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    No easy path for HIV/AIDS Speech at SA AIDS Conference by Yacoob Abba Omar, Director Operations, Mapungubwe Institute (MISTRA)

    Date published:12 June  2015
    Article category: Media

    Programme Director, Colleagues, Comrades, Friends. Ladies and Gentlemen.
    As the Deputy DG of Government Communications I served on the Inter-Ministerial Committee on HIV/AIDS, chaired by then Deputy President Mbeki. When the first South African National AIDS Council was appointed I served on that august body more or less until my diplomatic posting in 2003.
    When I was asked by my boss, Joel Netshitenzhe, Executive Director of the Mapungubwe Institute, if I would stand in for him at this conference, I did so with some trepidation. On one hand, I was looking forward to becoming once again part of a community, part of a cause which I had worked with during the period I was in GCIS. But I also had my own demons to deal with.
    It is fifteen years since the Durban International AIDS Conference but I still relive the intensity of that conference. No one can forget the words of Nkosi Johnson at that conference:
    Care for us and accept us - we are all human beings. We are normal. We have hands. We have feet. We can walk, we can talk, we have needs just like everyone else - don't be afraid of us - we are all the same!
    Also it had been more than 10 years since I had engaged with HIV/AIDS in the way I had in those days. I was very concerned about whether I would be able to add value at this conference given the constellation of stalwarts you have here.
    So being part of a research institute myself, I thought behave like a researcher: I set about scanning the environment. I started speaking to people who I knew well and who have remained involved over all these years. It was the usual suspects – like Dr Nono Simelela, Justice Edwin Cameron and others.
    I observed the evolution which had occurred over the past decade. In many senses the HIV/AIDS lexicon had grown longer, the alphabet soup of acronyms even longer – I was tempted to count all the ones just appearing in the conference brochure!
    The strides we have made as a country is truly incredible. SANAC has remained a highly relevant multisectoral coordination mechanism of our country’s response to HIV/AIDS. The public health system is testing 13m people per annum. South Africa has the largest ART programme in the world involving about 3.1m people. This has had concomitant improvements in life expectancy to about 61 years. The overall HIV prevalence among antenatal women has plateaued at 29.5% from 2011 with mother to child transmission rate estimated at 3.5% at 6 weeks in 2010, declining to 2.6% in 2012. Infant mortality has decreased. The 15-24 year olds are showing a reduced infection rate at about 7.3% in 2012. Government is taking an integrated approach dealing with TB as part of the same strategy. 
    Social grants are allowing young women to exercise some control over their bodies, not falling for the sugar-daddy syndrome. Research shows there is little truth to the myth of girls getting pregnant just to get grants.
    You know all the data, I don’t have go through it. In essence, the refrain is ‘we know what works’. We can actually dare begin dreaming of an HIV-free generation by 2030.
    However, some of the issues remained the same. Stigma for example persists. Justice Cameron remains the only person in an official public position in all of Africa to have stated his status. South Africa has the highest number of people living with HIV in the world, estimated at 6.4 million in 2012. Our society remains a deeply patriarchal one, with young women representing 25% of all those infected making them even more vulnerable. The numbers who have been tested and know their status is about 45%. There has been a slight decline in the use of condoms, 62.4% in 2008 to under 60% in 2012, while there is an increase in awareness in the under 15 year olds.
    There is also the challenge to ensure that patients initiated on ARVs, remain within the system, remain on treatment and that they are virally suppressed. And that number of people living with HIV/AIDS will keep increasing from the current 6.4m. They won’t die of HIV/AIDS but they will not be reaching their full potential either, remaining poor and powerless and picking up other health issues like diabetes, cardio=vascular diseases etc.
    And while we know what works, we are still struggling to find the holy grail of prevention. And that we have become victims of our own success, cutting back on aspects such as public education and communication. Again I have no doubt you have been addressing these and many other issues, agreeing that there is easy path our vision of an HIV-free generation.
    Having looked at the environment I realised that my twenty years plus in the public service has qualified me to add value in one important sense: looking at the response of the state, and my experience in the anti-apartheid struggle helps me to look at the response of civil society. And so I would like to sketch out a few key interventions which need to be made in relation to the state and in society generally. I will be arguing that for us to succeed in our fight against HIV/AIDS we need to ensure the state is strong and that it works in concert with the rest of society through a social compact on health generally and HIV/AIDS specifically.
    So let us begin with a basic premise: the state exists to protect and promote the welfare of its citizens, all of them. Some have raised to the level of self-evident truism that the state cannot do everything. But it should at least do certain things well. What those things are form the core aspect of my presentation.
    As most of you are practitioners in the public sector – education, health, Presidency etc, you are undoubtedly aware of the serious issues we face as far as the state is concerned. These range from simple issues of capacity, a lack of vision, a lack of leadership to downright lack of morality. The state is not acting in an integrated manner, there is no continuum, there are cracks in the system that people disappear into when they move house or as they grow older. Senior government officials waste time drawing up fancy policies – as if such writing was an end itself.
    Our development partners have pulled out, funding for NGOs have been drying up. These issues do not impact only on health, but because they impact on health we can see the more tragic and unfortunate consequences of the problems in the state.
    We do not have to flounder in the dark to figure out what the state should be doing. It has all been laid out very clearly, based on deep research and consultation, in the National Development Plan. Now, you all know the intense debates we have had around the NDP – it detracts from the fact that it has the support of 93% of the parties in the current parliament.
