Better Late than Never? Assessing Nelson Mandela’s AIDS Legacy

Written by Melissa O’Grady

The world is mourning the death of Nelson Mandela http://www.afripol.org/afripol/item/1492-on-nelson-mandela.html. Some are also reflecting on his achievements and failures. One of the most controversial points of discussion is Mandela’s actions over South Africa’s AIDS crisis. One of the biggest criticisms leveled against Mandela is that he was silent over AIDS in the crucial years before and just as it became a pandemic in South Africa.

It is difficult to deny that, on the one hand, HIV infection rate statistics reveal that the virus exploded under Mandela’s watch. In 1990 as little as 0.2% of the South African population was infected with HIV. In 1994, Nelson Mandela became president of South Africa. Two years later the infection rate had risen to 3%. By the time Mandela left office in 1999, the number of HIV-infected South Africans, at 10% of the population, had clearly spiraled out of control. Today the number of HIV/AIDS cases in South Africa is around 6.1 million, or around 12% of the total population. It is more prevalent among the adult population, with over 18% of people infected. Moreover, the death rate is estimated to be 240,000, which has left 2.5 million South African children as orphans.

*In denial?*

There are many theories that may explain why so little was done in response to HIV/AIDS during the Mandela presidency. Many believe that the stigma associated with HIV- as a virus primarily spread through unprotected sexual intercourse- prevented the South African leadership from speaking out about it. Others have suggested that, with South Africa just emerging from Apartheid and the South African economy and welfare at the forefront of political discussions, the mystery virus, which people still knew relatively little about, just was not on the priority list.

Mandela has also been criticized for his “silence” when his successor, Thabo Mbeki, made public statements, which have been widely interpreted as AIDS denialism <http://www.csicop.org/si/show/aids_denialism_vs._science>. Mbeki was heavily influenced by a clique of academics who argued against the link between HIV and AIDS. One of the most prominent was Peter Duisberg, Professor of Medicine and Cell Biology at Berkeley, California. Duisberg argued that HIV was a symptom not a cause of AIDS and AIDS had multiple causes, including drug use, promiscuous homosexual sex and malnutrition. Of course, in fact, as STD Panels points out, AIDS “starts as HIV, a condition which begins to attack cells within the human body”<http://www.stdpanels.com/information-links/the-dangers-of-sharing-needles-aids-and-hepatitis/>.

In the late 1990s, echoes of Duisberg’s argument could be heard in Mbeki’s words as he addressed South African television audiences questioning whether HIV and AIDS were linked. He also suggested that HIV could be cured through home remedies rather than expensive Western anti-retroviral drugs. Mandela did not publicly contradict these claims.

*Breaking the silence*

Mandela did start to speak up about AIDS as South Africa moved into the 21st century, however. An international AIDS conference in Durban, South Africa, was a watershed. At that conference, Thabo Mbeki made a famous speech, claiming that AIDS was linked to poverty: “One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defense against attack by many viruses and bacteria,” he said.

“Clearly, if we, as African countries, had the level of development to enable us to gather accurate statistics about our own countries, our morbidity and mortality figures would tell a story that would truly be too frightening to contemplate. As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus,” Mbeki went on.

When it was Mandela’s turn to speak, he was subtly critical of this view; he referred to an argument that was taking attention away “from the real life-and-death issues we are confronted with as a country, a region, a continent and a world”, an argument which Mandela claimed should be put aside. Although Mandela praised Mbeki he also called for the use of anti-retroviral drugs to prevent the transmission of AIDS from mothers to their children. Mandela’s decision to speak up proved a game-changer for South Africa. From then on, the Mbeki government quietened its reservations about HIV and the use anti-retroviral drugs. A treatment strategy was agreed and some treatment drugs began to drip into the public health sector.

Towards the end of his life, AIDS became the only subject that Mandela would accept invitations to speak on. He also set up the charity 46664, named after his prison number on Robben Island. Mandela was a co-chair on the advisory board of the International Aids Trust. Mandela also told the world that his son, Makgatho, had died of AIDS in January 2005 aged 54, which many have interpreted as a deliberate attempt to combat the silence and stigma surrounding HIV/AIDS.

According to a Harvard University report<http://news.harvard.edu/gazette/story/2008/11/south-african-aids-policy-tied-to-330000-lives-lost/>, AIDS denialism under the Mbeki government between 2000 and 2005 cost at least 330,000 South African lives. The number of deaths due to the lack of action taken when Mandela was President remains unknown. What is clear, however, is that Mandela still played a pivotal role in pushing for anti-retroviral and combating the stigma against AIDs in South Africa at the turn of the century. With millions of South Africans living with the disease today, and South Africa also struggling to get to grips with numerous social and economic problems, Mandela embodies the important lesson that it is never too late to do what is right.