themselves from the AIDS dissidents, asking them to remove Mbeki's
endorsements from their Web sites. ANC supporters of the unorthodox AIDS
theories were instructed to keep their opinions private.
"I think we
are beginning to turn a corner in our country," Health Minister Manto
Tshabalala-Msimang told reporters last week.
ministry continues to appeal the court case ordering it to provide
treatment - not because it wants to challenge the order but because it
wants a higher court to define the limits of the judiciary's power to
order the executive in the future.
But not everyone
is convinced that the shift is authentic.
clear yet that the government is going to own up," said Thabani
Masuku, a constitutional analyst for the Institute for Democracy in South
Africa in Cape Town.
health workers also are skeptical about the government's change of heart.
At the Cotlands
Baby Sanctuary in southern Johannesburg, Executive Director Jackie
Schoeman is impatient with the government's promise to provide Nevaripine
to babies - upon completion of a pilot program at 18 hospitals.
they're worried about the side effects of Nevirapine, but I don't know
what side effects could be worse than dying," said Schoeman, whose
hospice serves about 60 children at a time.
Each day at the
hospice, more HIV-positive babies arrive whose deadly infection might have
been prevented had they been given a single dose of Nevirapine at birth.
"We see more
and more children who are coming to us to die," said Schoeman.
"We need to get something in place soon."