Sunday Times (Johannesburg) - Sunday 14 July, 2002
Bobby Jordan

Within moments, the activist had joined in the rhythmic rendition of Shosholoza, believing she had caught up with a spontaneous fellow activist celebration of last week's Constitutional Court ruling that backed expanded drug access for South Africa's HIV-positive pregnant women.

What the activist didn't know was that her fellow celebrants were mostly from a delegation of South African government health officials. She had not seen the diminutive Health Minister, Manto Tshabalala-Msimang, toyi-toying at the front of the crowd while clutching a speech outlining President Thabo Mbeki's Aids policy.

What an unusual expression there was on that Aids activist's face when the dancing stopped and Tshabalala-Msimang began speaking.

That expression, of having been caught in the wrong camp, is perhaps an apt illustration of the complexity of South Africa's status in the global Aids forum.

South Africa remains big news, not least because it has the highest number of HIV infections worldwide. It also hosted the last International Aids conference two years ago, which means everybody looks to the southern tip of Africa in an attempt to chart any substantial changes to the Aids landscape and discourse.

And, the South African government's often hostile and reluctant engagement on a wide range of HIV/Aids issues and its combative approach to civil society organisations such as the Treatment Action Campaign have cast Tshabalala-Msimang and her colleagues as a hurdle that needs to be overcome.

Thus South Africa represented the key issue of the conference: the importance of harnessing political will to save lives.

In the words of Judge Edwin Cameron, one of a spate of South African presenters who led this debate: "We've got the framework, we've got the capacity, we've even got the international resolutions - what we need is political will, commitment and money."

And, as Professor William Makgoba pointed out rather sternly to his audience, immediate action is needed throughout sub-Saharan Africa, home to 28.5 million of the 40 million people infected with HIV.

"Ten years ago we had exactly the same prevalence as Thailand. Today they're 2.5% and we're 25%. We have been a society in denial, refusing to take action," he said.

This lack of action lies at the heart of what makes South Africa a conundrum to most of the 15 000 delegates who wafted in and out of the five giant conference halls adjoining Avenue del Paral-lel , particularly because the desperate search continues for a formula of action to combat the Aids disaster in sub-Saharan Africa.

Most delegates had hoped that come 2002 South Africa would have been able to help answer these questions by following the example of developing countries such as Brazil, which provides generic drug treatment to 115 000 people.

If South Africa can't get it right with its proud Constitution and human rights network, these delegates ask, then what hope remains for Zimbabwe, which has the second-highest HIV prevalence worldwide, or for Namibia, with the fifth-highest?

According to Professor Alan Whiteside, head of HIV research at the University of Natal and a delegate at Barcelona, the world is genuinely fascinated to see whether we will, literally, do or die.

"There's a sense that the government needs to be called to account around what they are supposed to be doing. Aids will either split us apart or draw us together. I really don't know which it will be."

On the plus side, South Africa has the continent's most ambitious government-backed prevention plans already up and running and the High Court ruling that enforced wider access to antiretroviral drug treatment. The country also seems to be gearing up for a massive rollout of cheap, generic anti-Aids drugs, as well as the first generation Aids vaccine within the next few years - one of the key topics during this year's conference.

On the minus side is the fact that Tshabalala-Msimang appears to have more important things to worry about. The elected representative of 4.7 million infected South Africans - a few hundred thousand less than the total population of Denmark - had already left for home on Monday. After that brief praise-singing for the government's Aids policy, the minister packed her bags and nobody seemed to notice.

Instead, delegates listened to moving presentations and discussions led by other African health ministers, who pointed out that the lack of effective Aids prevention and treatment in most African countries could not be divorced from the greater issue of global inequity of resources and wealth.

Dr Kevin de Cock, director of the Centre for Disease Control in Kenya, said: "We have to ask: what does it take to turn this around? Can public health interventions without substantial economic development turn around Southern Africa's health problems?"

A turning point for Kenya, De Cock added, came in 1999, when President Daniel arap Moi declared Aids a national disaster.

Dr Alex Coutinho, executive director of the Taso Aids welfare group in Uganda, said the region could do well to learn from that country's experiences.

"Uganda has accepted that it must develop its capacity because the drugs may be cheap soon and it would be a tragedy if when they become available we didn't have the capacity to deliver them," he said.

Africa certainly needs the drugs, judging by the figures touted at the conference - for instance, of an estimated six million people who want treatment, only 230 000 are receiving it. The plan is to boost the figure to three million by 2005, but it will require far more funding than the $3-billion (about R30.3-billion) sitting in the Global Aids Fund.

For South Africa, the bottom line from Barcelona was that it needed to find the political will to prevent more infections and unnecessary deaths from HIV/Aids. Whether the government will heed the message is uncertain - the jury will be out until the next International Aids conference in 2004.

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