Daily Mail & Guardian - Johannesburg, South Africa. March 14 2000
Mxolisi Ka-Mankazana

This is despite the appointment by the previous health minister of a special director to deal with the epidemic, and although we have seen high-profile publicity by the president which involved a train ride from Pretoria to Cape Town.

There has been the realisation that all is not well with the Department of Health's strategy to combat the epidemic, resulting in the president appointing a national council. This will, hopefully, lead to the appointment of a task force as a strategy to orchestrate and collate all aspects of a total onslaught against Aids.

The government has shown ambivalence in fighting the epidemic. On the one hand it has pushed for Virodene, despite its serious side effects, while on the other it has rejected AZT therapy for pregnant women because of serious side effects.

There appears to be a rift between the politicians and scientists on the ground regarding prophylactic therapy for pregnant mothers. The minister of health has rejected two reports from the Medicines Control Council about the efficacy of anti-retroviral treatments like AZT. The government is also sitting on the reports of two research projects by the Medical Research Council in favour of the use of anti-retroviral agents.

There is irrationality in the content of the debate around the fight against the epidemic, and the issue is becoming merely a political football. This poses the danger that the powers that be might ride rough-shod over doctors who are passionate about the plight of Aids/HIV victims.

There is a lack of an adequate information management system to intervene appropriately. The good suggestion that people should be testing for HIV anonymously, which could be applied to all target age groups to show what drives the epidemic, was slow in coming.

Are there any "bridging communities" that have been overlooked which are pivotal in driving the epidemic in some geographical areas?

There is a tendency for over-reliance on antenatal HIV testing to assess the size of the problem rather than as a monitor of the effectiveness of intervention measures. Combating Aids/HIV has come to be seen as an esoteric area.

The politicians and the scientists are now seen as the only people with enough wisdom to make things happen. What about inputs from the social sciences, religious groups, the lay members of the community (izakha muzi) and the like? What is their role in fighting this enemy at their door?

The existing approach is not in keeping with the presidential statement on this issue delivered on October 9 1998 that our aim was "to defeat the spread of HIV/Aids lies in our partnership. This is a call to every business, organisation, woman, worker, religion, parent, teacher, student, healer, farmer, young and old, rich and poor hands as partners against Aids."

The kind of questions the public out there are asking are: What areas of intervention are now operative? How well are we doing in these areas (strengths and weaknesses)? What then are the gaps in our intervention strategy in South Africa?

To start a dialogue about these questions, one has to divide the Aids/HIV scenario into three areas. One is the biological features of HIV, the second the epidemiological pattern/s, and the third intervention components of the epidemic.

Biological scientists need to tell us: What is the up-to-date scientific knowledge about this virus? Do the scientists know all that needs to be known to intervene? What are the gaps in our knowledge base regarding this virus? Do vaccines hold any favourable future for us, or will their contribution be marginal, just as the tuberculosis vaccine has been? How far are we in producing the vaccine in terms of stage of production and availability for clinical use?

Epidemiologists who deal with the factors that drive and perpetuate the epidemic must tell us : What are the critical demographic factors? Are there any "bridging groups" we have not yet identified that drive the epidemic? What are the various sexual behavioural patterns that spread the epidemic to different geographical locations? What the is role of the socio-economic status in the likelihood of infection? What are the salient socio-cultural factors -- for example, circumcision, indigenous value systems, religious influences on moral behaviour -- in the spread of the disease. Are there any cultural no-go areas of a kind that cannot be included in the dialogue?

The intervention strategy must be multifaceted. It must be everybody's business. We must identify clear roles for politicians, biological scientists, epidemiologists, clinicians, all age groups, civic organisations, religious organisations and each one of us. We must empower people to make informed decisions for themselves and their communities so that we can all play our role against the common enemy.
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