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February 2008: HIV & AIDS Monthly Newsletter


Funding is necessary, but leadership is essential

By JONATHAN MUNDELL (1)

2008 has begun in a similar fashion to how last year concluded, with South Africa being the focus of much attention with regards to HIV & AIDS. In 2007, South Africa was found to have overtaken India as the country with the largest number of HIV & AIDS cases. This news raised many eyebrows around the globe, with South Africa continuing to devote more resources to the epidemic than any other country in Africa, yet seemingly being unable to effectively address the many issues surrounding the epidemic. South Africa also receives the largest bulk of International assistance, including funding from the US Presidents Emergency Plan for AIDS Relief (PEPFAR).

US INCREASE FUNDING FOR SOUTH AFRICA

In January 2008, Mark Dybul, the US global AIDS co-ordinator, stated that the US would be providing South Africa with just under US$ 600 million (ZAR 4.3 billion) over the next year, in support of the country’s various HIV & AIDS programmes.

According to Eric Bost, US Ambassador to South Africa, PEPFAR is already involved with funding for over 600 HIV and AIDS related programmes in South Africa. With an increase of US$ 190 million (ZAR 1.4 billion) over the 2007 amount received, PEPFAR is set to contribute slightly more than US$ 600 million (ZAR 4.6 billion) during 2008. Interestingly, this increase is double that of the South African Government, who have budgeted just over US$ 700 million (ZAR 5.3 billion) for the next financial year.

Meanwhile PEPFAR is busy discussing a possible increase in global funds to the tune of US$ 30 billion.

As such, the question that South Africa and in fact the International community are asking, is how is it possible that the African country with the most resources and International assistance, has the highest number of HIV infections in the world?

According to the UNAIDS Report on the Global AIDS Epidemic, published in 2006, South Africa had an estimated 5.4 million people living with HIV and AIDS, which is higher that any other country in the world. In addition, some health advocates estimate that nearly 1,000 South African’s die from AIDS-related illness each day, with almost the same number of new infections.

LEADERSHIP IS ESSENTIAL

Proficient leadership is essential, if funding is to be utilised effectively in attempts to manage the HIV & AIDS epidemic. The amount of resources and funding a country has at its disposal are insignificant, if they are not managed efficiently. Uganda has proven to the world what a difference good leadership can make in reducing HIV prevalence, and really are an example for the rest of the African continent. A country’s success or failure depends on the leadership and management of those resources, the funding, and of the epidemic in general, and so it is critical that the leaders of the country act responsibly, conscientiously and responsibly in this regard. It is this point that could very well answer the question of how South Africa - with more available resources than any other country on the continent - still continues to struggle with such high rates of HIV infection.

CONTROVERSY SURROUNDS THE COUNTRY’S LEADERS

The leaders of any country should always set a precedent, taking into account the needs of the people, and of the country at large, and taking the responsibility of leading its people and managing the country effectively. While there have been many positive strides made by the current South African President, Thabo Mbeki, much controversy has surrounded his, and his Ministers’ stance in addressing the issues related to HIV & AIDS. Although the President has now stated that he is an AIDS "dissident”, and not a “denialist”, there were many questions asked about his attitude towards the HIV & AIDS epidemic earlier on in his presidency, and his belief that HIV does not cause AIDS. He has also questioned the efficacy of antiretroviral (ARV) medication.

South Africa’s Minister of Health, Manto Tshabalala-Msimang, who has become the public enemy of many AIDS activists around the country, reportedly shares the Presidents’ doubts over the effectiveness of ARVs. She has also been the focus of much controversy over her adamant support of nutrition over treatment in attempts to deal with the HIV & AIDS issue in the country. There was a period of some significant progress last year, when the Minister handed over her responsibilities to her deputy, Nozizwe Madlala-Routledge, while recovering from a liver transplant. Routledge immediately put HIV & AIDS at the top of the priority list, and the country began to see a unified stance against the epidemic for the first time. Following the Ministers return, the deputy was fired. According to the President, this was because she was not a team player. There have been various appeals by HIV activists and organisations around the world in response to this very controversial decision.

There has also been tremendous controversy surrounding the ex-Deputy President Jacob Zuma. Following his dismissal as South Africa’s Deputy President in 2005 by Mbeki over corruption allegations, Zuma has now been voted in as the ruling African National Congress’ (ANC) President - a position which places him as the probable future President of South Africa in 2009, should he overcome renewed attempts to prosecute him for the same alleged corruption. In addition to these allegations, Zuma was also on trial for allegedly raping an HIV infected women. He then stated publicly that the women had given consent, and that he had showered after sex, believing that this would reduce his chances of becoming infected. Not really the positive leadership one would expect from a possible future President and also not setting the necessary example for a country struggling to effectively respond to the HIV and AIDS epidemic.

NOT ALL BAD NEWS

On a more positive note however, the South African Government has finally reached a consensus with the HIV & AIDS sector this month, in adopting new guidelines for the prevention of mother to child transmission (PMTCT). This came soon after the Treatment Action Campaign (TAC) had condemned the Government for its inaction. The new guidelines will require a significant increase of more than triple the present budget for PMTCT.

Continuing with this more positive viewpoint, Mark Dybul, US global AIDS co-coordinator, and Michael Leavitt, the US Secretary of Health and Human Services, have shown confidence in the new HIV & AIDS and STI Strategic Plan introduced by South Africa in March last year. In fact, Dybul believes that it is “a model for the rest of the world in many ways”. The plan aims to halve new infections within the next four years, increase the provision of treatment to 80% coverage, and reduce mother to child transmission to less than 5%.

The world now holds it’s breath in expectation, eager to see whether the new plan, and the increased funding which will be provided to the South Africa in 2008, is implemented effectively, and whether South Africa’s leaders, and it’s people, can begin to turn the tide on an epidemic that has been running rampant for far too long.


(1) Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence (jonathan.mundell@consultancyafrica.com)

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