April 19, 2010
South African president Jacob Zuma may seem like an unlikely advocate for HIV prevention. Earlier this year it was revealed that he had fathered a child out of wedlock, even though he has three wives (and a new fiancé, who is not the mother either). And before he was acquitted in 2006 of raping an HIV-positive woman, he said he hadn't used protection during sex, choosing instead to shower in a misguided attempt to ward off HIV.
But despite his controversial personal life, Zuma is at the helm of South Africa's shift to an ambitious new AIDS-prevention-and-treatment plan.
On December 1, 2009, he announced that the country would be scaling up its fight against AIDS in order to meet the goals of its national strategic plan: to reduce the rate of infection by 50 percent by 2011 and to provide antiretroviral (ARV) treatment to 80 percent of those in need. South Africa intends to expand the pool of HIV-positive people eligible for treatment, offer comprehensive HIV services at all health facilities, and increase access to HIV-counseling-and-testing services.
And in March, minister of health Aaron Motsoaledi announced a national campaign to dole out 2.5 million condoms over the next year and test 15 million people for HIV/AIDS by 2011.
"I think this indeed indicates strong government commitment to fighting the epidemic," says Jonathan Berger, a senior researcher at South Africa's AIDS Law Project.
For years South Africa's AIDS policy seemed intractably muddled, largely because of former president Thabo Mbeki, who announced in 1999 that the drug zidovudine (AZT), which helps prevent mother-to-child transmission, was toxic and that therefore the government would not be providing it.
Later he questioned whether AIDS was caused by HIV; restricted the use of donated nevirapine, an AIDS medication; and delayed the implementation of a national ARV-therapy program, all while employing a health minister who became known as Dr. Beetroot for espousing the AIDS-fighting benefits of garlic, lemon and beetroot over ARVs.
Between 2000 and 2005, more than 330,000 lives were lost as a result of South Africa's inability to implement a feasible, timely ARV-treatment program, according to researchers at Harvard's School of Public Health.
The national strategic plan was developed in 2007, during Mbeki's second term of office, but the government did not truly focus on implementing the plan until Mbeki was recalled from office in 2008, according to Berger. The appointment of a new minister of health "signaled a decisive break with the past," he says, and Zuma's election and appointment of Motsoaledi "have been central to the new commitment."
Still, experts doubt that South Africa will be able to fulfill its ambitious new goals. The country just doesn't have the ability to thoroughly implement its new AIDS plan, observes Kevin Kelly, director of the country's Centre for AIDS Development, Research and Evaluation. HIV-prevention efforts so far have been "dismal" on the municipal and community levels, where the local organizations that support people living with HIV have not mobilized their fragile network to integrate prevention into their message.
Although South Africa has seen some success in its efforts to encourage youths to use condoms and to be wary of riskier sex practices, it must improve the way it teaches strategies for wellness and prevention to people already living with HIV, Kelly says. In addition, he explains, it cannot just latch onto relatively easy-to-implement strategies like HIV testing and male circumcision without developing counseling and treatment frameworks around those approaches.
But Kelly believes that by judiciously considering how to implement different interventions on a community level, instead of blindly hoping that the strategies in place will take root, South Africa will be in a better position to meet its prevention and treatment goals. "There's a good chance of creating a foundation for a new type of response, where people actually get more intense and more confident about the possibility of preventing HIV," he says.
As for Zuma's personal drama, Berger doubts that it will have much power to undermine the fight against HIV/AIDS. "I'm not convinced that people will follow his example and not use a condom just because he's the president," he says. "But having said that, [I will also say that] he has weakened his stature as a leader and as someone who walks the talk."
Tina Peng is a New York-based freelance reporter who has covered health issues for Newsweek and for South Africa's Business Day Weekender.