While statistics remain hard to collect, current estimates place the number of people living with AIDS in South Africa at 5.7 million people (out of a population of 47.9 million) with nearly a thousand AIDS deaths occurring daily. Various reasons have been blamed for the skyrocketing number of AIDS cases including government inaction, cultural beliefs concerning AIDS prevention, and scarcity of anti-retroviral medication.
When the first AIDS cases were identified in South Africa in the 1980s, the apartheid government of the time was slow to launch prevention and treatment programs. Even when these programs were finally established across the country, there was fierce opposition by anti-apartheid activists who viewed them as an attempt to control population growth (a popular parody of the time labeled AIDS as "Afrikaner Invention to Deprive us of Sex"). Some critics even found it easier to blame the rising number of cases on witchcraft.
By the time Nelson Mandela became President of South Africa in 1994, the AIDS rate had climbed to 2.2 percent of the population. The new government declared AIDS as a high-priority issue and the National AIDS Convention of South Africa (NACOSA) was formed to combat the crisis. As new cases arose, critics dismissed the NACOSA plan as being poorly organized and underfunded. In one controversial move, then-health minister Nkosana Dlamini-Zuma announced in 1998 that azidothymidine (AZT) would not be made available due to costs involved despite the proven value of the drug in reducing HIV transmission from pregnant mothers to their infants. When Nelson Mandela stepped down in 1999, official estimates of AIDS cases were estimated at 4 million people (10 per cent of the population) with 500 thousand AIDS deaths to date.
As Thabo Mbeki succeeded Nelson Mandela, he also took the country's AIDS strategy in an unexpected direction. While maverick AIDS researchers had always maintained that HIV was unrelated to AIDS, their views were held in low esteem by more mainstream researchers. President Mbeki, along with his health minister, Manto Tshabalala-Msimang, embraced the contrarian views and accused large pharmaceutical companies of falsifying evidence to sell anti-retroviral medications to Third World countries.
Mbeki established a "Presidential International Panel of Scientists on HIV/AIDS in Africa" in 2000 and invited numerous well-known dissident researchers to present their findings. While national and international agencies protested this decision, Mbeki and his supporters insisted that the dissidents were victims of scientific persecution.Anti-AIDS activists who pushed for anti-retroviral medication distribution in hospitals were accused of "poisoning black people". Mbeki dismissed the medications as "dangerous and toxic" and compared them to the "biological warfare of the apartheid era". He also insisted that AIDS was part of a CIA plot to unseat him.
His health minister, Manto Tshabalala-Msimang, was an long-time political crony who added to the outrage by urging the use of "natural" remedies for the treatment of AIDS without any evidence that they were effective.; Her emphasis on the use of fruits and vegetables such as beetroot, lemon and garlic as AIDS remedies made her the target of international scorn. Critics also found ammunition in her links vitamin entrepreneurs such as Matthias Rath who pushed "natural" remedies in lieu of convention medications.
Since South Africa was hosting an international AIDS conference in July 2000, the confusion took on worldwide significance. Before the conference, a declaration stating that HIV caused AIDS was issued with signatures by 5000 scientists (including Nobel prize winners and prominent researchers). Tshabalala-Msimang dismissed the declaration as an "elitist document" and that it would "find its place in the dustbins of the office" if presented to the South African government.
By 2001, health department surveys showed that up to 25 per cent of women receiving support from public birth clinics were HIV-positive and AIDS had become the leading cause of death in South Africa. The Medical Research Council issued a warning that AIDS would kill 5 to 7 million South Africans by 2010 if the disease was left unchecked. Finally, in that same year, an anti-AIDS organization took the government to court to force nevirapine distribution to pregnant women. Despite a lengthy battle, the South African Supreme Court ruled against the government in 2002 and ordered the medication to be provided in public hospitals free of charge "without delay".
The decision represented a major turning point for Mbeki and his government although the delays in implementing an AIDS drug programme would drag on for years. Only with the replacement of Thabo Mbeki as president in September 2008 by interim president Kgalema Motlanthe would real change begin. The appointment of Barbara Hogan as the new Health minister has left AIDS activists and government critics cautiously optimistic; especially since she has already announced that AIDS would be a top priority.
Despite Hogan's determination, the immensity of the task of reshaping government policy to deal with the pandemic is all too apparent. Anti-retroviral medications are only available in urban areas and are impossible to obtain in the rural townships. The financial burden on government agencies is aggravated by World Trade Organization drug patent rules limiting import of low-cost patented drugs to Third World Countries. While Canada and other countries have enacted trade agreements designed to overcome the import barriers, little progress has been made.
And the deaths are continuing. Despite a renewed push towards AIDS prevention programs (including sex education) and innovative new strategies in the fight against AIDS, the death toll is likely to rise in the years to come.
