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 AIDS and Southern Africa

By Howard Wayne    (c) 2006
jewishsightseeing.com, August 24, 2006

PRETORIA, South Africa—I don’t know how the recently concluded 16^th Annual International AIDS Conference, held in Toronto, played in the United States.  Here, the media portrayed South Africa’s role as disgraceful, ending in the trashing of the country’s display by the Treatment Action Campaign (TAC), a South African advocacy group.  South Africa’s execrable performance was largely due to its Health Minister, Dr. Manto Tshabala-Msimang, who advocates nutrition and the use of vegetables as an acceptable alternative to anti-retroviral (ARV) drugs in fighting AIDS.[1] 

One political cartoon in the Pretoria paper shows her taking a bedridden patient’s temperature with what resembles a yam and exclaiming, “I need a second opinion on this – get me my greengrocer.”   The UN special envoy for HIV/AIDS in Africa lambasted her theories as “worthy of the lunatic fringes.” She has acquired the nickname Dr. Beetroot and there have been calls for her removal.[2]  Those calls have been rejected by President Thabo Mbeki, who has his own controversial record on the causes of AIDS and the methods for fighting it.

AIDS is a problem in the United States, but its magnitude is far greater in Africa.  As of 2003, 34 million people in the world suffered from AIDS and 25 million of them were in Africa.[3]  Approximately 20% of the adult population of South Africa has AIDS or is HIV positive.  While nearby nations such as Botswana and Swaziland have even higher infection rates, they are comparatively small countries.  With more than five million cases in South Africa, this country has the highest number of HIV-AIDS victims in the world.  Last year South Africa also reported the largest number of AIDS death in the world, 320,000, or almost 1,000 per day.

Most of these people are young adults; in what should be the prime of their lives and when they could be contributing the most to the economy.  What I have been told is that during weekend there are traffic jams in cemeteries because of the number of funerals for AIDS victims.

Many of those dead are parents.  Available statistics indicated that in sub-Saharan Africa 14 million children have been orphaned by AIDS, a total higher than all the children in Canada, Ireland and Scandinavia combined. When parents die the burden of raising their children falls on the grandparents.  More than half of the orphaned children live in grandparent-headed homes.  Old age pension payments are used to support four, five and six grandchildren.

In many cases there are no grandparents and the children have to fend for themselves.  I have also heard of child-headed families as the older children struggle and sacrifice to raise their younger siblings.  I visited a school in Alexandra, near Johannesburg, that caters to AIDS orphans.

At times it is the children themselves who are HIV positive, the infection having been passed on by their mothers.  One project in Kenya has demonstrated that with proper pre-natal treatment this re-infection can be reduced by 99%.  Due to lack of money and will, this regimen is rarely available.

The effects of the epidemic ripple through society, pushing poor households deeper into poverty, reducing educational opportunities as teachers die, and increasing crime as AIDS orphans become street children who start with petty theft and graduate to violent offenses.  Projections show that AIDS will reduce both the economic growth and the population increase of the country.  One projection is that it will lead to a decline in the population.

Why the prevalence in southern Africa?  First of all, AIDS here is not viewed as a “gay disease.”  It is rampant throughout the region, with the highest rates in the black population.  The epidemic has become so entrenched and so generalized that most infections are now occurring among people previously considered to be low risk.

Part of the prevalence relates to historic labor patterns.  Men from the rural areas are separated from their wives and homes for long stretches of time so the men can work in urban areas to send money home.  With this separation they take up with a string of prostitutes, and when they go home they infect their wives.  This happened with more traditional sexually transmitted diseases and is now happening with AIDS.  Long distance truck driving is a variation of this labor pattern.  AIDS is transmitted from Central Africa from prostitutes who sleep with the truckers, and the truckers carry the virus home.  The epidemic came to South Africa during the period from 1990-1995, which was when anti-apartheid fighters, who had also been cut off from their families for years, returned to the country.

A second reason is the sexual practices of the country.  The age of consent is 16.  Part of culture is not to use condoms.  Poverty begets fatalism.  Life is hard and death can come at any time.[4]  Malarial mosquitoes swarm at night and poor Africans can’t afford mefloquine.  They take cheap, crowded minibuses to work that are poorly maintained and have questionable brakes.  Premature death is common.  It is difficult to promote the value of safe sex when poverty makes daily existence so problematic.

