December 1 was World AIDS Day. Populations of the United States and Europe no longer experience the panic that accompanied the HIV/AIDS pandemic in the 1980s. In sub-Saharan Africa, however, HIV/AIDS is an ongoing emergency that results in hundreds of thousands of deaths each year.
Josh Ruxin is Director of the Access Project for the Global Fund to Fight AIDS, Tuberculosis and Malaria at the Center for Global Health and Economic Development at Columbia University. He currently lives in Rwanda and works with myriad issues associated with HIV/AIDS: “Poverty reduction and prosperity creation is all part of the same development paradigm” he says. “It is possible to get traction in the fight against HIV/AIDS in Rwanda because the government takes an integrated approach and prevalence tends to be lower than in some sub-Saharan countries. About three percent of Rwanda’s population is infected and Rwanda takes the infection seriously and has delivered anti-retro-viral (ARV) treatments, the care, and the prevention programs required to staunch the epidemic.”
This is not the case in South Africa. After Thabo Mbeki’s disastrous policy of denialism, about one third to one quarter of South Africa’s population is infected. This means that, without fast action, about one hundred thousand people will die per year. Scientists say that well over 330,000 people died from AIDS-related illnesses during the Mbeki era; some deaths could have been prevented by the timely and purposeful roll-out of life-prolonging ARV. An ANC MP said the party planned a formal apology to the nation for Mbeki’s denialism. “We owe it to the nation. We, as MPs, were there and we failed to rise up.” Today, there are murmurs to charge Mbeki with genocide. Ruxin said, “Mbeki’s responsibility doesn’t just end in South Africa as his policy influenced other sub-Saharan countries. There is no doubt there is blood on Mbeki’s hands …[but] living as I do in a country that had a real genocide, this is an inappropriate use of the word.”
The next phase of the pandemic is well underway in South Africa – despite President Zuma’s pledged, on World AIDS Day, to undergo an HIV test in an attempt to overcome past political inertia. This is a step in the right direction for Zuma. As ex-deputy president he said he showered after sex with an HIV-positive woman as the believed this would reduce his risk infection. In his AIDS Day speech Zuma said all HIV-positive South African babies under the age of one will receive anti-retroviral drugs as part of a huge expansion of treatment. But entire families are affected and, as Ruxin explained, “when it destroys the fabric of society it improves the ground for cultivating the next wave of the epidemic.” When both parents die in a country that is unable to provide an infrastructure, education, and jobs orphaned children turn to whatever it takes to survive, including sex work. Or towards dangerous sexual relationships that offer other benefits such as school fees. This is also common in Uganda.
Uganda was touted as a real success story by the Bush Administration because it deployed the Bush policy of “abstinence, being faithful, and, if you must, using condoms.” Ruxin said, “They forgot to mention that the prevalence rate was dropping before we did anything because so many people were dying. The only way to drop the prevalence rate with that policy is that many more people are born…or people die. The data was really overblown…[Uganda has] not launched an effective response, the pandemic is still spreading at an alarming rate because of issues such as family planning, the use of condoms – of lack thereof – and corruption.” Uganda lost its HIV/AIDS funding in 2005 after it was revealed that someone within the country’s Ministry of Health had fraudulently taken $280,000 from the Global Fund.
Botswana has the world’s most concentrated epidemic: about 40 percent of Botswana’s adult population is infected. Nevertheless, Botswana has good resources and good management. Since it began organizing against the pandemic about a decade ago Botswana has been effective in getting people onto ARV therapy and preventing further spread. The death rate has dropped substantially.
Ruxin stated that the sad thing about this virus being with us for so long is that few people realized that there was this terribly destructive public health issue because we simply didn’t have the health surveillance systems or good development programs in Central Africa. Had we better development programs in the region in the ’60s and ’70s we may have noticed the emerging epidemic sooner. “We’re learning from SARS and the other viruses that we must have good surveillance at the sites where people come into close contact with other species and where there is no access to good health care. We don’t have the tools to squash this ongoing emergency and, as long as HIV/AIDS is on this planet, it seems very unlikely that we’ll get everyone to use condoms consistently – even though that would staunch the numbers of infections. We’re going to have to work towards the two things we do not have: an effective vaccine and a cure.”
Despite UNAIDS upbeat picture of the numbers of deaths dropping from infection Ruxin suggests the world is still in the middle of the beginning of the pandemic. He says, despite what is claimed on World AIDS Day, “this is a disease that is killing millions, is destroying tens if not hundreds of millions of families and is continuing to tear apart countries at their core. We need to demand that our leaders, particularly in the US government – USAID, CDC and other agencies that are pumping millions of dollars into combating this pandemic – heed this and do more for we are very far from making a real impact.”
SUSAN GALLEYMORE is author of Long Time Passing: Mothers Speak about War and Terror, host of Stanford University’s Raising Sand Radio, and a former “military mom” and GI Rights Counselor. Contact her at firstname.lastname@example.org.