What drove the Aids holocaust?

A genocide which has claimed more lives than Adolf Hitler’s gas chambers: the 20th century African holocaust. Who is to blame this time? What devil lurks in the background wreaking such ruin on our people? The answer is plain and simple — party politics.

A chapter in the long Aids death march has come to a close. Last week in the National Council of Provinces, President Jacob Zuma made clear his unequivocal stance on the HIV-Aids crisis. I have regularly criticised his government on this site, but his clear and uncluttered statement on the national fight against HIV-Aids was the stuff; the raison d’etre of leadership.

I have watched the twists and turns of this unfolding tragedy with grim fascination. A day does not pass without me thinking about it. As of last month, the disease has killed an estimated 1 000 people every day, and at least 5.7 million people are infected. This is surely the most enigmatic nation in God’s creation, blessed and cursed in equal measure. Blessed with life and beauty, cursed by divisions and bureaucratic stumbling.

In 2004, not long after Thabo Mbeki’s government retreated from HIV-Aids denialism and began to roll out antiretroviral drugs, Mangosuthu Buthelezi lost two children to the scourge of this disease. He was one of the first major African leaders to publicly reveal that he had lost family members to HIV-Aids. Nelson Mandela did the same in 2005. These two gentlemen used their positions as respected statesman and traditional leaders to promote awareness around HIV-Aids. They did this even in difficult cultural and societal circumstances where the dreaded disease is under a shroud of stigma and silence.

My most poignant memory of this time was when Buthelezi was filmed walking on the edges of his children’s graves. Victoria Macdonald, the social affairs correspondent for British Channel 4 News had asked if we could arrange this for a piece about the Aids tragedy. I had delicately put the proposition to him and he had plaintively replied that he would do it — if it helped. And it did.

I will never forget his grace and dignity. Strangely, in our Alice-of-Wonderland reality, it was British and not South African viewers who saw these images. Not for the first time, I reflected on how few of us have any idea of how difficult it has been for our political leaders to lead on this issue. In the context of Mbeki’s denialist views which were elevated to state policy the constant trauma must have been staggering.

HIV-Aids is the greatest tragedy of post-apartheid South Africa. What is even worse is the fact that HIV-Aids is a political tragedy. This silent killer is the biggest challenge to both South Africa’s democracy and its security. On the ground, the pandemic has redrawn the social map of South Africa and redefined many interpersonal relationships. It has created brand new categories of Aids orphans, child-headed households, and terminally-ill patients who cannot perform their daily tasks without cumbersome assistance.

In purely statistical terms, the HIV-Aids pandemic has transformed South Africa in ways that no one thought possible 25 years ago. It has been calculated that without the blight of Aids, the average life expectancy would be 64 years. Today in South Africa, we can expect an average of only 54 years. Over half of 15-year-olds are not expected to reach the age of 60. Between 1990 and 2003 — a period during which HIV prevalence increased dramatically — South Africa fell 35 places on the Human Development Index.

South Africa’s hospitals are tottering under the numbers of HIV-related patients. Leading researchers estimate that HIV-positive patients will soon account for three quarters of the medical expenditure in South African hospitals. A clear theme runs through the literature on
South Africa’s response to the HIV-Aids epidemic: the fundamental role of party politics as distinct from the state’s response in discharging its public health responsibilities. It is almost impossible to imagine that party politics could have played such a role, for example, in the USA or Great Britain when Aids emerged in the 1980s, apart from on the far-right and Christian fundamentalist fringes. Political differences were nuanced and tended to revolve around education, awareness campaigns, the role of faith-based organisations, or the state as an arbiter and legislator of morality. They did not question the scientific evidence, the efficacy of medication, or, most fundamentally, the state’s obligation to intervene. This is not to say that stigma and prejudice were not part of the social and political landscape. They were. One recalls the blanket media attention when Diana, the Princess of Wales, merely shook hands with Aids victims in Britain in the 1980s. The point I am making is that the debate in these societies never became entrenched in partisan party political terms. Aids was, and is, essentially first and foremost a public health issue.

I cannot think of any body of literature, constituted of such disparate studies and writings about a major public-policy issue, which together forms an almost unified picture like a jigsaw puzzle. I have seen little, or perhaps no contradiction, in the literature I have reviewed in seeking to explain the impact of party politics on the provision of antiretroviral drugs since 1994, yet despite being a recurrent theme it is never a central question in any of them. Further, it would have been impossible to cherry pick literature to lead the reader to such a conclusion. Each study and theory provides a partial explanation of cause and effect. I would contend that party politics in and of itself provide little in the way of explanatory power. But it is only if we grasp the origins of party political positions or worldviews that we can understand the impact of party politics on the South African HIV-Aids discourse. Judge Edwin Cameron in Witness to Aids convincingly sketched the factors which led to the denialist theories becoming official government policy.

