In 1988, the UN General Assembly officially recognized the World Health Organization (WHO) declaration that December 1 would be internationally commemorated as World AIDS Day. The virus was first identified in 1981 and named human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in 1982.
The WHO realized that it posed a threat to global health and that a concerted effort was needed to fight it. Annually, the day aims to rally support for people living with HIV and to commemorate those who have died from AIDS-related illnesses.
The day also presents an opportunity for governments and civil society to take stock and assess their respective responses to the epidemic. While the first waves of the Covid-19 pandemic swept across the globe and demanded much attention and resources, the current HIV/AIDS epidemic seems to have been pushed to the side, relegated to the background, if not eliminated entirely. as a matter of urgency.
One reason for this could be that HIV/AIDS is more prevalent in the poorest and developing countries, while Covid-19, with death rates that spare no country, significantly affects the whole world.
What HIV/AIDS and Covid-19 have in common, however, is that they both challenge political leadership, test governments, and expose weaknesses and vulnerabilities in societies. The following statistics are a reminder that South Africa is still at war in terms of combating HIV/AIDS and, in fact, may be further from winning the battle than it was before COVID-19.
South Africa: the epicenter of the HIV/AIDS epidemic
Africa, a continent with a predominantly young population, is the most affected by the epidemic, with an estimated average of 3.9% of the population infected with the virus, a higher prevalence than in any other continent. South Africa is at the epicenter of the epidemic. The following statistics provide insight into the scope and severity of the HIV/AIDS crisis in the country, but fall short of revealing the emotional toll and human suffering associated with the disease.
According to Statistics South Africa, in 2021, the estimated overall HIV prevalence rate among the South African population was approximately 13.7%. In the same year, the total number of South Africans living with HIV was estimated to be around 8.2 million.
That said, according to UNAIDS data, the number of new infections per year in South Africa has more than halved in the last two decades, from 510,000 in 2001 (at a time when the South African government was still in denial about the disease). to 210,000 in 2021. However, this is no reason to celebrate or become complacent.
AIDS-related deaths remain unacceptably high in South Africa. In 2022, the estimated number of deaths from AIDS-related illnesses reached about 85,800. This number was lower than the previous year, when AIDS-related deaths in the country reached almost 88,000. Adding up all deaths related to AIDS since the 1990s, South Africa has lost up to five million people to the disease, a figure comparable to the population of Cape Town. If the millions of South Africans had been victims of war or natural disaster, a monument would probably have been erected to them by now.
HIV/AIDS has the devastating attribute of particularly affecting young adults, those of reproductive and economically productive age who are considered the backbone of society. In 2021, an estimated 19.5% of the population aged 15 to 49 years was HIV positive. In addition to age, the virus seems to have an unfair gender bias, with women at significantly higher risk of contracting it than men. Nearly a quarter of women of reproductive age (15-49 years) are HIV positive.
Thanks to the groundbreaking 2002 constitutional court ruling and the free availability of antiretroviral (ARV) treatment, being HIV positive is no longer a death sentence. However, the risk of contracting and succumbing to tuberculosis (TB) and other opportunistic diseases is significantly higher due to a compromised immune system.
While the infection and mortality rate statistics are unacceptably high and require urgent political intervention, it should not be forgotten that progress has been made, not least thanks to the dedication and activism of civil society organizations working on this field.
When leaders fail, the human costs are high
While there are many individuals and organizations in South Africa that have done (and are still doing) remarkable work in the fight against HIV/AIDS and its treatment since the disease first came to public attention more than three decades ago, there are an organization that stands out and has managed to force the South African government to take action.
In 2002, the Treatment Action Campaign (TAC), an organization founded just four years earlier, in 1998, took the South African government to constitutional court over its refusal to widely distribute life-saving ARVs to HIV-positive pregnant women and to prevent maternal pregnancy. -child transmission of the virus. The bitter court battle was preceded by intense advocacy work and was widely seen as something of a last resort to change the government’s stance towards HIV/AIDS in general, and ARV deployment in particular.
When Thabo Mbeki assumed the presidency in May 1999, the death toll from the AIDS epidemic was staggering. It is estimated that in that year alone, around a quarter of a million people died of AIDS-related causes in South Africa. The most populous provinces, such as KwaZulu-Natal, Gauteng and the Eastern Cape, were the hardest hit in terms of absolute numbers.
