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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 Africas 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 Mbekis 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. Its 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 Mbekis stance at their national congress in August, putting the president on notice that they were clearly separating COSATU from the governments 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 dont have to be dependent on the ANCthey dont 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 governments 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 Mbekis 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 womendespite 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 dissidentsadvocates of the increasingly isolated and discredited view that HIV does not cause AIDS.
Behind Mbekis unpopular opinions may lie cold pragmatism. Pointing to South Africas sagging economy and 38 percent unemployment rate, Mbeki claims the government is unable to muster the resources to supply South Africas 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 Mbekis go-slow approach grew increasingly short. In October a national poll showed only 1 in 2 South Africans approved of the job he was doingdown 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 copycatit 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 TACs 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 mens power over sexwhen, how and with whom it takes placeis 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, Theres still an enormous negative stigma attached to being HIV positive. Until people with HIV come forward and begin to take on a political identity, well be held back. Thats why TACs work is so importantI only wish they were stronger.
As to President Mbekis leadership on the AIDS issue, Colvin waxes bitter: Its difficult enough earning the trust of sex workers to participate in HIV prevention programs. Now weve got people asking, why take precautions against HIV when the president says it doesnt cause AIDS? Were 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 encouragednot coercedto 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 thats 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.