On a brilliantly sunny November afternoon in Cape Town, 12 seasoned labor
organizers are gathered in conference at the Western Cape headquarters
of the Congress of South African Trade Unions (COSATU). For weeks COSATU
leaders in the Western Cape have been bringing their shop stewards to meetings
exactly like this one. Their goal is to train as many of them as possible
to be HIV/AIDS peer educators in the workplace, and eventually expand the
training programs to other regions of the country. The project is the outgrowth
of an unusual alliance between South Africa’s leading labor organization
and the Treatment Action Committee, a grass-roots organization of AIDS
treatment activists who have made headlines for their vocal opposition
to Mbeki’s AIDS policies, including filing suit against the Ministry of
Health and calling press conferences to announce they are illegally smuggling
antiretroviral drugs into the country.
The unique COSATU-TAC alliance was born out of political necessity. It’s
nearly impossible to overstate the AIDS crisis in South Africa. Lack of
HIV testing resources and data make accurate HIV infection figures impossible
to pinpoint, but the infection rate is believed to be close to 16 percent
of the population with 1,700 new cases being reported daily. Today COSATU
is faced with carrying out their 15-year-old political mission to advance
the interests of South African labor with the knowledge that a quarter
of the workforce they represent may be infected with HIV within the next
three years.
President Thabo Mbeki sent the country reeling this past spring when only
a few months before the international AIDS conference was held in Durban
in July 2000, he began publicly voicing doubts that HIV is really the cause
of AIDS, instead suggesting that poverty and malnutrition may be the culprits.
In response, COSATU publicly blasted Mbeki’s stance at their national congress
in August, putting the president on notice that they were clearly separating
COSATU from the government’s line on HIV/AIDS.
In the last year COSATU has organized against discrimination of HIV positive
workers and succeeded in adding anti-discrimination language in collective
bargaining agreements of major unions including the South Africa Clothing
and Textile Workers Union. Says Elma Geswindt, regional director of COSATU-Eastern
Cape, “We don’t have to be dependent on the ANC—they don’t tell us what
to do. Obviously as part of the alliance we are compelled to work with
them, but I see COSATU as a force that can make a difference on HIV/AIDS
irrespective of the current government’s policies.”
The alliance she refers to is the tripartite alliance of COSATU, the ANC,
and the South African Communist Party that led the struggle that overthrew
apartheid and brought the current government to power. It is a bond forged
in history that is now being strained from many directions, HIV/AIDS being
only one.
A look backward at the milestones of Mbeki’s AIDS policy is all that is
necessary to see how he forged his own political isolation on this issue.
In October 1999, Mbeki announced the government would not be taking steps
to provide AZT to pregnant women—despite studies in other African countries
that showed AZT treatment to reduce mother- to-child HIV transmission by
as much as 70 percent. Last March Mbeki organized a government summit on
AIDS under the auspices of the Ministry of Health and flabbergasted the
medical community by stacking half its seats with international AIDS dissidents—advocates
of the increasingly isolated and discredited view that HIV does not cause
AIDS.
Behind Mbeki’s unpopular opinions may lie cold pragmatism. Pointing to
South Africa’s sagging economy and 38 percent unemployment rate, Mbeki
claims the government is unable to muster the resources to supply South
Africa’s PWAs with drugs that could keep them alive. With the typical anti-
retroviral drug cocktail costing more than the average South African earns
in a year, the President has a point. But even negotiations to get pharmaceutical
companies to make available much cheaper drugs to treat the opportunistic
infections associated with AIDS amounted to nothing after two years. Meanwhile,
South Africans were confronted daily with alarming newspaper headlines
such as: “Sixty Percent of the South African army may be HIV Positive;
AIDS Wreaks Havoc on Trucking Industry; AIDS-ravaged households headed
by nine- year-olds in Natal.” Popular patience with Mbeki’s go-slow approach
grew increasingly short. In October a national poll showed only 1 in 2
South Africans approved of the job he was doing—down from a 70 percent
approval rating 4 months previously. Political pundits from the left and
right heaped generous blame on his stumbling AIDS policy.
