War against Aids: Reason for hope

It is too late, however, for thousands of South Africans who have already died of Aids-related diseases.

Summary - The government’s decision to order the department of health to prepare a detailed plan for the provision of antiretroviral drugs to Aids sufferers is welcome, though it is a case of better late than never. The decision comes during the countdown to next year’s elections and Bantu Holomisa has speculated whether the ANC’s strategists warned that continued procrastination on the ARV roll-out could cost votes. Past experience suggests we should temper our optimism about any rapid deployment of the plan. And days later, Mbeki defended the Medicines Control Council’s announcement that it would deregister Nevirapine unless the company produced further proof of its safety and efficacy. Nevertheless, the government appears to have made a radical shift in its policy on HIV/Aids. The report of the task team that was presented to cabinet acknowledged unequivocally that ARV therapy would ‘significantly extend life, reduce mortality and improve the health status’ of many South Africans living with HIV/Aids. It seems this time the government means business.

The government decision to order the department of health to urgently prepare a detailed operational plan to provide anti-retroviral drugs to people living with Aids is to be welcomed, with a few caveats.

It is not being excessively critical or curmudgeonly to note that it is a case of better late than never. It is too late, however, for thousands of South Africans who have already died of Aids-related causes but who might have still been alive if the government had shaken itself out of its denialist trance earlier and if president Thabo Mbeki had ended his dalliance with dissident scientists sooner.

In the world of realpolitik opposition politicians have justifiably observed that the government's decision to sanction the provision of anti-retroviral drugs to patients in the advanced stages of Aids comes amid the countdown to next year's scheduled national and provincial elections and amidst speculation that polling could take place as soon as next April. United Democratic Movement leader Bantu Holomisa, with his penchant for straight talking, ponders aloud whether the governing ANC's electoral strategists have warned that continued government procrastination on the need for anti-retroviral therapy could cost it dearly on election day.

The timing of the decision - it comes in the wake of the national conference on Aids in Durban, as well as within earshot of the faint but audible rumbling of advance electioneering - invites South Africans to temper their relief and joy with prudence. Past experience offers a similar counsel of caution. Remember that between April and June last year government undertook to provide anti-retroviral therapy to the victims of rape, and (in response to a Constitutional Court ruling) the anti-retroviral drug, Nevirapine, to HIV-positive pregnant women and their still to be born infants, only to falter when it came to walking the talk.

It is pertinent to recall, too, that only days before the August 8 instruction to the department of health Mbeki was defending the Medicines Control Council against fierce and sustained criticism after the council gave the manufacturers of Nevirapine notice of intention to de-register the drug unless the company produced further proof of its safety and efficacy within 90 days. In the August 1-7 issue of ANC Today, Mbeki defends the MCC decision, arguing that Africans should free themselves of the influence of their pseudo-friends "from the world of the rich". There is a hint in his defence of the view that was prevalent in ANC circles until about a year ago: ie that the only beneficiaries of anti-retroviral drugs were the companies manufacturing and selling them to the under-developed world.

Another memory strengthens the counsel of caution: it is of finance minister Trevor Manuel dismissing the belief that anti-retroviral drugs are a panacea in the war against Aids as "a lot of voodoo". While Manuel might have merely chosen his words carelessly, they have aroused suspicion that he sympathises with dissidents who see anti-retroviral drugs as the cause, not the cure, of Aids.

But the case for reacting with cautious restraint to the government's decision has to be balanced against evidence that it has indeed made a radical shift in its policy on HIV/Aids.

The most important reason for taking a positive view is the report of the health and treasury task team that was presented to cabinet. It is logical and lucid, unlike the bizarre discussion document that was circulating within the ANC in 2001. It unequivocally recognises that anti-retroviral therapy has been demonstrated to "significantly extend life, reduce morality and improve the health status" of people in the advanced stages of "HIV disease". Beyond that it calculates the many thousands of deaths that will be deferred until after 2010 through the use of anti-retroviral therapy.

Since the cabinet decision to mandate the department of health to develop an operation plan by the end of September to include an anti-retroviral component in the existing comprehensive programme to combat HIV/Aids, the government should be given the benefit of the not unreasonable doubt. Until and unless there is conclusive contrary evidence, the citizenry should accept the assurance that "government shares the impatience of many South Africans on the need to strengthen the nation's armoury in the fight against Aids".