Sunday Times (Johannesburg) - November 25, 2001

The government's 2000 plan on HIV/Aids and sexually transmitted diseases notes: "In South Africa, despite our best efforts, the HIV infection rate has increased significantly over the past five years. This increase calls for a renewed commitment from all South Africans."

The Joint Standing Committee on the Improvement of the Quality of Life and Status of Women responded to this call. Its report, based on extensive public hearings, endorses the government's plan and recommends that it be fully implemented.

It responds to the government's 1997 call for "the need for leadership and political and public commitment". It starts from the government's premise that HIV causes Aids.

In 1998, President Thabo Mbeki said: "For too long we have closed our eyes as a nation, hoping the truth was not so real. For many years, we have allowed the HIV virus to spread, and at a rate in our country which is one of the fastest in the world."

The government's plan notes that from 1990 to 1999, HIV prevalence rose from 0.7% to 22.4%. Women aged 20 and 30 have the highest rates and women under 20 the highest percentage increase.

Apartheid has entrenched patriarchal religions and traditions which equate women and sex with sin. The migrant labour system contributed to widespread poverty and gender inequality. Two hidden truths about single-sex hostels and prisons were male homosexuality and poverty-driven sex work.

Women trying to get men to abstain, be faithful and condomise face rejection, beatings and even death.

Scientific studies establish that in Gauteng a woman is killed by a partner every six days, that 39% of girls aged between 12 and 17 have been forced to have sex, that 32% of young men believe "forced sex with someone you know is not sexual violence" and sex workers face violence for insisting on condoms.

The LoveLife organisation reveals that one in four young South Africans believes the myth that "sex with a virgin cures HIV/Aids".

In September, Safety and Security Minister Steve Tshwete said child rape had doubled in the past year.

Society's double standards give males licence to be sexually adventurous without taking responsibility for their actions, while controlling female sexuality.

UNAIDS found that most women who have the disease are infected by a male partner to whom they are faithful. Yet women and girls are blamed for the spread of HIV/Aids.

Men have the power to reverse this by respecting women and children as equals; by changing sexual behaviour; by ending the myths and by building a culture of peace.

South Africa needs a holistic response to prevention and treatment that addresses HIV/Aids, poverty and gender-based violence and that is driven by people living with Aids. An evaluation of policies and programmes must address unequal power relations, especially sexual inequality. Women and girls must be empowered as agents of change.

There must be a public education campaign to show how sexual inequality, violence and the rape-of-virgin-myth spreads HIV/Aids. Female-controlled prevention such as female condoms and microbicides must be available. Home-based care that includes men as carers must ease women and girls' disproportionate burden in this area.

The Equality Act and the Domestic Violence Act must be fully implemented; the Sexual Offences and Customary Law on Inheritance Bills and laws to legalise sex work and prohibit trafficking in women and children must be enacted.

The government must effect its priorities on poverty, employment and social systems. Its 1998 initiative towards a gender-responsive budget must be reinstated. The government's plan requires departments to develop "operational plans" for prevention and treatment. This requires budgets and time-frames for implementation.

President Mbeki noted: "Every year in the developing world 12.2 million children die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die because they are poor."

In 1999, the multinational pharmaceutical companies' profits totalled $27.5 billion. Rich countries responded to the anthrax threat (which has claimed only five lives) by over-riding the arguments used against poor countries, in order to gain access to generic medicines.

Rich people with HIV/Aids in South Africa have access to good nutrition, a healthy lifestyle and can choose antiretroviral treatment. Poor people with HIV/Aids have no such option.

In the early 1990s Brazil, a similarly unequal society to SA, was heading for a devastating Aids crisis. It developed a vigorous prevention and treatment campaign. It produces generics in state laboratories and provides free Aids drugs, which cost Brazil 4% of its health budget in 2000. The HIV/Aids mortality rate has dropped by 50% and hospitalisation from all HIV/Aids-related diseases dropped by 80%.

South Africa needs to use its rights in terms of the Medicines Act and Trade-Related Aspects of Intellectual Property Rights to access and eventually produce affordable, good-quality generics. There must be clinical management of potentially toxic drugs. SA needs guidelines for health workers, similar to the Centre for Disease Control guidelines for the use of antiretrovirals, which state that treatment should be offered to all patients with the acute HIV syndrome.

In a speech to Parliament, Health Minister Manto Tshabalala-Msimang said a decision on the use of nevirapine could be made after the medicine was registered and a study on it completed. The study concluded that a single dose of nevirapine to mother and child reduced HIV transmission by 50%. Nevirapine is registered by the Medicines Control Council, establishing that the benefits outweigh the risks. Its use could save the lives of 60 000 to 70 000 babies annually.

A health economist, commissioned by the Health Department, concluded that voluntary counselling and testing, along with nevirapine and six months' supply of infant formula, might achieve an overall saving of R270-million.

The existing capacity in tertiary institutions and the pilot programmes can be used to build and strengthen capacity elsewhere.

Women must be able to exercise a fully informed choice on anti-retroviral treatment, termination of pregnancy, opportunistic infections, mode of delivery and breast-feeding vs formula.

The government's plan calls for a review of research on using anti-retrovirals to prevent HIV transmission following sexual assault. The Centre for Disease Control's 1998 guidelines suggest that triple therapy taken soon after a rape would probably ensure that 81% of patients would not become HIV-positive.

The government needs an expert committee to develop a guideline for use of antiretrovirals. Outrage at rapes must convert into action to prevent additional tragedy.

South Africans have the individual and collective power to replace hate, fear and pain with the inherent human values of love, peace and joy. We can revalue the life of each and every one. As President Mbeki said: "The message is that we are a country and a continent driven by hope and not despair and resignation to a cruel fate".

This is an abbreviated version of a report by the Parliamentary Joint Standing Committee on the Improvement of the Quality of Life and Status of Women, titled "How best can South Africa address the horrific impact of HIV/Aids on women and girls?" Govender chairs the committee

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