Sunday Times, South Africa - July 9, 2000
Left Brain; Frank Meintjies

There is now a strong imperative for bold action from politicians and community leaders.

For sure, there is growing awareness. But it mostly lives just under the surface of everyday life. It is carried in the heart, in many cases in the form of fear, rather than as a spur to action.

Today few can deny that hundreds of people are dying daily, but getting families and communities to admit to AIDS and to talk about related illnesses and deaths is a major problem.

The situation calls for politicians, community leaders, non-governmental organisations, parastatals and government organisations to rise to the occasion. When will the politicians intervene? When will they go to towns, villages and townships across the country with one mission: to exhort people to take AIDS seriously, to support victims, to change behaviour and to spread the word about combating the spread of HIV? How many more people must die?

Ours is not the only society underplaying the scourge. Zimbabwe, Botswana and other sub-Saharan countries face similar problems of national denial and, consequently, are losing ground in the battle against AIDS. But our failure to get to grips with the pandemic is starker and less forgivable for several reasons:

Our relatively higher rate of economic development, modernisation and in some cases organisational capability.

Our ambitions for a tone-setting role in a continental renaissance.

We often act as spokesman for the developing world in international affairs.

One of the main problems to be overcome, and which stunts effective response, is the culture of silence in society generally and in communities in particular.

Even though its presence is felt, the disease is not usually called by its name. There are huge cultural barriers to the open discussion of AIDS. In some cases, the silence is tied up with superstition and ignorance. Mostly, however, it is linked to shame, where families of the deceased fear community prejudice and ostracism, particularly of surviving children. This prejudice is driving the problem underground. The result is that the simmering sense of emergency is not shared in communities. It is near impossible to establish accurate information on the impact of AIDS and the base of knowledge, acceptance and understanding needed to trigger common action is limited.

Another major problem is the attitude of the youth, who have the highest infection rate. They form society's soft underbelly as far as the spread of HIV is concerned. Yet information and "the facts" are penetrating that group far too slowly. To a great extent, doubts and myths about HIV and AIDS persist. And even when information gets through, indications are that many young people are prepared to take a gamble anyway. There is that old avoidance trick: HIV/AIDS will happen to someone else.

Among the youth underclass, this attitude mingles with deep-set problems of lack of self- esteem and the sense, among many, that life "isn't worth much anyway". These frightening ideas hold sway mainly among males in the most deprived localities, but through a web of complex power and sexual relations, young black women become part of the consequences of such thinking.

Disseminating treatments to extend and improve the quality of life for people living with AIDS is no doubt part of the campaign to build awareness and an effective social response. It fits with other processes aimed at curbing paranoid responses, prejudice and, in some senses, the fatalism that exists among a core of youth.

However, the available drugs - effectively used to turn the tide against the disease in developed countries - remain largely out of reach for poor and middle-income countries. Not only will expenditure on such drugs "wipe out" our health budget, it will also be a major setback to government's Gear economic policy projections that are central to plans to make SA an important global player.

So far, as a country, our response to AIDS has been woeful. We need much bolder action. While efforts to mobilise and agitate at community level must continue, government and political leaders must give stronger direction to help us take a quantum leap forward.

As difficult as it may be for them personally, I would like to see at least some prominent politicians who have HIV or AIDS publicly acknowledge this. Given their influence, they can play a heroic role in exploding myths about the disease. I would also like to see political parties taking steps to end the culture of silence around AIDS-related deaths. Denying that a political figure has died of AIDS may seem an easier way out, but there is much more to be gained through actions that acknowledge that many ordinary South Africans are infected.

In addition, government must start a public discussion about how we adjust the national commitment to Gear to accommodate the costs of prevention and treatment.

Even if government's campaign for lowering the cost of drugs succeeds, mega-millions of rands are needed - and the public should be fully involved in juggling the options. We should explore such options as ring-fencing a slice of lottery proceeds, a once-off AIDS levy and shaving portions from other expenditure items.

* Frank Meintjies is a change management specialist at Deloitte Consulting
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