    As Joel Netshitenzhe’s put it “we should not ‘demonise or canonise’ the NDP. But we should also avoid chipping it in increasingly strident tones to the extent of delegitimising it altogether…The best approach is: debate while implementing!”
    If President Zuma is beginning to worry about his legacy, and I would if I were him – then I would be working hard now to ensure that the NDP is my legacy – not Speargate, not Nkandla, nor Guptagate; not the scandal of a Public Protector assailed by gangs of MPs.
    And the most crucial aspect which is required to make the NDP a reality is leadership across all sectors of society. As Vision 2030 of the NDP states: ‘We all assist the institutions we have creatively redesigned to meet our varied needs; we reach out across communities to strengthen our resolve to live with honesty, to be set against corruption and dehumanising actions’. Now if President Zuma could just stick to that – building the institutions needed to meet our varied needs, to fight corruption and violence - he would leave office in 2019 with the whole country wishing him well for his retirement.
    The rescuing of the health system which Minister Motsoaledi has made a top priority is probably the best example of addressing the institutional needs of our country. If we do not get this right then achieving trust in our public institutions and our leadership would remain a chimera.
    The Institute for Justice and Reconciliation does a regular report on South African attitudes. The two graphs drawn from their report show that there is a direct impact between the ANC’s behaviour and the attitude of the South African public.
    As can be seen from the first graph the impact of Polokwane has been to reduce public trust in national leaders – for most communities we have never gone back to the pre-Polokwane days. In fact as Nkandla became a hot issue, we saw that trust drops further. The only race group in SA which has shown increased support for national leaders – and that is after 2009 – are the Indians. Maybe I should call that the Gupta effect.
    The next graph shows that trust in parliament has gone down amongst Blacks, Coloureds and Whites while amongst Indians it remains high. The figures for whites show an uptick, probably linked to the DA successes in local elections of 2011 and will probably continue given the way the DA has been managing its own transition. The disconcerting behaviour of the ANC, of its Speakers of both houses and of its MPs, especially the manner in which representatives of the people were physically assaulted and thrown out of parliament will in all likelihood continue the downward trend amongst Blacks.
    This ready use of violence by the ruling party in the hallowed grounds of parliament while good friends of ours on the front benches, really good comrades who even believed in non-violence during the struggle against apartheid, look on is bad enough. But it has become the norm within its own conferences. The continuing racist and xenophobic attacks and gender-based violence also reflect the worrying state of South African society.
    Civil society cannot sit back and allow this lemming like descent into violence to continue unabated. For those of us who work with vulnerable communities – be they young single mothers, sex workers, LGBTI communities etc we have to remember Martin Niemoller’s evocative poem: ‘Then they came for me—and there was no one left to speak for me’. We must speak out against this culture of stigma and intolerance, speak out now and speak out loudly.
    This brings me to what I regard as the other crucial aspect of our response to the various challenges raised by HIV/AIDS. In a sense we have the outline of this aspect in the form of the South African National AIDS Council (SANAC). I am talking here of a social compact or social contract. There is broad consensus in the South African context that when we refer to a social compact we are talking of a core agreement among various societal role-players and the government that outlines the rights and duties of each party.
    As you are well aware, we have had several really good experiences of such compacts – Codesa being probably the pinnacle, with NEDLAC being a good example. The moments when these compacts came to fruition is similar to what we face in terms of HIV/AIDS. We arrived at these moments because of the realisation that the prevailing situation should not be allowed to continue; that political arrangements alone were not sufficient to address socio-economic issues; a recognition of the need for compromises and cooperation; and that that there is a need for consultation and consensus. Such social compacts succeeded where there were structures to effect the agreement reached.
    So what should a compact around HIV/AIDS look like? To begin with we should ensure that everyone understands our vision – an HIV-free generation by 2030. By everyone I mean everyone. Every taxi driver, every teacher, every priest, every sportsperson – almal, zonke!
     This vision must be articulated by society’s leadership. Our number one priority should be to get our leadership across all sectors to, in the words of this conference, reflect, recommit, repledge, refocus, renew  their commitment in this fight. They must be part of this national social compact. While SANAC can be the vehicle, this social compact should undergird it.
    By the time we get to the Durban International AIDS conference in 2016 we must make sure that we have reached the same level of awareness, activism, and knowledge that we had in the lead up to the 2000 Durban International Conference.
    Armed with our vision, strengthened by leadership inspired by a higher sense of morality and buttressed by community-based activism we can take on the crucial tasks of the day:
    •    Strengthening of the health system as the NHI is ushered in;
    •    Mobilising the resources of all of society – especially the business sector. The business sector is sitting on cash piles because it claims there is policy uncertainty in SA. In HIV/Aids there is no policy uncertainty. We know what works – we just don’t have all the resources we need to make it work;
    •    Restore faith in the public institutions, which is a big part of restoring faith in society. Improving the behaviour of our elected leaders in parliament, of our public officials, our care givers, will go a long towards that.
    •    Revamping our communications system so that it becomes a proper dialogue between state and citizens, in the mode of development communications;
    This compact must place at its core the addressing of the culture of violence, crime and corruption which is slowly choking the life blood of our society. This can go a long way to addressing the issues of people taking responsibility over their lives, faith in the long term, hope for the future.
    As the Nono Simelela’s, Prof Coovadia’s and Edwin Camerons, and Slim Karrim’s, as we all start entering our twilight years the least we can do is leave the incoming generation with a sense of hope and optimism for the future.
    I thank you.

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