The loss of one of SA’s most longstanding HIV activists comes when politics and dwindling resources are pitting stalwarts against each other.
In the moments after Prudence Mabele died, HIV activist Phindi Mkhabela looked around the waiting room of a Johannesburg hospital and saw the faces of those who had gathered to keep vigil, of women, who turned to each other and asked:
“But how will I tell my children?”
“That’s how Prudence was – she touched you, she touched your family, she touched your friends,” remembered Mkhabela, speaking at Mabele’s memorial on Sunday.
More than one hundred people filled Wits University’s main hall to commemorate Mabele, who passed away on 10 July from pneumonia following a struggle with tuberculosis (TB).
Mabele was a leading voice in South Africa’s struggle for HIV treatment after becoming one of the first women to publicly disclose her HIV-positive status in 1992. She went on to co-found a host of organisations such as the Treatment Action Campaign, the Positive Women’s Network and the Aids Consortium. These groups would be pivotal in securing treatment but in producing waves of activists that, like Mabele, would go on to fight for the right to health as well as the rights of women and the LGBTI community at home and abroad.
The concept of intersectionality – or the idea that social categories such as race, class and gender create overlapping and yet independent systems of disadvantage – has seen a resurgence in popular culture. Mabele, a sangoma who preached the gospel of antiretrovirals early on, was the embodiment, said many.
“Nowadays, we have to teach activists about intersectionality. Prudence lived intersectionality – for her, every struggle was worth the passion,” remembered Lebo Ramafoko, CEO of the non-profit Soul City Institute for Social Justice.
Mabele was a fighter, dogged in her pursuit of justice. She was also stylish, grinning in mint-green kimono, and matching lipstick and oversized cat-eye sun glasses in a photo posted on Facebook and also on Sunday’s programme.
She loved being “Aunt Pru” to her friends’ children. And she had a horrible singing voice, her friends related.
Like us all, she was fragile.
HIV activist Phindile Malaza explained: “As much as it didn’t seem like it to the world, Pru was lonely. There was a void in her life that none of the spaces could fill. Even in her last days, she was alone. Maybe part of it was that she didn’t want people to see her at her weakest point. Even if she was sick, some of us who claimed to be her friends would never know.”
Before HIV treatment became widely available, some forms of pneumonia were so common among people living with HIV that a 1988 study in the Journal of Acquired Immune Deficiency Syndrome estimated that two our of every three HIV-infected people in the United States would eventually develop the illness. The condition is known as an “opportunistic infection” among HIV-positive people, or an illness that is more likely to occur or more severe in people living with the virus.
“Can you believe that people used to die of pneumonia? Malaza remembered Mabele saying when Mabele was admitted to hospital shortly before her death.
“We shouldn’t have people who led the struggle for treatment dying of opportunistic infections,” Malaza said.
‘Either you join us, or you move on’
If the recent funeral of struggle stalwart Ahmed Kathrada offered an opportunity to reflect on the state of South African politics, then Mabele’s memorial could be said to have done same for the country’s HIV response. Her death also comes at a time when HIV activists may be more politically divided than they have been in more than a decade.
In July, South Africa held its bi-annual national Aids conference. Mabele led protests against gender-based violence, draped in an activist t-shirt – one hand on a megaphone, the other motioning to the crowd as she hung out of the window of a South African Police Service car. In footage captured on a cell phone, she throws a mischievous look towards the camera.
Days later at the conference, South African National Aids Council deputy chairperson Mmapaseka Steve Letsike held a press conference in response in part to unhappiness among some sectors of civil society regarding the new HIV plan for 2017 to 2022.
At the meeting, she requested that Parliament and the public protector investigate “the entire HIV sector in South Africa to see who is funded by whom and where the money is going”.
In short, Letsike seems to draw on existing narratives of a Western-funded third force that have been used to discredit civil society.
In May, amaBhugane reported that a confidential ANC report called such organisations “Trojan horses” that served a “subversive agenda”.
But it’s unlikely that any major HIV organisation has not benefited from Western funding in South Africa.
The US government has been one of the largest funders of South Africa’s HIV response, investing more than $5.6 billion in the country since 2004. In 2017, it committed $483 million to fighting HIV and TB in the country until September 2018, according to the US President’s Emergency Plan for Aids Relief (Pepfar). South Africa also receives substantial support from the international financing mechanism, the Global Fund to Fight Aids, TB and Malaria.
The United States remains the leading donor to the Global Fund, 2016 research by the American health organisation, the Kaiser Family Foundation, stated.
The inability of smaller, more grassroots bodies to access Global Fund money directly because of the fund’s reporting requirements (also cited by Letsike at the press conference) has been a long-standing critique of its funding, 2012 research by the Open Society Foundations showed.
At the conference, Letsike, who also chairs the civil society forum, had stern words for members of the forum who had concerns about the plan and who accused her of denying alleged conflicts of interest involving her media company: “Either you join us, or you move on.”
The meeting was also the first time the national HIV body admitted that it, not Cabinet, had cut the call for the decriminalisation of sex work – a hallmark of HIV plans in the last decade – from the final draft. This followed weeks of outrage over the omission from many activists.
Will competition for resources fuel tensions?
A scarcity of funding for HIV organisations was mentioned by several speakers at the memorial. Also, the scramble for resources between organisations, that may in part be fuelling divisions within civil society and is likely to intensify. Pepfar plans, as well as the newest national HIV plan, call for more money to be invested in fewer, but high impact, projects. Both plans also suggest that money should largely be spent in high HIV prevalence areas – 27 to be exact.
Organisations not working in these districts may face a tougher time accessing funding through the usual large-scale funders.
Journalist Lucky Mazibuko also disclosed his HIV-positive status early on in South Africa’s HIV struggle and joined fellow HIV activist Zackie Achmat in refusing to take treatment until it was available to all South Africans.
But Mazibuko found himself on oxygen for the third time, he also found Mabele in his living room: “She said, ‘Lucky, you fought a good fight. We need you alive. It’s time that you take treatment and show people this treatment works.’”
Mazibuko concluded: “In all my life as a columnist at the Sowetan, the one thing I have bemoaned is the disunity that exists within the HIV movement. There is strength in unity. In everything Prudence and I did, it was our people who were first and foremost in our minds.”