10th March 2009

The Minister of Health, Barbra Hogan, has constructively reversed many of the trends of her predecessor, thereby breathing new life into old problems. But she has done nothing new in relation to HIV/Aids other than to acknowledge its reality and thereby attempt to diminish the denial factor that has seeped deep into the South African psyche.

It was Hogan's stance on HIV and her grasp of economics, that catapulted her into the position of Health Minster and she could make a huge contribution to the struggle against HIV if she were to courageously break the mould in which the debate has been set.

The United Nations has characterised AIDS as a human rights issue and countries with the highest rates of infection blame their failure to treat patients on drug manufacturers holding on to patents. Yet neither of these approaches reaches the root of the epidemic, which would be more effectively curbed if regarded as a public health issue.

The focus on the right to secrecy has outweighed the practical implementation of an adequate response to the pandemic and it would breathe fresh life into the battle against HIV, to recognise that rights misapplied can do more harm than good, particularly when the rights focus is set by activists furthering their own agenda.

The insistence on secrecy as the primary right in HIV came from the West where homosexuals were struggling to gain acceptance. It was imported into Africa, fostered by academics and endorsed by our leaders. That emphasis, unlike the usual confidentiality that applies to  medical information, has contributed to making HIV different, requiring one on one pre-test counselling, special permission to perform tests and to give people their results, anonymous testing and non disclosure to partners and families. Had we focused on treating HIV like an ordinary illness it would be regarded as such by the public and until leaders foster that approach, the old paradigm will persist.

We should shift the focus from secrecy to non-discrimination and apply no different provisions for HIV testing, reporting or treatment, than for any other medical condition, regarding HIV like a chronic illness. If we focus on non discrimination we would not allow the illness to be treated differently by insurance companies with regard to death benefits paid to families. We would not allow medical aids to treat persons with HIV differently with regard to their chronic medicine benefits. We would not allow the chronic medicine grant to be based on a CD4 count, but rather on a person's ability to work, linked to their attempts to try to find work.

As for the claim that countries are prevented from treating HIV effectively because of patent protection of medicines, this too masks a simpler truth.

Countries with effective health systems and the will to treat HIV can engage in good faith negotiations with drug companies and design partnerships that enable appropriate medicines to be provided for as little as R130 per month. In South Africa this was achieved without requiring a compulsory license to be issued under the TRIPS agreement in the WTO, which allows for compulsory licenses to be issued when companies exploit their patents in emergencies. As new generic medicines or combinations become necessary this is the approach to follow, with TRIPS as a backup if negotiations fail. Too often, when the blame is placed at the door of manufacturers, the real fault lies with the health service.

In South Africa, the structure of our health service does not favour access to treatment or to medication. Budgeting and implementation are confused and bureaucratic. Some programs are duplicated while others contradict one another; some budgets are not spent while others are overspent. The solution would be to have an integrated service, based on patient needs, as close to the point of delivery as possible. This would improve transparency, efficiency and accountability. It should be done with the aid of private partnerships where contracts go to best bidders and not best buddies and it should entail the use of fleets of mobile units to serve rural areas.

NGOs are a crucial part of the war against AIDS but to be effective they must cease to be vehicles for political patronage.

We should also open our arms to international donors and not insist on our country being self sufficient in providing an equal service to all. Rather than more committees or model laws drafted by activists, we need actors on the ground. Rather than debaters we need drivers, who recognise the problems for what they are and adopt practical strategies to lift us out of the quicksand that envelopes South Africans every minute of every day. 

Contact:
Dr Ruth Rabinowitz     011 802 1826 or 082 579 3698. or

Media Officer:
Liezl van der Merwe,   083 611 7470.