Mail & Guardian (Johannesburg) - July 14 2000
Belinda Beresford

But, as the Aids 2000 conference in Durban has demonstrated, South Africa is a world leader in other ways. South African scientists, and those from other parts of the continent, can produce world-class research. One of the reasons why so much international research is done in South Africa is because it provides developing-world illnesses and large numbers of potential patients, with First World facilities.

South African NGOs, parastatals and community leaders have also shown strong leadership. However, the perception at the conference has been that South Africa's government has been on the defensive, rather than taking the lead. The tone was set by President Thabo Mbeki's opening speech, which was regarded as disappointingly defensive.

Possibly the most eloquent statement was that of high court Judge Edwin Cameron, who charged: "In my own country a government that in its commitment to human rights and democracy has been a shining example to Africa and the world has at almost every conceivable turn mismanaged the epidemic. So grievous has governmental ineptitude been that South Africa has since 1998 had the fastest-growing HIV epidemic in the world."

But the government has come out fighting. Department of Health officials point out that it has been making efforts to counter the epidemic, including making large strides in public education, supporting research and development of vaccines and drugs for HIV. The health minister has also pointed out that the present government is saddled with the negligence of the past, given the length of incubation of HIV.

Scientists have been warning about the epidemic since the 1980s when it first hit Central Africa, but the National Party paid little attention.

The epidemic's explosion has also coincided with the major restructuring of the health sector undertaken since 1994. The restructuring has been supposed to convert an advanced health sector designed for a white minority into one which can also cater for the black majority - a process that has meant budget reductions at hospitals which should be at the cutting edge of Aids treatment and research. Many such institutions have had to either downscale or close their Aids units.

An Aids policy has been created, one of the requirements to aid from international donors. But doctors and researchers working in the country say that is part of the problem: there has been too much talk, consultation and discussion, and not enough action.

Kenneth Roth of Human Rights Watch said: "A government's message about preventing HIV infection is not a matter of resources: it is a matter of political choice, courage and will."

Repeatedly government officials have said the president has never doubted that HIV causes Aids. Whether true or not, he has spent R2-million on a panel which is widely seen as trying to reinvent the wheel as far as as the virus is concerned.

Speaker after speaker has side-swiped the discussion about the origins of Aids. In a sense the government could be hampered by its failure to compromise and its desire for the best practice possible. For example getting drugs to all in the country - citing the Constitution's requirement for equal treatment for all - means delays while infrastructure is set up in more remote areas. However, during that time treatment could be initiated in urban areas.

Another example is the South African government's expressed desire to have a Southern African Development Community-wide response to the disease. This appears to be undermined by the decision of Botswana, for example, to go ahead with an infrastructure-building and drug-donation programme from the Bill & Melinda Gates Foundation and Merck respectively.

Also striking has been the split between the government and the pharmaceutical industry, exacerbated by the still-outstanding court case the industry has brought against legislation allowing parallel imports. But to beat the epidemic all governments will have to work with the pharmaceutical companies. After all, as one delegate said, you don't argue in the emergency room when the patient is dying.
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