World AIDS Day: South Africa to treat all HIV children

To mark World AIDS Day, South Africa's President Jacob Zuma announced a major policy shift, offering to provide treatment to all children diagnosed as HIV-positive.

Denis Farrell/AP
A child plays in a plastic playhouse at Cotland's, a South African children's home that offers community-based and residential care facilities to sick and vulnerable children in Johannesburg. In a World AIDS Day address, president Jacob Zuma said Tuesday that the government will treat all HIV-positive babies and expand testing, a dramatic and eagerly awaited shift in a country that has more people living with HIV than any other.

South African President Jacob Zuma, during his World AIDS Day speech, announced that South Africa would provide treatment for all HIV-positive children, a dramatic step forward for a country with the world's highest rate of people diagnosed as HIV positive.

Mr. Zuma's pledge marks a departure from the policies of his predecessor, President Thabo Mbeki, who disputed the scientific evidence linking HIV with AIDS, and who actively discouraged the rollout of antiretroviral treatments to help AIDS patients live longer, more productive lives.

Speaking to an enthusiastic crowd in the nation's capital in Tshwane (Pretoria), Zuma compared the fight against AIDS with the struggle for freedom against the white-racist rule of apartheid.

"That time has now come in our struggle to overcome AIDS," Zuma said. "Let us declare now, as we declared then, that we shall not submit."

The battle against HIV in South Africa has become a deeply transformative one for this country. More than one out of every 10 South Africans, or 5.7 million of them, has been diagnosed with the virus, and more than 2.4 million children have been orphaned by the disease thus far. Researchers say HIV tends to strike those in their child-bearing years, the disease has had a powerful economic and social effect on families in South Africa, a country where nearly 40 percent of the population lives in poverty. When parents die, their children lose disciplinarians and role models. When breadwinners die, a society loses its most productive workers, and children are forced to live with grandmothers and extended families, many of whom are already struggling themselves to make ends meet.

"I think it is beginning to dawn on South Africa as a whole that the scale of the situation is so alarming, it's difficult to imagine how we are going to deal with it," says Ivor Chipkin, the chief research specialist at the Human Sciences Research Council in Tshwane. "By 2015, 32 percent of all young South Africans will have lost one or both of their parents to HIV. That is astonishing. The South African family is in deep crisis."

Although the HIV virus appears to have first emerged in central Africa, perhaps around the Democratic Republic of Congo, it is southern Africa that has borne the greatest brunt of the disease. All of the top five HIV-affected countries are neighbors of South Africa, according to the UNAIDS. As of 2008, an estimated 22.4 million Africans were diagnosed as HIV-positive, out of 33 million HIV patients worldwide.

The policies of Thabo Mbeki, who disputed the link between sexual behavior and AIDS, together with antagonistic attitudes of his Health Minister Manto Tshabalala-Msimang – who urged HIV patients to eat garlic and beet roots, and to drink lemon juice to ward off the disease – contributed to an estimated 330,000 premature deaths, according to a Harvard University study. Some African National Congress party radicals have called for Mr. Mbeki to face charges of genocide for his HIV policies.

But while calls for punishing Mbeki might please some, Adam Habib – no fan of Mbeki – says that other ministers in Mbeki's Cabinet, including Mbeki's former vice president, Jacob Zuma, would also be equally guilty, if only for remaining silent.

"Zuma is taking a stand that irrevocably puts South Africa on a different path, and he's trying to distance himself from his predecessor, and for that he should be applauded," says Mr. Habib, a political analyst and vice chancellor at the University of Johannesburg. "My question is why didn't he think his voice could be heard before? If Mbeki should be charged with genocide, then half of the current cabinet who were with Mbeki could find themselves in a mess too. Where does it stop?"

But Zuma's announcement leaves open a key question: who pays for it?

South Africa currently provides anti-retroviral (ARV) treatments to 700,000 HIV-positive patients, an increase of 216,000 from last year. Each ARV treatment costs roughly $1,500 per year. In the past, the US government and foreign donors helped South Africa to provide those ARV treatments free on demand, and today, the US ambassador to South Africa, Donald Gipps, announced that the US would pitch in an additional $120 million next year for AIDS treatment and research. But over time, the greater burden for providing treatment will fall on South Africa's shoulders.

"I don't know how we're going to do it," says Mr. Chipkin. "We have to somehow scrape it all together, but what that means in terms of sacrifices, I can't say."


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