ART and Political Will 12 March 2003
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Louis-Jacques van Bogaert,
postdoctoral fellow Centre for Applied Ethics, University Stellenbosch, South Africa
Postnet suite 7 Private Bag x8689, Groblersdal 0470 South Africa

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Re: ART and Political Will

Editor- There is no single, much less simple, explanation or justification of a complex problem. Fassin & Schneider [1] invite the reader "to move beyond a simplistic view" on the South African HIV/AIDS predicament. I an afraid that they only manage to keep the vicious circle of "apartheid bashing" alive and well. To keep blaming everything that is or goes wrong to the legacy of apartheid does not help progress. Worse even, I should argue, their paper might mislead the ill-informed but benevolent reader who might believe that, at lomg last, the government has decided to make anti-retrovirals (ARV) available in the public health services that cater for more than 70 percent of the population (politicians have access to ART through their private health insurances).

A single example, but a telling one, will make this apparent. In this same issue of the journal, the Editor's Choice, AIDS in Africa, states:"In the past year, South Africa has made nevirapine available for pregnant women infected with AIDS"[2]. The reality, however,is that only half of the Provincial Governments, some before and others after the July 2002 Constitutional Court judgement, have started the implementation of the prevention of mother to child transmission (PMTC) of HIV. The other Provinces are in contempt of court by stalling the roll out. One of them is currently on trial for violation of human rights in this regard (case no 35272/02 High Court of South Africa, Transvaal Provincial Division).

I wish to claim loud and clear that I have no inclination whatsoever in favour of apartheid. During the transition from apartheid to democracy (from the liberation of Nelson Mandela in 1990 till the first democratic elections of 1994) I have been victimised and harmed for allegedly being a "communist" (the arch enemies of apartheid). Under the new dispensation I got labelled "activist" (as bad) for advocating women's reproductive health and rights (with the support of the Treatment Action Campaign).During all these years, as referred to by the authors, an annual "anonymous survey of antenatal women" has been run showing a 0.7 percent prevalence in 1990 and a 36.2 percent in some Provinces in 2000. This survey was initiated during apartheid (who knows for what purpose) and taken over by the post-apartheid dispensation. What could be the use and the ethics if the survey did not lead to steps to prevent or limit the onslaught? I wish not deny thye many factors that have contributed to the epidemic. However, one should present the facts undisguised. I fail to understand why or rather how "adults with a single lifetime sexual partner face an extraordinary high prevalence of HIV". What I know about a Carleton survey sponsored by the Population Council is that it was initially thought that the local spread of HIV was a matter of sex- workers/mineworkers. To their surprise, it showed that it was much more intricate (but promiscuity, wherever, is taboo and politically incorrect).

Colonialism and racism/apartheid are an unfortunate and ugly face of humankind. They have been with us from times immemorial. No continent has escaped. Africans themselves have invaded and conquered neighbouring countries. Colonialism begot anticolonialism and later neocolonialism. Apartheid begot antiapartheid. Let's beware of neoapartheid/reverse apartheid. To deny or even to stall the PMTC on the grounds that is "poisons" women with Western medicines is nothing else but racism/reverse apartheid. Unfortunately, it has the perverse effetc of victimising the very same people politicians claim to protect.

[1] Fassin D, Schneider H. The politics of AIDS in South AFrica: beyond the controversies. BMJ 2003;326:495-97.

[2] Editor's choice. AIDS in Africa. BMJ 2003; 326.

Louis-Jacques van Bogaert
Postdoctoral fellow, Centre for APplied Ethics, University of Stellenbosch

Competing interests:   None declared