KATE WILKINSON* Has President Jacob Zuma set back the fight against HIV and Aids more than his predecessor? Helen Zille believes so but the evidence shows otherwise. Has President Jacob Zuma done more damage to the fight against HIV and Aids than his predecessor, Thabo Mbeki? Helen Zille, premier of the Western Cape and leader of South Africa’s opposition party the Democratic Alliance (DA), thinks so. On her official Twitter account, Zille recently tweeted: “If Mbeki set the Aids fight back, Zuma has done so far more.” In another tweet, Zille claimed that Zuma’s “multiple concurrent sexual partners” had “equally undermined [the] fight against Aids”. Is there any truth to her claims? A reader asked us to investigate. Zuma’s ‘role model’ impact Zille told Africa Check that it “is certainly my opinion that Zuma has done far more than Mbeki to set back the fight against Aids”. She said that while Mbeki had publicly questioned the link between HIV and Aids, “it was possible to get across the fact that unprotected sex is the primary cause of transmission”. Zuma, by comparison, “is notorious for having sexual partners outside his current marriage relationships”. “He made world headlines when he announced that he had knowingly had unprotected sex with an HIV positive woman and had a shower afterwards to stop himself getting Aids. And this very graphic example of behaviour that leads directly to the spread of Aids had a far stronger role model impact than anything obtuse that Mbeki ever said on the subject.”South African National HIV Prevalence, Incidence and Behaviour Survey, which shows that “469 000 new HIV infections occurred in the population two years and older during 2012”. Her tweet and an article published in the DA’s newsletter argue that these infections are being driven by “multiple, concurrent sexual partners”. However, the HSRC report notes that it “has been argued that concurrency [multiple, overlapping sexual partners] does not fully explain the high HIV epidemic in sub-Saharan Africa”. It states that “it remains crucial to reduce exposure to multiple sexual partnerships irrespective of concurrency”. A journal article published in 2012 by Francois Venter, an HIV clinician, scientist and deputy director at the Wits Reproductive Health and HIV Institute, and Lucy Allais, professor of Philosophy and Director of the Wits Centre for Ethics, concluded that “some forms of concurrency and some forms of serial partnering are important drivers of HIV infections”. “It does not follow from this that where there are higher rates of infection they must be driven by higher rates of these forms of partnering, and whether these forms of partnering are more common in sub-Saharan Africa is not known.” A study conducted in KwaZulu-Natal found “no evidence to suggest that concurrent partnerships are an important driver of HIV incidence in this typical high-prevalence rural African population”. It also advised that HIV education messaging should be aimed at “the reduction of multiple partnerships, irrespective of whether those partnerships overlap in time”. Zille also ignores the fact that people can engage in concurrent sexual relationships responsibly, says Mary Crewe, director at the Centre for the Study of Aids. “People may have moral issues about multiple concurrent sexual partners but you can be safe if you are using protection.” A president in denial Zille’s comments isolate Zuma and Mbeki’s “role model impact” from the steps that they and their respective governments took to respond to the HIV and Aids crisis. Their interventions, or lack thereof, cannot be ignored. Marcus Low, head of policy at the Treatment Action Campaign, a South African HIV and Aids activist organisation, told Africa Check that “while President Zuma’s response to Aids has not been perfect and he has often failed to set a good example, his shortcomings in the Aids response pale in comparison to those of former President Mbeki”. Nicoli Nattrass, director of the Aids and Society Research Unit and professor in the University of Cape Town’s School of Economics, explained in a 2008 African Affairs journal article that government opposition to the use of antiretroviral therapy hardened when Mbeki became president. “In the early years of his presidency, [Mbeki] championed a small group of Aids denialists who believed that HIV is harmless and that Aids symptoms are caused by malnutrition, drug abuse and even ARVs themselves,” Nattrass wrote. Government resisted introducing a national prevention of mother-to-child transmission programme. They only did so after being forced to act by the Constitutional Court in 2002. Under increasing pressure, government announced in 2003 that it would implement a national antiretroviral treatment programme. “The gains that were made under Mbeki were hard won. It was a completely different environment. Gains were made in spite of Mbeki, not because of him,” Venter told Africa Check. A study by Harvard University estimated that “more than 330 000 lives or approximately 2.2-million person-years were lost because a feasible ARV treatment programme was not implemented in South Africa”. Improvements in response to HIV and Aids Zuma’s personal actions and comments are certainly open to criticism. However, a number of key HIV and Aids indicators have improved under his government, despite Mbeki’s poor start.
- HIV incident rate down
- Aids deaths down
- More people on ARVs and increased life expectancy
- HIV counselling and testing increased
- Prevention of mother-to-child transmission improving