Two years before Mbeki fell into this political morass, the Treatment Action
Campaign began as a tiny grass-roots AIDS advocacy organization, and has
since became the catalyst for popular anger over government inaction. TAC
launched a campaign to pressure the government to make the drugs AZT and
Nevirapine available to pregnant women, including pressing legal action
against the Ministry of Health for endangering human life by not distributing
the drugs. TAC spent much of the last year holding loud protests outside
the Ministry and the offices of international pharmaceutical companies
demanding access to treatment and an end to AIDS profiteering. They have
embarrassed the government with TV images of emaciated children holding
handmade placards reading, “Mbeki Please Help Us.” Their volunteers canvass
neighborhoods with packets of free condoms and give demonstrations on their
proper use. But TAC is no ACT-UP copycat—it is a uniquely South African
entity, predominantly Black, township-based, and the first AIDS advocacy
organization in the country with openly HIV positive leadership.
Vicki Apleni, Western Cape Provincial coordinator of TAC, says the five
months since the International AIDS Conference in Durban have been encouraging:
“People are starting to come around. At first it was difficult because
people saw us as troublemakers. But we tell them, we are not against the
government, we are for people with HIV/AIDS —and that means we must oppose
certain government policies and struggle for something better.” Even more
encouraging is the growth in TAC’s numbers: in the last two years their
rolls have jumped from ten to two thousand members.
The TAC-COSATU alliance faces an uphill climb in more ways than one. In
addition to endemic poverty, lack of education, and lack of sanitation
services in Black townships, organizers must deal with the particular legacy
of apartheid, under which workers traveled many miles from rural to urban
areas to work, and both men and women often had concurrent sex partners.
To a large extent, this is still the case, as what jobs there are still
tend to be located in the city. South Africa is an intensely male-dominated
society where it is common and expected for men to have several sex partners
and men’s power over sex—when, how and with whom it takes place—is rarely
challenged. Unemployment among women is more than 50 percent in some regions
and prostitution is rampant, both as commercial sex work and informal arrangements
where women trade sex for necessities such as food, school uniforms or
a paid electric bill.
Dr. Mark Colvin, Acting Director of the HIV/AIDS prevention and vaccine
program in Kwa-Zulu Natal says, “There’s still an enormous negative stigma
attached to being HIV positive. Until people with HIV come forward and
begin to take on a political identity, we’ll be held back. That’s why TAC’s
work is so important—I only wish they were stronger.”
As to President Mbeki’s leadership on the AIDS issue, Colvin waxes bitter:
“It’s difficult enough earning the trust of sex workers to participate
in HIV prevention programs. Now we’ve got people asking, why take precautions
against HIV when the president says it doesn’t cause AIDS? We’re in a situation
where the best thing Mbeki can do at this point is keep his mouth shut
on this issue and get out of the way.”
Mbeki may be doing just that. In the last three months the President has
been noticeably quiet on the HIV/AIDS issue. On World AIDS day it was not Mbeki, but the elder statesperson Nelson Mandela who addressed the nation
in a prime-time television broadcast, exhorting the people to “be faithful
to one partner. Use a condom…Leaders in all spheres living with HIV should
be encouraged—not coerced—to disclose their HIV status.”
Of course, actions speak louder than words. As Mandela was addressing
the nation, the South African government signed agreements with Pfizer
and Behringer Ingleheim pharmaceutical companies, making 50 million dollars
worth of HIV/AIDS-fighting drugs available for free in South Africa. The
drug Fluconzole treats both cryptoccocal meningitis and the more common
esophagal candi- dosis (thrush), an often deadly affliction affecting about
40 percent of HIV positive South Africans. Fluconzole will be provided
free to patients in public clinics and hospitals for the next two years.
Boehringer Ingram will donate Nevirapine, effective in preventing mother-to-child
HIV transmission, over the next five years. How widely Nevirapine will
be distributed is yet to be determined.
These small breakthroughs can only encourage a budding HIV/ AIDS treatment
advocacy movement that’s just starting to be heard.
Z
Rebecca Minnich is a freelance writer living in New York City. She has
written for POZ, MAMM, and Metrosource magazines.