The International Aids Conference returns after 16 years to a very different South Africa, but the battle against HIV is not yet over.
At the Durban 2000 International Aids Conference, South Africa had little to brag about other than its vociferous HIV activist movement.
It was a conference of shame for the country. Then president Thabo Mbeki opened the event with a speech that ignored well-established facts and doubted that HIV caused Aids. With the world watching he walked out on 11-year-old HIV activist Nkosi Johnson, who from the stage was pleading with him for access to antiretroviral treatment.
Less than a year later, Nkosi was dead. He was one of many casualties. A 2008 Harvard University study published in the journal Acquired Immune Deficiency Syndrome holds Mbeki and his health minister Manto Tshabalala-Msimang responsible for 330 000 deaths that could have been prevented had the government provided treatment to HIV-infected people at the time.
While Mbeki’s HIV dissidence is ongoing, the government has drastically turned around its policies. Initially, activists had to force the state to do so through court orders, but over the past decade the health department’s efforts have been entirely voluntary.
New leadership, new story
This week South African Deputy President Cyril Ramaphosa visited Nkosi’s Haven, a facility that provides shelter to HIV-infected mothers and their children. Nkosi’s adoptive mother started it and named it after him. It was Nkosi’s dream to see infected mothers and their children live together.
Ramaphosa’s visit, to kick off the government’s five-day countdown to the Aids 2016 conference, was in sharp contrast to the Mbeki administration’s behaviour in 2000.
Many HIV scientists believe Mbeki’s HIV dissidence at the event 16 years ago achieved exactly the opposite of what he intended: instead of leading to delegates casting doubt on HIV science, it produced a “treatment revolution”.
Mbeki became the common enemy. “When people left the Durban 2000 conference, everybody, barring the Aids denialists, was singing the same tune: we have to provide treatment to everybody,” says Salim Abdool Karim, co-chair of the 2000 conference.
South Africa now has the largest antiretroviral programme in the world.
By the end of March, the government had provided free antiretroviral drugs to 3.4-million HIV-infected South Africans. The impact has been significant. National Health Laboratory Service data shows that the country’s mother-to-child transmission rate has fallen from about 30% in 2004 to about 1.5% in 2015. Our life expectancy increased from 54.6 years in 2002 to close to 63 years in 2015, according to Statistics South Africa data — largely as a result of access to HIV treatment.
There can be no clearer proof that antiretroviral treatment works.
For young women, the epidemic is still raging
But to relax now would be to do a disservice to the dead, and to those still living with HIV.
The virus continues to spread rapidly among girls and young women between the ages of 15 and 24: there are about 2 000 new infections in this group every week, according to the Joint United Nations Programme on HIV and Aids.
HIV activists remain concerned about “political interference” in their work. They tell of how donors who fund groups such as the Treatment Action Campaign and Section27, both often critical of the government, were summoned by ANC leaders earlier this year and questioned about their investment in organisations perceived to be pushing for “regime change”.
Yet it is fact that our government, or at least the health and finance departments, now leads the way in implementing evidence-based HIV treatment and prevention programmes.
Aggressive but responsible activism must ensure, and be allowed to ensure, that the state continues to make progress.
When Durban 2016 opens, South Africa will have much to boast about. But it must never again allow the political meddling of a few individuals to derail the progress of our HIV response.
Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.