Often the cause of a loved one’s death was kept secret and officially attributed to other illnesses due to family members’ fear of stigmatization and ostracism from the community. The stigma attached to the disease has led to a large underreporting of HIV/AIDS-related deaths in South Africa, making it difficult for health experts and policy makers to understand the full extent of the epidemic.
Being infected was close to a death sentence as no cure had been found and no treatment was available. There was no widespread testing for HIV, leaving people in the dark about their status and thus increasing the risk of unknowingly spreading the virus and promoting new infections. Since the virus is spread primarily through sexual transmission, the shame and stigma associated with HIV/AIDS prevented people from speaking openly about it and seeking help.
Not many public figures have admitted that they or their family members have been affected by the virus. One notable exception in this regard was Prince Mangosuthu Buthelezi, leader of the Inkatha Freedom Party, who, at his son’s funeral in Mahlabathini, north KwaZulu-Natal in 2004, openly stated that the cause of death of her son was HIV/AIDS. Buthelezi was one of the few politicians to speak out strongly against the government’s slow response to the pandemic and actively helped combat the stigma around the disease.
Mbeki was criticized for how he handled the health crisis within his own party. Contrary to the ANC’s unwritten protocol, former President Nelson Mandela criticized the Mbeki government’s “lackluster” response to HIV/AIDS. In 2002, Mandela told the Johannesburg-based newspaper sunday time: “This is a war. It has killed more people than in all previous wars and in all previous natural disasters. We must not continue debating, arguing, when people are dying.”
To the horror of scientists, health professionals and activists, Mbeki publicly contradicted accepted scientific research by expressing the view that HIV did not cause AIDS. His health minister at the time, Dr. Manto Tshabalala-Msimang, and other dubious experts supported his views and went so far as to officially promote herbal remedies, such as garlic and beetroot, as an alternative to the ARVs.
The failure of the Mbeki government to adequately respond to the HIV/AIDS crisis and enact the implementation of free antiretroviral interventions throughout the country had an enormous human cost. According to a Pride Chigwedere article published by the Harvard School of Public Health, more than 330,000 people died prematurely from HIV/AIDS between 2000 and 2005 due to the Mbeki government’s obstruction of vital treatment, while at least 35 000 babies were born with HIV infections that could have been prevented.
A Constitutional Court ruling that saved lives
“The magnitude of the HIV/AIDS challenge facing the country demands a concerted, coordinated and cooperative national effort in which government in each of its three spheres and the panoply of civil society resources and skills are led, inspired and He directed. This can only be achieved if there is proper communication, especially from the government.”
The Constitutional Court issued this statement on July 5, 2002 as part of its judgment in Minister of Health and Others v Treatment Action Campaign and Others. The ruling confirmed the constitutional right of all HIV-positive pregnant women to access health services to prevent mother-to-child transmission of HIV.
“The court found that the government had not reasonably addressed the need to reduce the risk of HIV-positive mothers transmitting the disease to their babies at birth. More specifically, the conclusion was that the government had acted unreasonably by (a) refusing to make an antiretroviral drug called nevirapine available in the public health sector where the treating physician deemed it medically indicated, and (b) failing to establish a deadline for a national program for the prevention of mother-to-child transmission of HIV”, stated the sentence.
The ruling supported the petitioners’ view that the government’s restrictions on ARV implementation were unreasonable when compared with the Constitution, which requires the state and all its organs to give effect to the rights guaranteed by the Bill of Rights. , including the right of access of all people to public health services and the right of children to special protection.
The constitutional court ruling was a major victory for the applicants and paved the way for access to ARVs in the public health system, which has saved millions of lives since its implementation in 2004.
In subsequent years, the TAC was instrumental in ensuring a universal government-provided AIDS treatment program. In 2007, the parliament adopted the National Strategic Plan on HIV, TB and STIs 2007-2011.
Currently, more than five million people receive ARV treatment in South Africa and are able to lead normal lives.
Christina Teichmann is a political consultant and board member of the FW de Klerk Foundation. She has a master’s degree in education from the Rand Afrikaans University and Landau University, and a master’s degree in philosophy from the University of Cape Town.
