Sunday Times (Johannesburg) - Sunday 31 March 2002
David Bullard

At this point, I imagine, those of you who are HIV-positive or like to think of yourselves as concerned citizens are thinking of writing an indignant letter to the editor of The Sunday Times complaining (in the strongest possible terms) about my insensitivity and lack of compassion and demanding that he sack me. Before you go to all the trouble of finding a pen that works and a piece of notepaper worthy of a letter to this august newspaper, allow me to explain myself. I have just paid you the compliment of being refreshingly honest and I suspect that my lack of concern is rather more commonplace than you may care to think.

The vociferous and well-organised HIV/Aids lobby would have us believe that this is an issue which affects us all; it is not. Many people couldn't give a toss because it is not a problem that directly touches their lives. Besides, why should people who are HIV-positive be more deserving of public sympathy and government funding than tuberculosis sufferers, cancer cases or manic depressives?

For some bizarre reason, HIV has become the maladie du jour, the illness to be fashionably concerned about. Perhaps this is because we know so little about it but my natural cynicism tells me that anything fashionable today will, as like as not, be out of fashion tomorrow.

People wander around with those trendy red-ribbon brooches to show they care, which is all very well but what, apart from publicly demonstrating a cringing deference to political correctness, does a red Aids ribbon brooch actually mean? Are we to believe that the wearers are tirelessly working behind the Aids frontline, taking chicken soup to the sick and needy or changing the soiled bed linen of people too ill to move? I rather doubt it.

For the rest of us, it's all very well to get hot under the collar about President Mbeki's apparently weird views on HIV but are the rest of us any better informed? The endless debate on how to combat the problem of HIV/Aids has become so dreary and tedious that it ranks with the Middle East peace process as one of the longest-running and most repetitively boring news stories of all time. The relative merits of giving something called Nevirapine to the HIV-positive mothers of babies has been used as a political football for so long now that someone should think of blowing the final whistle. It's a game no one can win because nobody has yet been honest enough to address the real issue.

If the government is going to commit itself to providing drugs to those with HIV it would have to do so at the taxpayer's expense. Given that the majority of those infected are not the most economically productive members of society, this would amount to preserving the lives of those who are unlikely to make any significant economic contribution to South Africa at the expense of the economically active.

To put it in business parlance, it's a lose-lose situation. It's a negative return on investment because it is highly unlikely that the children of poor HIV-infected parents will lead bountiful lives, walk into well-paying jobs and become valuable members of the SA economic machine. Not impossible I grant you, but highly unlikely.

So the government has to make a difficult decision. Does it hand out taxpayer-sponsored, life-preserving drugs to the poor, knowing that, by so doing, the drain on the exchequer can only grow, or does it take the view that a smaller, healthier and more economically viable population is in South Africa's long-term interest? I believe it has decided on the latter but, because HIV/Aids is such an emotional matter, it has to fudge the whole issue by pretending it is not convinced that Nevirapine is the right drug to hand out.

Unless we are living in an Orwellian topsy-turvy land, we must assume that the Minister of Health, a qualified doctor, is there to promote the good health of all South African citizens. Since there is not a shred of evidence to suggest this is the case, I can only assume that her best intentions (not to mention the Hippocratic oath) have been over-ruled in the interests of a socio-economic master plan for a lean and mean, economically sound future South Africa. John Stuart Mill would have been proud of her.
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