John Sandman

Old Racial Policies Still Affect HIV/AIDS in the New South Africa


According to the Website medwiser.org, the first AIDS case in a white South African was identified in 1983. The first black South African with AIDS was identified in 1987. The virus didn’t reach the pandemic stage until after 1996.

Human rights attorneys and AIDS activists I spoke to in South Africa were alarmed by the practice of having anyone tested for HIV identified by name because it drove at-risk people underground, discouraging them from seeking medical care or modifying their behavior. Public health officials often seemed indifferent to the benefits of anonymous testing versus the drawbacks of name reporting, but this may have reflected a separate conclusion that many had come to—that they could not hope to have access to the public health resources available in the West and their expectations may have been low as a result. Many advocates for people with HIV/​AIDS would argue that anonymous testing wasn’t significantly more expensive than name reporting—although that might not be true throughout the developing world. But more to the point, the efficacy of testing in South Africa was not then universally recognized by that country’s government.

On July 5, 1996, the same month that this story appeared, South Africa’s Health Minister Nkosaqana Zuma spoke at the 11th Annual Conference on AIDS in Vancouver, British Columbia and said, “Most people infected with AIDS live in Africa, where therapies involving combinations of expensive anti-retroviral drugs are out of the question.” It’s a view that suggests an abdication to the disease, for whatever reason, and most likely influenced attitudes on testing. That year the South African Health Ministry estimated that about 850,000 people—about 2% of the population—was HIV positive.

The HIV/​AIDS crisis became something of a metaphor for the hopes many had for post-apartheid South Africa--hopes that were deferred or dashed. Thabo Mbecki, who succeeded Nelson Mandela as president, was widely scorned when he embraced the theory that AIDS was not caused by a virus. Mbeki’s health minister, Manto Tshabalala suggested that eating lemons, olive oil and garlic would cure the disease. Mbeki’s administration thwarted attempts to make anti-retroviral (ARV) drugs available to people with AIDS in South Africa, even though ARVs had been shown to be successful in blocking perinatal transmission, from a mother to her unborn child. During his presidency, which lasted until 1999, Nelson Mandela was indifferent to the AIDS crisis until the early 2000s. He later expressed regret that he didn’t speak out sooner.

Gordon Nary, then editor of JIAPAC when I wrote the story and who later volunteered to test the first AIDS vaccine made with a live strain of HIV , wrote in a 2000 op-ed piece in a journal published by Medical Advocates for Social Justice, “The South African Government’s intransigent refusal to permit the use to antiretroviral drugs to prevent perinatal HIV transmission presents a moral challenge which few in the global community have the moral leadership and clout to effectively intervene.” Nary went on to accuse the South African government of crimes against humanity for withholding these drugs.

The Mbeki government’s policies did not end until he was replaced by Jacob Zuma as president. Zuma had baggage of his own, including being charged with raping an HIV-positive woman. While acquitted, he stated at trial that having a shower after sex would minimize the risk of transmission.

The Mbeki years represented a huge setback in the fight against AIDS. The South African Health Ministry said in 2005 that South Africa had the highest HIV seropositivity rate in the world.

But AIDS denialism ended with Zuma. By 2009, the government publicized a commitment to test all children exposed to HIV and provide all HIV-positive children with ARVs. According to South African History Online, “the National Strategic Plan of 2007-2011 (established) coverage of HIV-positive mothers with AZT treatment that was estimated at over 95% by 2010. Transmission from mothers to their children was thereby reduced to just 3.5%.”

According to AVERT, a UK-based organization with partnerships with South African community-based organizations, there were 6.1 million people living with AIDS with 240,000 dying from AIDS-related illnesses in 2012. Some 17.9% of South Africans were then HIV positive.

AVERT noted that by 2007 South Africa’s National Strategic Plan ramped up efforts for an antiretroviral treatment program aimed at decreasing the number of new HIV infections. “The current National Strategic Plan for 2012-2016 is framed primarily around the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths," it said. It had similar goals for the prevention of mother-to-child transmission.

Selected Works

Fiction
The story of two minor league baseball players, pitcher Carl Hubbs and catcher Joe Sperma, and their low-rent struggle with religious fundamentalism in hurricane-ravaged South Florida in the 1970s.
Nonfiction
When HIV/AIDS surfaced in South Africa during the 1990s, public health officials were slow to react.
The Securities and Exchange Commission’s Consolidated Supervised Entities Program regulated investment bank holding companies such as Bear Stearns and Lehman Brothers. Critics say it contributed to the 2008 financial crisis.
In the wake of Bernard Madoff’s Ponzi scheme, the Financial Information eXchange Protocol could have led examiners to the fraud.
By the mid-1990s, public health officials in the United States had become concerned that women of child-bearing years were at risk of contracting HIV, the virus that causes AIDS. Yet family planning agencies were slow to recognize or react the needs of vulnerable clients. Name reporting of people being tested for HIV was thought to drive those who should have been tested underground.

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