With almost four million people living with HIV/AIDS and a staggering 1 600 new infections every day, the epidemic is in danger of crippling most developmental gains made since 1994.

“The epidemic is spinning out of control and setting up a disaster of unimaginable proportions and yet, the most committed we seem to be as a nation is to wear red ribbons and salute World AIDS Day,” says Mary Crewe, head of the Centre for the Study of AIDS at the University of Pretoria.

Most South Africans will probably not even be aware of the existence of a national AIDS plan. Despite the hope pinned on the plan when it was accepted in 1992, it faltered at the very moment it should have been strong and that was in the implementation design.

AIDS consultant Dr Clive Evian believes that overall, the government (former and present) has for many years been making an effort, but that this is nothing like the effort that needed to be made relative to the size of the problem.

Evian believes that although the AIDS plan is sound, there are many obstacles to implementing the plan which have nor been overcome.

“There are endless workshops, bosberaads, debates and policy discussions, but no delivery. We know what to do, but there is a lack of capacity to deliver.”

Anthony Kinghorn, an AIDS policy analyst, believes that there is now genuine, if somewhat belated, commitment and appreciation of the problem at national government level, but that the response at local and provincial government level has often been far too limited.

Evian also accuses government of “failing with distinction” when it comes to dealing with issues such as mother to child transmission.

“They are using any and every excuse not to make AZT available. A concern for government should be what to do with these infants once their parents die,” Evian says

Projections reveal that there will already be nearly a million children under the age of 15 who have lost their mothers to AIDS by 2005. Care for these orphans will be one of the greatest challenges facing the country.

Health minister Dr Manto Tshabalala-Msimang and her predecessor, Dr Nkosazana Zuma, have consistently branded AZT as unaffordable and have stuck to the basic plan of creating awareness to achieve prevention.

Returning from a fact-finding mission to Uganda recently, Tshabalala-Msimang indicated that the only real hope lay in bringing the “ABC” message across. A appeals to young people to “abstain” from sexual intercourse, B stands for “being faithful” and C for when all else fails  “condomise”!

Tshabalala-Msimang also emphasised the need for the destigmatisation of the disease, the effective and early treatment of other sexually transmitted diseases and the development of an AIDS vaccine.

But Alan Smith, Professor of Virology at the University of Natal, points out that in all provinces the focus on awareness campaigns does not address the stigma attached to an HIV-positive status.

“Part of the thrust of these awareness campaigns should be to deepen the general understanding of AIDS and to promote acceptance of HIV-positive people in the community.

“This is important not only for humane reasons, but also because the state will not be able to look after people living with Aids full-time,” he says.

Acting national director of the National Association for People Living With HIV/AIDS, Nkululeko Nxesi, praises government for being prepared to fund his organisation, but at the same time criticises them for not making enough money available relative to the enormity of the epidemic.

He also accuses Mbeki of confusing people living with the disease, by questioning the safety of AZT.

South Africa’s response to the epidemic has been shrouded in controversy.

Kinghorn says “unfortunate” responses to issues such as Virodene, Sarafina 2 and the latest AZT debate have set back the AIDS programme significantly.

Gary Adler of the AIDS Foundation goes as far as to say that the Sarafina scandal threw the national AIDS directorate into disarray and caused the demise of a shared vision for Aids in this country.

“Any organisation or arm of civil society that dared to question or express concern about the lack of accountability of the national programme was silenced either through funding cuts or by other means,” Adler says.

For example, the national directorate cut non-governmental organisation funding from R19-million in 1996 to R2-million in 1998, and the then Minister (Nkosazana Zuma), disbanded her national AIDS advisory council in the wake of the Virodene scandal in 1998.

According to Crewe, the greatest scandal of all is just starting to unfold, and that is “the scandal of lack of delivery, failure to engage the society in the urgency of prevention and lack of any planning for care and support”.

But some believe that there are indications that the situation is changing for the better.

The establishment of the Inter-ministerial Committee on HIV/AIDS in 1997, chaired by the President Mbeki, has elevated AIDS to a level that is far higher than the Health Department’s AIDS directorate alone. Responding to HIV/AIDS is now the shared responsibility of all ministries within government.

The launch of the committee’s Partnership Against Aids in October 1998 is further broadening the responsibility to all sectors of civil society and such initiatives must be applauded.

As Kinghorn points out, the challenge of HIV/AIDS is much too big for government to deal with alone.

What remains now is for South Africa to make up for lost time.

“It simply requires the courage to say no more of the same,” Crewe concludes.

Perhaps former President Mandela summed it up best when he spoke in Davos three years ago: “The vision which fuelled our struggle for freedom; the deployment of energies and resources; the unity and commitment to common goals all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response.” – Health-e News.