A president who denied that HIV caused AIDS, and so banned the use of life-saving antiretroviral (ARV) medicines in public health facilities. A health minister who declared ARVs to be “poison” and instead advocated garlic and potatoes as cures for HIV.
During this period in South Africa, which lasted from 1999 until a court ordered the government to give ARVs to HIV-infected people in 2004, more than 330,000 people died of AIDS-related illnesses, according to a study by Harvard University.
Despite their legal obligations, President Thabo Mbeki and his health minister Manto Tshabalala-Msimang continued to resist a large-scale roll out of ARVs until they were both ousted from their positions in 2008.
Health activist group, the Treatment Action Campaign, said two million South Africans died “prematurely” of AIDS during President Mbeki’s tenure. It maintained that many of these deaths could have been prevented had the government facilitated wider access to ARVs.
Phumelele Dlamini almost joined the list of fatalities. Diagnosed with HIV in 1995 after giving birth, the Soweto resident and her son had no access to ARVs for almost a decade.
“We were dying. I still don’t know how we survived,” she recalled. “At that stage in South Africa death from AIDS was certain. The only question you asked yourself as an HIV-infected person was, ‘How much time do I have left?’ I never thought that things would change.”
But change has indeed come, and it has been radical … to the point where South Africa now has the largest public sector ARV treatment program in the world.
According to UNAIDS, there were 1.5 million people on state-sponsored ARVs in the country in 2011, but medical sources said this figure has since increased to 1.7 million.
Dlamini and her son are two of these ARV recipients.
“Right now, we’re living positively, and we’re taking our ARVs. I can say life is good,” she told VOA. “Drinking the ARVs is the only thing that I know that keeps people like me alive. I don’t like doing it, but it has given me life.”
The appointment of Aaron Motsoaledi as health minister in May 2009 heralded a new era in South Africa’s response to its HIV epidemic. Health workers in South Africa describe the medical doctor from Limpopo province as a “man of science, not superstition” and a stark contrast to his predecessor.
“He speaks softly. He listens. When we activists disagree with him, he doesn’t shout and scream. He’s just a nice man,” said Dlamini, who is also an HIV counselor and is well-known in Soweto for her advocacy around the disease.
Dr. Kevin Rebe, a medical director who monitors South Africa’s progress in combating HIV for the Anova Health Institute, said, “Aaron Motsoaledi really does seem to have a firm grasp of what the HIV issues are...When you listen to him speak he’s coming from a very educated and researched position, which I think is quite confidence inspiring.”
He added that health providers now felt comfortable using science to treat HIV, unlike previously. “The science has helped us to allay fears associated with being diagnosed positive,” said Rebe. “Somebody who’s diagnosed as HIV positive today faces a very different level of stress than maybe five years ago in South Africa because the disease is publicized, treatment is publicized, people know it’s not a death sentence.”
But, while treatment has advanced significantly in recent years, South Africa remains the country with the highest number of people living with HIV – about 5.5 million. And, according to fieldworkers and health NGOs, infections are increasing.
“Our pool of people living with HIV is growing, not shrinking,” said Rebe.
He described the picture of where South Africa stood today in terms of HIV as “problematic,” explaining, “When you roll out big ARV programs like ours, obviously people don’t die of AIDS. They live with HIV for a lot longer. So what’s actually happening in the country is that there’s just this ever growing pool of people living positive, living with HIV and AIDS, and requiring healthcare. And obviously that’s an unsustainable situation long term because eventually the pool gets too big for your taxpayer allocation to healthcare to sustain it.”
He said South Africa was in urgent need of better HIV prevention programs. Dlamini agreed, saying, “We can’t carry on throwing pills at the problem and praising ourselves forever for treating HIV. We now have to prevent new infections and from what I see every day on the ground, we are not.”
She said although there was much more awareness about HIV and how it was spread, ignorance levels around the virus remained “shockingly high” in South Africa.