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A new take or a louder echo of an old policy?
John Battersby, Charles Phahlane and Christelle Terreblanche The Mercury, 6 June 2002 - republished courtesy of Independent Newspapers (Pty) Ltd
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Six weeks after a watershed Cabinet meeting in which government announced a turnaround in its AIDS policy, there appears to be increasing confusion in government as to whether the policy has changed or whether the government was merely restating a policy it was failing to implement.
While South Africans remain fairly convinced that there has been a change, there is growing confusion in the international community ahead of a series of crucial meetings on the New Partnership for Africa's Development (NEPAD) - a plan which seeks investment in Africa by the industrialized countries in exchange for a commitment to accountable political and economic governance.
Time magazine, in a cover story which hit the shelves yesterday, says President Thabo Mbeki has "finally faced up to the AIDS crisis". Minister in the Presidency, Essop Pahad, said at a media briefing this week that the government's HIV/AIDS policy had not changed by was being "intensified".
In a reply to a journalist's question in Oslo, Norway earlier this month, Mbeki said that government policy had not changed. Health Minister Manto Tshabalala-Msimang said in the debate on her vote in parliament yesterday that the government's HIV/AIDS policy was being "consolidated and fine-tuned".
Deputy President Jacob Zuma said in a weekend interview with Independent Newspapers that it was fair to say that government policy had shifted in three respects. Zuma said the April 17 cabinet decision had marked a new era in the fights against HIV/AIDS which had been widely welcomed by the society and within government, and that a new momentum in the fight against HIV/AIDS was being sustained across society. "People were very happy that it (April 17) happened and everyone is working on it. There is no doubt in government and everyone is very clear about what we have to do."
"In a sense I am sure that people were not wrong when they said there has been a shift in policy because Cabinet had never come out in the whole debate to say: 'This is what we are saying since the beginning'," Zuma said. "It was a restating of policy, but there were other things that were added that were new." He said the new policy elements included: anti-retrovirals for rape victims, the substantial increase in the budget for HIV/AIDS which indicates the degree of government's commitment and the implementation of the Court decision that the state must provide anti-retrovirals for people living with HIV/AIDS so there could no longer be a situation where government said it was refusing.
"For the first time Cabinet came out to clarify the issues to the country as to where government stood because - up until that meeting - people even believed that the government believed that HIV did not cause AIDS and, therefore, the policy was not there," Zuma said. "That was a point that had been debated for a long time. The April 17 meeting was a restatement that our programmes are based on the fact that HIV causes AIDS. "It was saying: 'This is the situation. Let's stop the confusion.'"
But Pahad, echoing Mbeki's statement in Norway, told the Pretoria Press Club yesterday: "No. What the President has said, and what we said ?… that the programme that the government has laid out regarding dealing with the issue of AIDS and HIV has not changed but intensified," he said. "That has not changed at all except to say that more money will be made available and a great deal more attention will be paid to the implementation side of the programmes that were actually agreed upon," Pahad said.
Pahad said the only new issue in government policy was to allow women to receive anti-retroviral drugs for rape after being properly counseled. "What Cabinet agreed to - and this is a new thing and not so much a shift - was to say that a woman who has been sexually assaulted has to be properly counseled so she could make an informed choice as to whether she wants the drugs or not. At the end of the counseling, the woman has to make an informed choice, and if she makes an informed choice that she wants to receive anti-retroviral drugs, then that should be made available to her," Pahad said.
He said there was no agreement within medical circles as to what the time factors were for the administration of the drug. Some say anti-retroviral drugs should be provided immediately, others say after three to six hours, while others say up to 72 hours. Also there was no "established scientific evidence" that the drugs worked. "We had to take that decision because what we are dealing with are very sensitive issues around the emotions of a woman who has been physically, mentally and emotionally violated. Therefore, we have to be extremely sensitive with the way we deal with that woman," Pahad said.
Health Minister Manto Tshabalala-Msimang spoke through her budget speech of the "consolidation" and "fine-tuning" of the AIDS policy as announced on April 17. "Central to this endeavour will be the consolidation of our multisectoral response and improved implementation of all major aspects of our national five-year strategy," she said. "Government and its key partners continue to asset that prevention programmes are the cornerstone of our national HIV and AIDS strategy. During the coming year, the amount allocated to the Department for prevention increases from R158 million to R172 million. In total, the HIV/AIDS budget substantially increased this year with R1 billion, while another R400 million which is not in the national budget, is provided to the provinces to help relieve pressure on health care facilities for treatment of conditions relating to HIV/AIDS."
She announced that the HIV rate had begun to drop and was now considered stable. "But perhaps the biggest cause for optimism is the sustained drop in HIV prevalence among mothers under 20 years, making for a total drop of 5,6% since the prevalence peaked in this age group in 1998."
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