The policies of the Bush administration also contribute to the spread of AIDS.  While some countries have pushed a three-fold prevention strategy called ABC – abstinence, be faithful, and condoms, the Bushies only want to fund programs for the first A.  Abstinence is preferable for teenagers, but it is not realistic to expect people in their twenties to abstain.  What were successful ABC programs become failures when only abstinence is promoted.

Why is HIV-AIDS so much more prevalent in southern rather than in western Africa?  One explanation I have heard in that the strain of AIDS in southern Africa is more virulent than in West Africa.  Another is that male circumcision is more common in West Africa.  Circumcision substantially reduces HIV transmission.

The government is engaged in a prevention campaign.  Television advertisements, in greater numbers and with much more explicit portrayals than we see in the United States, encourage the use of condoms and urge couples to be tested before engaging in intercourse.  Safe sex messages are everywhere.  Condoms are readily available – and free – in many public restrooms, including those in the US Embassy and the National Prosecuting Authority.  What can be considered encouraging is that South Africa does not have the infection rates of nearby countries.

The government’s shortcomings involve the failure to provide treatment. This does not increase the rate of HIV-AIDS, but only the severity of the consequences of the infection.[5]  What has been the story of the government’s ineptitude?

In the mid-1990s the African National Congress, with the backing of then deputy president Mbeki, endorsed a cheap quack remedy developed at the University of Pretoria called virodome.  The Medicine Control Council halted trials of the substance when it was discovered that its active ingredient was a solvent used for freezing animal organs which had no impact on AIDS.  Mbeki criticized the council for sacrificing lives by holding up the miracle cure.

In 1999, shortly after becoming president, Mbeki questioned the value of the ARV drug AZT, and suggested it was so toxic it might do patients more harm than good.  Mbeki had discovered the websites of AIDS dissidents, whose views on the disease are analogous to the small minority of scientists who claim global warming is a myth, to the delight of the Bush administration.

Conspiracy theories are at the heart of the dissidents’ cause.  One asserts that the AIDS pandemic is a genocidal conspiracy intended to decimate the continent so the West can gather its natural resources.  Others assert that HIV has never been isolated, HIV tests are worthless, and that death is caused not by AIDS but by ARV drugs used to treat a non-existent disease.  Some argue that there is no viral cause of AIDS.  They maintain AIDS in Africa is a result of the collapse of the immuno-suppressive system caused by malnutrition and other poverty-related illnesses. The afflicted patients are killed by the new toxic ARV drugs.

The pharmaceutical companies are presented as the real villains.  Dissidents argue that they manipulate research funding to shut out dissenting scientists and maximize profits by getting researchers they have funded to support drugs they have developed as the only acceptable remedy.

This final argument may have resonated with Mbeki.  In 1997, when the HIV rate began to skyrocket, South Africa enacted a law to allow the government to acquire generic versions of drugs at much lower prices than the pharmaceutical companies were charging.  Although international agreements permit countries facing a national emergency to do this, large American companies objected and forty of them filed suit in the South African Constitutional Court on the basis the law violated their intellectual property rights.  Two years of heavy US diplomatic pressure followed, including placing South Africa on a watch list for possible punitive action.  In the face of mounting international pressure the drug companies backed down and offered to slash the prices of their anti-retroviral drugs.

It was during this conflict that Mbeki began to argue that African AIDS was different and more virulent than AIDS in the developed world.  Consequently he urged the need to develop an African remedy.

Mbeki also may harbor a belief that those who point to the disease’s catastrophic scale in Africa are maligning black people in a manner that amounts to a condemnation of African culture and sexual practices.  In 2000, referring to a declaration signed by 5,000 scientists at the International AIDS conference, Mbeki wrote of the “desperate attempt made by some scientists . . . to blame HIV/AIDS on Africans, even at a time when the United States was the epicenter of reported deaths from AIDS.”  On another occasion he said that AIDS scientists were denigrating black people as vice-ridden germ carriers.

Mbeki’s attitude has damaged his, and South Africa’s, image both in the country and internationally.[6]  The repeated criticisms have forced him to become silent on the issue, but have neither quieted his health minister nor led to her dismissal.  Instead South Africa has become the ‘worst practice example.”  Meanwhile 1,000 people die of AIDS here every day and another 1,000 acquire the disease.