We see plainly how South Africa’s legacy of racialism and colonialism provided fertile ground for conspiracy theories to take root. We see how Mbeki conflated HIV-Aids with the noble quest to eradicate poverty and inequality and to restore Africa’s dignity. Only the most partisan opponent ascribes mendacious motives to Mbeki. None did in the literature I reviewed — and I think I have pretty much read most of it over the last decade. And yet, for him, there never was a debate about Aids; there was only a never-ending debate about race. Tony Leon in his memoir On the Contrary notes how Mbeki’s de-linking (disengaging the virus from the syndrome) of the virus and syndrome crept into the political lexicon of the Department of Health and became an inherent part of the internal discourse of the ANC.

He claims that “when the Health Department insisted that the disease be referred to as ‘HIV and Aids’ rather than the more conventional ‘HIV/Aids’ — thus de-linking the virus and the syndrome — the ANC faithfully complied”. This, of course, contributed to the cementing of the debate in partisan and polemical terms. As did the acrimonious exchange of correspondence between Leon and Mbeki pertaining to the efficacy of antiretroviral drugs at the turn of the century. There is a huge a gap in the literature about how the fraught relationship between these two protagonists contributed to the casting of the debate in party-political terms to the detriment of public health policy.

The Mbeki-Leon relationship was without doubt the most acrimonious relationship between a head of state and a leader of the opposition in modern times. Indeed, the two leaders only met formally after Leon resigned. Thus HIV-Aids, a public-health issue, was morphed into a partisan political issue under their respective terms of office (Mbeki 1999-2008/Leon 1999-2006). Simply put, the debate revolved around the dramatis personae rather than the substantive issues. Some might argue that Leon (as well as Mbeki) should have recused him/themselves from the debate, not because Leon’s technical arguments were not scientifically-based, but to allow HIV-AIDS to be refocused as a public health issue, as opposed to a political one.

There is a compelling argument, however, that such a course would have been an abdication of Leon’s constitutionally mandated role as leader of the opposition. As a very subjective opinion, I believe that Leon might have neutralised the political toxicity of this issue by adopting the bipartisanship style and spirit of the late senator Edward Kennedy. I am, of course, referring to the senator’s groundbreaking work in the United States Congress in his advocacy of healthcare initiatives. But, these things are very easy to say in hindsight. The flipside of the coin is whether the ruling party would have been amenable to such an approach. The most delicate question of all, in a scenario reconstruction, is how the debate would have played out if Tony Leon had delegated the issue to a black member of the DA with “struggle” credentials. I am thinking of figures such as the party’s national chairperson and former Robben Island prisoner, Joe Seremane.

Perhaps this would have “de-racialised” the debate — to interrogate Mbeki’s inversion of colonial and racial discourses. I informally put the question to Tony Leon just before he left to take up his ambassadorship in Argentina. “No” he replied without hesitation, “It would have made no difference at all”. I am sure he is right. Mbeki had set his course. In contrast to the top-down process of the state, the writer Jonny Steinberg has illustrated how from the community upwards — in South Africa’s poor and largely illiterate rural hinterland — stigma and sexuality takes on an extraordinary salience. Both worldviews, the state and the local, nourished the other and were informed by and informed party politics. Each worldview nourished the other in a symbiotic relationship where both are informed by party politics. Overall, the issue of providing antiretroviral drugs splintered almost precisely along party political lines.

This points, sadly, to the persistent dominance of identity politics in South Africa: a recurring theme on Thought Leader. Party politics determined which constituencies (opposition-led provinces) received lifesaving antiretroviral drugs first and, in the case of the national government and ruling-party led provinces, set the rollout back by precious years. To the present day, the government has not recovered lost ground. Nor will it. Above all else, this is the tragic story of a nation that has had to learn that Aids respects neither race nor political affiliation. Sometimes, in the early hours of the morning I think about these questions. Most of all I wonder, how did Thabo Mbeki get it so wrong? Mbeki is not an evil man. When an ordinary man makes a mistake in judgment the consequences are small. But Mbeki was no ordinary man. He had the well-being of a nation entrusted to him. Perhaps he succumbed to the same fantasies and hubris as the tragic Shakespearean hero, King Lear. A tragic hero gains insight through suffering, only to realise his mistake at the end.

I think we have suffered enough. Perhaps now he has gained the insight that previously eluded him, but in the meantime, 6 million people lay dying.