Zuma stirs the HIV hornets

President Zuma is the African Sarkozy, a man of boundless energy and craving for the headlines, no topics barred. Last week he completed a rapid transition from hero to zero in the eyes of AIDS activists.

Hero in December for his speech on World AIDS Day which decisively marked the end of his predecessor’s disastrous policies. At last South Africa is committed to deliver antiretroviral treatment to 80% of those in need by 2011.

Zero by the end of January having embarked on a further polygamous marriage at the age of 67, whilst tidying away the inconvenient news of the arrival of his 19th or 20th child, depending on which paper you read.

“There’s no fool like an old fool” is what they will be muttering in the cloisters of Winchester.

Out on the streets of the wide world the debate is somewhat more heated. “Leave our culture alone” say the ANC supporters. “Hand back our $120 million” say the conservative Americans, referring to the boost in US funding timed to coincide with Zuma’s December speech.

What lies behind the tension is the growing sense of failure of all those AIDS prevention programmes spouting the cosy fireside stuff about abstinence, faithfulness and condoms. The ABC principle has produced results but not commensurate with the need or the vast expense.

More and more campaigners are summoning up courage to challenge the alpha male culture of multiple and concurrent partners that is indulged in much of Africa.

Having updated our AIDS Guide last week, I’m more worried about the bigger picture. You don’t have to be an expert to figure out that the fragile progress reported by UNAIDS in the 2009 AIDS epidemic update is currently tiptoeing through a minefield of threats.

These include the impact of the global economic recession and a probable backlash from the wider health sector which is desperate to get level with generous AIDS funding. There are also new WHO guidelines recommending that antiretroviral treatment should start at an earlier stage in the progression of HIV (advice which South Africa has accepted).

The final section of our Guide goes into more detail and I’m inclined to think that Zuma has done the AIDS lobby a favour by getting the subject back into the headlines.

The real crunch is surely that no government can withhold drugs from existing patients. Quite apart from the health implications, interruption in treatment increases the risk of resistance. Alternative second line drugs are acutely expensive.

The consequence will be withdrawal of funding of HIV prevention programmes, potentially on a massive scale. It’s already happening in some countries. We’re potentially heading back to those desperate days when it seemed as though nothing could be done to halt AIDS other than beg government leaders to inspire by word and personal example.

The timing of Zuma’s peccadillos is therefore not good. The president of South Africa is in a position to assume leadership of a continent whose troubles might be eased considerably by a lighter touch on the pedal of promiscuity and fertility. Mbeki fluffed his lines and now Zuma is reduced to the ranks.

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this article was first published by OneWorld UK

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