Sunday Times (Johannesburg) - August 11, 2002
John Stremlau

SOUTH Africa's brokering of peace between the Democratic Republic of Congo and Rwanda has been rightly hailed internationally as a victory for the New Partnership for Africa's Development.

Now other African-led partnerships must quickly be forged to ensure Nepad's credibility. Halting the spread of HIV/Aids is as important to the continent's survival and success as ending its wars.

National, regional and global partnerships against Aids would give Nepad an enormous boost. Failure could doom Nepad and President Thabo Mbeki's vision of an African renaissance.

Recent UNAIDS forecasts show overburdened African states losing a quarter of their workforce by 2020. Under such dire straits, talk of partnerships for Africa's development is fanciful. With no Aids cure or prevention vaccine on the horizon, fighting the pandemic will remain essentially a political and public policy challenge, for rich and poor.

In Western democracies, media reports of the number of African Aids orphans rising to 25 million are generating pressures for action that could soon match those at the height of the anti-apartheid movement. In Africa, public demands for antiretroviral treatment to prolong life and sustain families and communities reflect growing civic awareness that Nepad presumably promotes and supports.

Nepad boasts African leadership but, unlike with the Congo crisis, South Africa has so far chosen to follow rather than lead the public in the war against HIV/Aids.

The UN Global Fund, established earlier this year, has become a major vehicle for supporting vital projects that need Nepad standards of sound public management and accountability.

UN secretary-general Kofi Annan's minimal estimate of R70-billion annually to fight an effective global campaign to reverse the spread of HIV-Aids is no more than the US military spends each week.

For the first time, Africans can claim the political and moral authority to manage a major foreign aid programme in the best interests of donor and recipients alike.

South African leadership is required, for it makes no sense to import antiretroviral drugs. South Africa has the scientific, industrial and financial base to mass-produce a basic three-drug antiretroviral prescription that could greatly extend the lives of millions of parents and workers across Africa. As in Brazil, the government would be both buyer and seller of these drugs, at prices set by social policy, not the market, with subsidies covered by external donors in accordance with Nepad principles and practice.

The UN fund could be used to expand local production capacity and subsidise growing demand.

International support for Botswana's comprehensive programme for providing antiretroviral treatment to all in need suggests a new donor responsiveness to African anti-Aids initiatives. SA has the capacity to ensure such coverage is, with Western support, extended to all SADC countries and beyond.

The cheapest antiretroviral triple cocktail costs about R3 000 a patient annually, beyond the reach of many South Africans and prohibitive across a continent where many countries have per capita health budgets of only R100.

Who gets access to which drugs, when, for how long, and at what price, raise unavoidable political, financial and ethical dilemmas.

Resolving such difficult issues fairly and legitimately is presumably why President Thabo Mbeki has pushed so hard for democracy and good governance to be the foundation upon which Nepad partnerships must be built.

Aids prevention is ultimately a personal responsibility, with the provision of treatment a social responsibility for which governments and private service providers must be held accountable.

Those who call for reducing poverty as the surest way to beat HIV/Aids put the cart before the horse. Efforts to prevent and treat the disease will drive efforts to improve the public health system, and this, in turn, will give impetus to broader campaigns for poverty alleviation and development.

A growing north-south consensus about the humanitarian, political and international security imperatives for containing and eventually winning the war against HIV/Aids could be the basis for partnerships at local, national and regional levels which could facilitate agreements in other sectors.

Pretoria has pursued uncharacteristically defensive and divisive HIV/Aids policies, treating the pandemic as an obstacle rather than an opportunity for advancing Nepad.

As the region's richest country, SA may have to bear extra costs for effective regional coverage. But using Nepad to mobilise local and global resources in the war against Aids would reaffirm South African leadership for the benefit of all Africans, and people everywhere.

John Stremlau is head of international relations at the University of the Witwatersrand. Matt Stremlau does Aids vaccine research as a PhD candidate at Harvard University
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