South Africa's Context Sets the Stage for IAS 2009

by Hoosen (Jerry) Coovadia, IAS 2009 Local Co-Chair, and President of Dira Sengwe

I look forward to welcoming IAS 2009 participants from all over the world to South Africa this week. As many of you begin your journey to Cape Town, I wish to share some thoughts on the somewhat unusual political epidemiology of the AIDS epidemic in South Africa. I think it will give you a different, and I hope interesting, slant on the subject.

As a South African, I and the overwhelming majority of this country’s citizens had the highest expectations for the first democratically elected government in the history of our country. In 1994, the man Nelson Mandela, the century-old political party of liberation, and the people who were the heirs of a long, long period of opposition to different forms of domination, created a surge of hope in millions of us. We seemed to be at the moment of greatest possibility as a nation.

From the mid-seventeenth century we had experienced the subjugation of Dutch and British colonialism, the privations of harshly enforced segregation, and finally apartheid – the most brutal, rigid and consolidated form of separation of a population on the basis of race and colour. Among the multitude of deprivations during these centuries, the health of the indigenous and slave groups, and in the 20th Century, the well-being of people of colour generally suffered greatly.

The HIV epidemic has been a defining feature of the period that straddles the closing of the last hundred years and the nascent footprints of the twenty-first century. South Africa’s transition to democracy over the past 15 years has not been easy; the years have seen aspirations of the poor dim and fade. There have been many shortcomings of the government, some trivial but many very serious indeed. Without a doubt, AIDS occupies a pivotal position in our history, characterizing the health of an independent, non-racial South Africa, while simultaneously framing the country`s moral, political, social and economic life.

It is for these reasons that IAS 2009 is so well timed, as South Africa ushers in a new government. Yesterday’s government of Thabo Mbeki earned a unique reputation among modern democracies for discarding the scientific basis of medicine. This split the country into those who tried to explain the world through reason, and others who were misled into denial and doubt. Medically proven interventions were delayed and a concerted strategy against this deadly disease never materialized. Confusing and conflicting messages also left the people bewildered. As a result, a complicated social disease – the likes of which had rarely if ever been experienced by humankind, and which therefore required absolutely unequivocal and clear guidelines – spread unhindered. The number of infected reached thousands and then millions, and many hundreds of thousands died. Today’s government – the same party, but from the point of view of public health what may be an entirely new regime –promises a healthier approach.

There is an interesting symmetry between the two major AIDS conferences held in South Africa; the 13th International AIDS Conference in 2000 and IAS 2009. Both events coincide with critical thresholds in the epidemiology and control of HIV/AIDS in this country. AIDS 2000 is considered a landmark event in the global calendar of AIDS. It was the first time the conference left the rich world and came to Africa, bringing it to the people who bore the largest burden of the disease. And what a victory it was for all of us! Since then drug prices have been forced down to affordable levels, civil society won numerous struggles against the state in South Africa, and so on.

Today the Zuma government is beginning anew to confront HIV/AIDS. The ministries are explicitly opposed to the social and economic policies of the previous government, and it is possible to see glimmers of commitment to an implementation plan that addresses the weakest elements of the health system. I am confident that evidence of what works best against HIV/AIDS, to be presented at IAS 2009, will be the instrument for another victory almost a decade later.

So, welcome to a setting in which you will see the close nexus between HIV and context – as well as the connections between public policy, cutting-edge science, and individual outcomes of disease and health – perhaps more vividly than anywhere else in the world.