The biggest problem facing post-apartheid South Africa is the spread of IDS. Deaglán de Bréadún reports from Johannesburg, in the lead-up to world AIDS Day on Monday
Amid the buzz and bustle of Cape Town's Greenmarket Square you would never think there was anything wrong. Music booms in trendy cafés, traders and tourists haggle over souvenirs, waiters tidy up after last night's customers and array the tables for lunch, smartly-dressed young folk flirt in the morning sunshine. But this isn't Touristville, in the State of Anywhere. This is post-apartheid South Africa, a new democracy where the races live in peace and harmony and a bright future beckons for its 45 million citizens.
At least that is the theory, the aspiration and the hope. But for more than five million South Africans, an early grave beckons as victims of HIV/AIDS.
Ahead of World AIDS Day on Monday next, the United Nations has issued a report on the incidence of HIV/AIDS around the globe. We now know from this and other sources that there are some 40 million people living with AIDS; an estimated 5.3 million of them are in South Africa with a further 21.3 million in other parts of sub-Saharan Africa. Meanwhile, in the prosperous West, despite its vast population, there are about 1.5 million cases.
It's no accident that the poorest part of the world is also the most heavily afflicted by HIV/AIDS. After all, the virus or syndrome is never the proximate cause of death. It operates by weakening the body's ability to withstand infection and disease. In poverty-stricken places where people are close to starvation, AIDS is simply the last straw, the final landmine that fatally undermines their defences.
Even in what is known as the advanced world, the advent of AIDS initially aroused a wave of irrational fear, prejudice and denial. You could get it from kissing or spittle, some said. Fundamentalists claimed it was God's revenge on homosexuals. Early public advertising campaigns reflected an element of near-hysteria and panic at official level.
With all its advantages, the West found AIDS difficult to cope with and still does. Imagine, then, the impact on traditional African cultures, which lack the resources in information, science, technology and education that the West enjoys. Inevitably the reaction has often been one of denial, and a failure to comprehend the seriousness of the threat posed by HIV/AIDS.
Time and again as I visited shanty towns and rural communities in South Africa and neighbouring Mozambique in the last fortnight, I was told how virtually nobody admits that their recently-deceased mother, father, brother or sister had AIDS. The label "TB" covers a multitude and may, indeed, have been the immediate cause of death.
In these deeply-traditional societies, there is a shame and stigma attached to HIV/AIDS. Men won't admit to the possibility they may have it and, consequently, will not take necessary precautions. Even when condoms are available in these highly-deprived shanty-towns or villages, they are dismissed as a barrier to pleasure and will often be made of faulty material in any case. And, as the head of a rural hospital in Mozambique told me, the man has the "big voice" and the woman's opinion is overruled.
The consequences are horrific. They were evident in the haunting sight of a woman living in a cardboard shack in Atteridgeville, outside Pretoria. She sat there half-blind, her face a mass of cancer-sores, unable to speak as her Irish visitors struggled to find words of comfort. Her children sat nearby, smiling and friendly despite the ominous cloud over their future. Nobody seemed to know where the man of the house was, except that he was gone.
On the road nearby, there was a large billboard warning about the dangers of HIV/AIDS. Teach your children sex is worth waiting for, was the message. It was only a mile away in geographical terms but it seemed a million miles from the reality of the cardboard shack. Besides, as a local aid worker commented, this message was like telling the children there was ice-cream in the fridge. He complained that while there was an emphasis on abstention in the official and religious anti-AIDS campaigns, the general atmosphere was not conducive to responsible sexual behaviour and local strip-joints were putting on shows from three o'clock in the afternoon.
What is the way forward? Although some aspects of the regime of Uganda's President Museveni have been fiercely criticised, his success in the AIDS war has won praise. He and his government confronted the issue and brought it out into the open, bringing home to the public that there was a serious threat which had to be faced.
South Africa has now moved onto this road, but there were initial hesitations, doubts and difficulties.
President Mbeki appeared to align himself, at least by implication, with the AIDS dissidents, who claim the whole thing is a conspiracy devised by the West and the pharmaceutical giants against the poor of Africa, yet a further stage in the relentless exploitation of this unfortunate continent.
Mbeki's initial failure to distance himself from the doubters caused enormous damage to his international image and obscured the fact that he is one of the most able, intelligent and articulate leaders on the world political scene. It is still a sensitive issue and there was an initial silence when I raised the issue with South African government people working to defeat AIDS. But South Africa seems to have turned the corner, now pouring enormous resources into an all-out drive to bring AIDS under control and eventually to eliminate it.
The scale of the challenge is intimidating. A national survey estimated that at the end of last year, more than a quarter of South Africans between the ages of 15 and 49 were infected with HIV/AIDS.
Apartheid may be so dead that young people around the world have to be taught that there was once a system of white supremacy where blacks did not have the vote or the right to live in the same area where they worked, but the sinister legacy of that evil system is still with us. Black men who went to work in mines and factories in the "white" areas were legally forbidden to bring their families with them and ended up spending months or even years away from home. Millions of men became involved with prostitutes or in other extra-marital relationships in an unsafe and unhygienic urban environment and often contracted disease, which they brought with them when they returned home.
The same is true in Mozambique, where health workers told me how 60 to 70 per cent of the adult male population went to work as migrant labour in the South African mines and often became infected with HIV/AIDS while they were away. Truck-drivers travelling around the region were other prime agents of infection, and it is still going on.
A report by the World Bank said the South African economy was likely to "collapse" if the government did not intervene to stop the spread of AIDS. On November 19th, the cabinet approved the "Operational Plan for Comprehensive Treatment and Care for HIV and AIDS" prepared by South Africa's Department of Health.
A total of €157 million is being spent over the next three years to combat AIDS, including drug treatment. At the same time, there are disturbing reports that some provincial administrations under-spent last year's anti-AIDS budget.
It is not just an issue for South Africa but for the whole world. For one thing, if the South African experiment in multi-racial democracy is undermined by AIDS, this will have political and security implications for the region and the entire international community. At the same time, the AIDS issue cannot be seen in isolation. Poverty intensifies the AIDS problem and needs to be tackled on an international basis. The thorny issue of subsidies to farmers in the developed world, which makes it difficult for African countries to sell products in the West, has considerable relevance here.
Whereas in the West, a programme of drug treatment would have immediate effect,the situation is rendered problematic in South Africa by the prevalence of poverty and malnutrition. The anti-retroviral drugs used to fight AIDS are hard on the stomach and need to be taken with meals. But what if there is a food shortage, as is frequently the case? The level of AIDS in the West suggests that the eradication of poverty in Africa would reduce the incidence of the disease in the most dramatic terms.
But until that dream can be realised, there is practical work to be done. Ireland is playing a part through the State agency, Development Co-operation Ireland, and voluntary organisations and agencies including missionaries, but a final resolution of the problem will require the entire international community acting through multilateral bodies such as the United Nations, the European Union and the African Union and with the close involvement of the sole superpower, the US.
It is obvious that we can't go on closing our eyes and turning our back. Or as a senior UN official put it, we must "act now or pay later".
