REUTERS Then-deputy president Jacob Zuma and then-health minister Manto Tshabalala-Msimang dancing at a World Aids Day commemoration in Cape Town in 2004. Picture: Reuters/Mike HutchingsHelen Zille believes Zuma has set back the fight against HIV/Aids even more than Mbeki. But the available evidence suggests otherwise, writes researcher Kate Wilkinson
Has president Jacob Zuma done more damage in the fight against HIV/Aids than his predecessor, Thabo Mbeki? DA leader and Western Cape premier Helen Zille thinks so.
On her official Twitter account Zille has tweeted: “If Mbeki set the Aids fight back, Zuma has done so far more.”
In another tweet Zille said that Zuma’s “multiple concurrent sexual partners” had “equally undermined (the) fight against Aids”.
Is there any truth to her claims?
Zille told Africa Check: “It is certainly my opinion that Zuma has done far more than Mbeki to set back the fight against Aids.”
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 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.
“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.”
Are multiple concurrent sexual partners driving HIV?
As evidence, Zille cites the latest Human Science Research Council’s National HIV Prevalence, Incidence and Behaviour Survey, which found that “469 000 new HIV infections occurred in the population (two years and older) during 2012”.
Her tweet and an article in the DA’s newsletter argue that these infections are being driven by “multiple, concurrent sexual partners”.
However, the research council’s 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 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: “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. Whether these forms of partnering are more common in sub-Saharan Africa is not known.”
A study 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 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 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.”
Zille’s comments isolate Zuma and Mbeki’s “role model impact” from the steps that they and their governments took in response to the HIV/Aids crisis.
Their interventions, or lack of them, cannot be ignored.
Marcus Low, head of policy at the Treatment Action Campaign, told Africa Check: “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 with those of former president Mbeki.”
Nicoli Nattrass, director of the Aids and Society Research Unit and professor at 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 had hardened when Mbeki became president.
“In the early years of his presidency (June 1999-October 2000), Mbeki championed a small group of Aids denialists who believed that HIV was harmless and that Aids symptoms were caused by malnutrition, drug abuse and even ARVs themselves,” Nattrass wrote.
The Mbeki government resisted introducing a national programme to prevent the transmission of HIV from mother to child. It did so only after being forced to act by the Constitutional Court in 2002.
Under increasing pressure, the government announced in 2003 that it would implement a national antiretroviral treatment programme.
“The gains that were made under Mbeki were hard-won,” Venter told Africa Check.
“It was a completely different environment. Gains were made in spite of Mbeki, not because of him.”
A study by Harvard University estimated that “more than 330 000 lives were lost because a feasible ARV treatment programme was not implemented in South Africa”.
Zuma’s personal actions and comments are certainly open to criticism.
However, a number of key HIV/Aids indicators have improved under his government, despite Mbeki’s poor start.
The report, which Zille cites, estimates that there were 469 000 new HIV infections in 2012.
Zille claims these infections are being driven by sexual behaviour.
However, the figure includes children who acquire HIV from non-sexual interactions, such as mother-to-child transmission or during breast-feeding.
The report contains data on the estimated number of people in the 15 to 49 age group who had acquired HIV since 2002.
Venter told Africa Check that this age group would almost exclusively acquire HIV through sexual activity.
The report shows that the HIV incidence rate among people in this group has decreased since 2002.
In 2002-2005, 2.2 percent of people in the 15 to 49 age group acquired HIV. The HIV incidence rate declined slightly to 1.9 percent in 2005-2008 and had remained the same in 2008-2012.
In 2002, 43.6 percent of the 631 383 deaths reported were Aids-related. The number of Aids-related deaths peaked in 2005, at 50.8 percent. Since 2005, the percentage has decreased year on year.
This year, 31.1 percent of deaths have been Aids-related.
Statistics South Africa has noted that “the decline in the percentage of Aids-related deaths from 2005 can be attributed to the increase in the roll-out of antiretroviral therapy”.
Estimates from the University of Cape Town show that in 2004 about 47 500 people received antiretroviral therapy. Of this number, only 9 600 (8 percent) received their treatment from public hospitals and clinics.
The latest figures from the Department of Health’s annual report show that in 2012/13, 1.9 million people were on antiretroviral therapy in the public sector.
Health Minister Aaron Motsoaledi said in his budget vote speech this year that this figure had been increased to 2.5 million people.
The national antiretroviral therapy programme has been partly credited for the significant increase in South Africa’s life expectancy.
In 2002, male and female life expectancy was 53.4 years. It declined to 52.1 years in 2005. It has since increased year-on-year, and this year is estimated to be 61.2 years.
South Africa’s HIV counselling and testing campaign was launched by Zuma in 2010.
A previous Africa Check report said that about 27 million people had been tested since the campaign began.
At the time of the launch Zuma announced publicly that he had been taking regular HIV tests and was HIV-negative.
He explained that the purpose of revealing his HIV status was to “promote openness and to eradicate the silence and stigma” that accompany the pandemic.
In 2001, Mbeki was asked if he would take an HIV test. He said that “the matter of whether I take an HIV test is irrelevant. It might be dramatic and make newspaper headlines.”
He added that he did not “believe that publicity stunts help in addressing the health needs of our people”.
The number of infants being tested for HIV has increased and the percentage of those infants testing positive for the virus has decreased.
A World Health Organisation study has shown that in 2008 an estimated 36.6 percent of infants exposed to HIV were tested for the virus before reaching the age of two months.
Of those tested, 9.6 percent were HIV-positive.
By 2011, the percentage of infants exposed to HIV and tested before reaching the age of two months increased to an estimated 70.4 percent. Only 2.8 percent of those infants tested HIV-positive.
The evidence doesn’t support Zille’s opinion.
Zuma deserves criticism for having unprotected sex with an HIV positive woman and then taking a shower in an attempt to reduce his chance of contracting the virus.
However, it is unfair for Zille to compare these actions with “anything obtuse that Mbeki ever said on the subject” while ignoring the effect of Mbeki’s denialism.
Mbeki publicly questioned the link between HIV and Aids. His government stalled the roll-out of a programme to prevent mother-to-child transmission and a national antiretroviral programme. Hundreds of thousands of lives were lost and the fight against the virus was delayed.
Zuma’s government has prioritised the treatment of HIV and the prevention of new infections. More people are being tested for HIV, more people are on ARVs, the incidence of HIV has decreased among people aged between 15 and 49, fewer people are dying of Aids-related diseases, fewer babies are contracting HIV from their mothers and life expectancy has increased
To judge Zuma wholly on his personal failings is disingenuous and glosses over the devastating effect that Mbeki’s denialism had on South Africa and its people.
* This article first appeared on http://africacheck.org
** The views expressed here are not necessarily those of Independent Media
Sunday Independent
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