Mail & Guardian (Johannesburg) - June 20 2000
Steven Friedman

Take one of our toughest and most important challenges, HIV/Aids. At first glance the idea that beating a virus has anything to do with getting politics right and handling people well seems odd. But a second look will show that we are losing the battle against Aids solely because the government is getting the politics wrong.

In the 'developing' world only three countries are widely believed to have fought Aids effectively: Cuba, Thailand and Uganda. Since their political systems, economies and cultures differ greatly, what is it that they have in common which enabled them to fight the virus?

The answer is political leadership: in each case the head of government was fully and publicly committed to treating Aids as a national priority. But it was leadership of a particular sort. It is simply impossible for any government to fight Aids on its own: society must co-operate not only by changing attitudes and behaviours, but also in its willingness to support and help those who live with the virus or are orphaned by it.

So the key goal of political leadership in the three countries was to rally society around the battle against Aids. The government needed to take the lead, but its task was to get everyone who could contribute to a solution to work together to achieve it.

By contrast, our Aids programme is not working: recent studies have, for example, found low levels of condom use and a startlingly high number of people who still believe that Aids is not fatal. We have not even begun to inspan society behind the task of dealing with its effects. And the reason is that our government's response has deterred people from working together to tackle the epidemic.

One example is well known: the government's role in backing 'dissidents' who deny a link between HIV and Aids. There is no need here to rehash the medical debate. The government may claim that it is trying to show absolute seriousness about HIV/Aids. But the effect has clearly been to divide rather than unite, to create doubts about the seriousness of the problem and the need to pull together to deal with it.

Less publicised is the state of government relations with Aids specialists and activists. They are, in a word, hostile.

Earlier this year, Minister of Health Manto Tshabalala-Msimang was jeered at an Aids conference when she refused to answer questions after her opening address. That this was merely a symptom of a rift was confirmed when the government's National Council of Aids included no members of the local Aids community -- health professionals, NGO activists and the like.

Friction seems to centre on: the government's refusal to approve the use of AZT for Aids treatment; its previous support of the development of Virodene, which would have had higher toxicity levels than AZT; and an announcement by former minister of health Nkosazana Zuma that Aids would be made a notifiable disease, contrary to what local activists claim was agreed in negotiations.

As with the debate on the HIV link, the issue is not who was right or wrong on the technicalities. It is that the government has failed to reach agreement with -- and so to forge co-operation with -- those whose skills and energies can help it fight Aids; in each of these cases, it was surely not beyond its skill and power to negotiate with them common approaches to problems. The composition of the council suggests that it has not even acknowledged that it needs their help.

So two features mark the political management of Aids. First, despite the prevalence of Aids ribbons on the lapels of our leadership, citizens receive confusing signals rather than a clear and simple message that the virus is a killer that we need to fight. Second, instead of using its political resources to draw those it needs to fight Aids into a partnership, its insistence that it will take the key decisions whatever those in the front line of the fight against it think has had precisely the opposite effect, creating tension where unity of purpose is needed. And, as long as that persists, we will continue to lose the fight, however much energy and effort the government devotes to the battle against Aids.

The Aids issue is not only very important in itself, it is an indicator of general trends in the government which make it more difficult for us to resolve problems. In other areas too, the government implies that problems are technical rather than political, that they are about finding the 'right' solutions rather than those with which the widest possible range of key actors are comfortable.

The desire to show that the government is in control and is not obliged to listen to key interests in society is also widespread. Negotiation is often portrayed as a luxury which gets in the way of our most pressing need -- getting things done. In its desire to show it is effective, this administration is far less inclined to take the time to consult and include than its predecessor.

If that approach does not work in the fight against Aids -- a challenge which, with the exception of a few right-wing crazies, every citizen recognises as a threat to us all (making it far easier in principle to achieve agreement) and one which would seem more open to technical solutions than others -- why should it work anywhere else?

The Aids issue shows what evidence from elsewhere is also suggesting: that it cannot work. South Africa is too fractious a country, with too many independent interests, to be run by a group of smart technicians at the top. Just as widespread agreement on the need to work together is crucial to beating Aids, so is it vital to the quest for economic growth, the fight against poverty or creating a workable education system.

In these areas, as with Aids, the government certainly needs to provide leadership and to show that it wields power. But, in these areas too, real power lies not in imposing government decisions on people on the grounds that they are 'technically' sound, but in persuading people to co-operate in realising the society's goals.

The government has enough support to mobilise citizens and interest groups behind its goals. But, to do that, it needs to take their views and needs more seriously -- and to realise that, however clever technical people may be, the solutions which win the widest and most enthusiastic support in society usually work better than those decided alone by clever people.
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