When the obvious isn’t obvious

Fr Joseph Wilson MSC

A  new book by the Rev Frank Chikane, the former close aide to ex-President Thabo Mbeki, provides a fascinating insight into Mr Mbeki’s personal thinking and response to the HIV/Aids pandemic facing South Africa on the threshold of the third millennium.

In The Chikane Files, the former director-general in the Presidency writes: “There were five critical questions we had to answer. The first was about how we could prevent transmission from pregnant mothers. The second was about treatment for those living with HIV. The third was about the impact of HIV on the poor. The fourth was about research to find a vaccine. This led to the fifth, key question: about the science of HIV/AIDS.

“This debate went on for a shorter time than we imagine— only about two years, from 2000 to 2002.”

Another emperor without clothes! Probably more accurate to say: another emperor without wisdom.

I honestly thought Rev Chikane was building up to the crescendo question: “This led to the fifth, key question, indeed the most obvious: how could we convince South Africans to change their behaviour to mitigate these preventable deaths?”

Imagine a very large river in front of the emperor’s palace (and I don’t mean that casino!) where more than a thousand dead bodies float past every day. The emperor looks out and cries: “My God, treatment, research, science! My kingdom for a non-toxic drug!” Would he not be better served by sending some of his wiser cabinet ministers upstream to try to find out why the people are dying in the first place? And on finding the reason, prevent it at source? Instead, our emperor orders cabinet ministers to wear red-ribbons to work and chooses to spend his time acquainting himself with the contra indications on the medicine bottle.

But if you ask the wrong question, you get a detour.

Mr Mbeki seems to have addressed every question except the essential one: How do we prevent HIV at source? When prevention did come up, it was always to lift up that uncontested saviour of the masses: the condom.

But rather than address behavioural change, that is, the source, Mr Mbeki’s “key” focus became the campaign to mitigate the toxicity of antiretrovirals.

While this might not be wrong in itself, the emphasis however was—and still is—in the wrong place. No one in leadership pointed upstream. Rev Chikane did not mention government’s about-face around 1990 from enthusiastically advocating CBA (condomise, be faithful, abstain) to ABC as the pandemic increased.

Notwithstanding Mr Mbeki’s concern about the toxicity of the drugs and the need to use them in combination with other drugs to prevent mutation, it is unforgivable that government did not do more to publicly endorse tried, tested, proven and far cheaper methods of HIV prevention.

Despite his unending trips around Africa, Mr Mbeki might have put ideology aside and lingered longer in Uganda to find out first-hand a successful African solution to a global pandemic. Instead, he became fixated on the West’s double standards.

They expected Africans and developing nations to ingest toxic antiretroviral drugs which they would not countenance alone for their own citizens. The US Food and Drug Administration was loath to recommend monotherapy antiretroviral treatment for its own citizens, but Africans could chance it for themselves! The recommended triple combination of drugs would prove prohibitive in price. Mr Mbeki saw politics. But none of this stopped the body count coming down the river.

Ten years on, what can we say? The body count coming down the river has slowed, and like decreasing homicide figures (down from 20000 to 18500), people go away thinking: “Oh, it must be on the mend!” The sad reality is that it is not on the mend.

South Africans have settled for treatment rather than cure. When last did you hear an official government warning to change behaviour?

One behaviour that won’t change in the foreseeable future is, come December 1, government ministers will pan out all across South Africa stadia, like the old guard on the Kremlin, solemn and wearing their red-ribbons, calling gravely the now well-torn line: Comrades, wear a condom!  This is the unchallenged orthodoxy of the day and will be repeated like a tired responsorial psalm.

But with so many bodies still floating down the river, isn’t it time that this orthodoxy be fundamentally questioned? Is this the best we can do: merely plugging a hole with latex in the bursting dyke of human misery? Is this Africa’s best: bringing barrier technology to solve what Pope John Paul II called “a pathology of the spirit”?

Despite its antipathy to the West, this government will knuckle under and chant orthodoxy, which ensures continuing and badly-needed overseas funding for its programmes.

To prove her credentials, it will only be a matter of time before we see the South African flag on the government issued condom itself. We do this for Africa! Cometh the day, the reassuring noises will be made, the ribbons worn, the stirring speeches made. Yeah, we will go home feeling we have struck our annual blow against the disease, and like donning the Bafana Bafana jersey every Friday, it is bound to help the boys to kick the ball straight. It costs nothing; it means everything!

“We know with great confidence that at least one in ten of all people in South Africa is HIV-positive,” says the Treatment Action Campaign. UNAids and the World Health Organization estimate that Aids has claimed 350000 South African lives in 2007—nearly 1000 every day (UNAids/WHO “2008 Report on Global AIDS epidemic”).

Imagine the outcry, the rolling mass action in this country, with cabinet ministers outdoing each other to demand “real change”, if a thousand bodies were pulled out of South African mine-shafts every day!

But then, like everything else in South Africa, even death itself has become politicised.

Fr Joseph Wilson MSC is the priest in charge of St Martin de Porres parish in Geluksdal, Johannesburg.