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A truth commission can account for South Africa's past HIV/AIDS denialist policies and rebuild trust, says AIDS expert, Salim S. Abdool Karim.

The HIV/AIDS epidemic is one of the greatest challenges facing post-democracy South Africa. In 2007, the country, which is home to less than one per cent of the world's population, carried 17 per cent of the global burden of HIV infection — and the virus continues to spread relentlessly.

The government's response to the epidemic during the last decade has contributed to this disproportionate burden. It not only questioned the reliability of HIV testing, the safety and efficacy of antiretroviral drugs and the accuracy of statistics on AIDS-related morbidity and mortality, but also the very premise that HIV causes AIDS.

Deliberate attempts were made to undermine scientific evidence as the basis for action and to place politics at odds with science. President Thabo Mbeki's AIDS Advisory Panel, set up in 2000, marked a low point in the government's relationship with scientists when he asked AIDS scientists to engage AIDS 'denialists' in a debate for political adjudication.

Preventable deaths

The impact of these policies was very damaging. The government delayed the implementation of nevirapine — an antiretroviral drug proven to prevent mother-to-child transmission of HIV — which resulted in hundreds of thousands of newborns becoming infected unnecessarily. Researchers at Harvard University estimate that between 2000 and 2005, 330,000 lives were lost to HIV/AIDS and 35,000 babies were born with the virus because of government inaction and failure to provide lifesaving drugs.

AIDS activists have repeatedly had to challenge health service providers, government and pharmaceutical companies. Through petitions, marches, mobilising communities and legal action they have sought to bring more treatment to poor people.

But the change in government leadership last year has created new hope that the country will rise to the challenges posed by HIV/AIDS. President Jacob Zuma's 2009 State of the Nation Address boldly stated: "We must work together to improve the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50 per cent by the year 2011. We want to reach 80 per cent of those in need of ARV [antiretroviral] treatment also by 2011."

Yet, while these statements are welcome, should we simply forget the past and accept that it was unfortunate — but there is nothing we can do about it now? To simply ignore the actions that led to hundreds of thousands of avoidable deaths would be to condone them and lay South Africa open to history repeating itself.

Call for a commission

South Africa needs an HIV/AIDS truth commission as a vital step towards establishing what happened and why, including detailed estimates of how many people died.

It is particularly important to hear directly from the decision-makers and to gather personal testimonies from all parties involved on how the damaging policies took hold in a democracy, where government should be accountable to the public for its actions.

The commission would also help us understand how to prevent the situation from happening again and would give the many people who lost loved ones to AIDS an explanation for why they died unnecessarily.

It is also needed to rebuild trust among people working against HIV/AIDS in South Africa, including those in research, government, health and local communities.

Simply establishing the truth is an important step. But for real reconciliation, the truth must also be made public and open to scrutiny before we can move on.

As South Africa starts building a new era in its response to the HIV/AIDS epidemic, we must work together — government, scientists, civil society and community organisations. It will take all our efforts — unimpaired by any ill-feeling or hurt from the past — to build a constructive foundation for tackling this devastating enemy.

Salim S. Abdool Karim is director of the Centre for the AIDS Programme of Research in South Africa at the University of KwaZulu-Natal. He was a member of Thabo Mbeki's AIDS Advisory Panel.

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