Nov. 20 was a good day in South Africa, according to U.S. Ambassador to South Africa Cameron Hume.
A day earlier, the South African government had finally stepped up to the plate on AIDS, unveiling one of the world’s most ambitious programs to combat the disease.
The plan would triple AIDS spending, to $1.7 billion over the next three years, and move ahead with plans to distribute free anti-retroviral medication to millions of South Africans infected with HIV.
The sudden movement represents an abrupt shift in the government’s position, which had questioned accepted science on the disease and been criticized for years as being an obstacle to AIDS-fighting efforts.
Hume, speaking to a group gathered at the John F. Kennedy School of Government’s Program on Intrastate Conflict and Conflict Resolution, compared the action to the first hints of spring after a long, cold winter.
“Today is a really good day for South Africa,” Hume said. “It’s like ice cracking on a pond. You hear it, but you don’t see it. I think today there’s some clear water.”
Robert Rotberg, director of the Program on Intrastate Conflict and Conflict Resolution in the Kennedy School’s Belfer Center, said learning about South Africa is critical to understanding the continent itself. South Africa’s position of prominence on the continent makes it key to resolving Africa’s disputes.
“Conflict is a constant curse of Africa,” Rotberg said. “South Africa and Nigeria are the big powers in Africa and can and do make a difference in reducing and preventing conflict in many of the troubled parts of the continent.”
Rotberg praised Hume’s candor in talking about South Africa’s virtues and weaknesses, saying even though Hume pointed out weaknesses in South African approaches toward AIDS and the struggles in neighboring Zimbabwe, he also gave the government overall high marks.
AIDS an important factor in future
With 5.3 million people infected, South Africa has the largest number of HIV-infected residents in the world and one of the world’s highest infection rates, about 30 percent for those between the ages of 15 and 45.
Hume said though HIV has been spreading in South Africa for years, deaths from AIDS have not yet skyrocketed. That’s because the deaths typically don’t begin until five to 10 years after infection. South Africa, he said, is just at the beginning of the phase of the epidemic where it will see rapid increases in deaths.
Unless the disease is fought successfully, Hume said, it will have effects far beyond the nation’s health care system. He said it could hurt the nation economically, as workers in their prime are lost, and socially, producing millions of AIDS orphans.
By the end of the decade, life expectancy in South Africa is expected to fall from 59 years to 41 years, he said, and 2 million orphans from AIDS are expected.
Hume said the disease is much worse among women than among men, and reflects the fact that older men often have sex with younger women. The average five-year period of HIV infection is between ages 15 and 20 for women, but between 25 and 30 for men.
The government plans to provide anti-retroviral drugs for millions of those infected with HIV, extending their lives for years. Hume said the government’s action means mothers will be able to see their small children grow.
The government’s plan will set up AIDS treatment centers in each of its 50 health districts within a year. Within five years, each of the nation’s 250 municipalities will have a center, if the plan is successful. Anti-retroviral drugs, which have proven effective in alleviating the symptoms of AIDS and in prolonging patients’ lives, will become more widely available, with an estimated 50,000 patients treated in the first year.
Lower cost, rather than a philosophical shift, is responsible for the government’s changed position, Hume said. Anti-retroviral drugs have come down in price drastically over the past two years, from $1,400 per year, to $200 per year. Keeping an orphan in an orphanage, Hume said, costs the government $500 per year.
Hume said he still believes the government’s attitude toward AIDS is lagging that of the public, 58 percent of which said health care is their biggest concern in a recent poll, up from just 2 percent two years ago.
Halfway from apartheid
Hume’s talk, which lasted about an hour and a half, touched on many aspects of South Africa today. He described a nation that has made long strides since apartheid was abolished in 1991. Despite that progress, however, South Africa still has the highest income inequality in the world, with 30 percent of its majority black population unemployed.
Violent crime is common to the point where Hume said it’s become second nature to leave 10 or 15 feet between cars at stoplights, to allow room to escape if attacked.
Corruption happens in South Africa, Hume said, but he doesn’t believe it is a systemic problem, particularly at the higher levels. Rather, he said, corruption is a symptom of another problem, poorly educated and poorly trained bureaucrats filling jobs in a new, regulation-heavy bureaucracy across the country.
Even with those challenges, Hume said the government has made good progress in building health clinics and extending power and water infrastructure into areas lacking it. He praised aid programs helping the nation, but said their effects can only be minimal because of the sheer size of the country. Real changes in the standard of living for millions of South African poor will come if the government emphasizes more rapid economic growth and education.
Though South Africa disagrees with the United States on Iraq, Hume said the two nations have good relations, largely because they agree on issues regarding Africa. The United States has supported South African actions in Burundi and the Congo and supports efforts to improve leadership across the continent.
Those good government efforts lose their luster, however, Hume said, as South Africa’s silence on Zimbabwe continues. Zimbabwe, on South Africa’s northern border, has descended into turmoil under President Robert Mugabe. Zimbabwe’s economy today is just 30 percent of what it was in 1992, Hume said. Unemployment there is close to 70 percent and in recent years, the nation has gone from a food exporter to an importer.
“You can’t get a peep out of South Africa,” Hume said. “It’s somewhat surprising to me that no one [in South Africa] cares.”
South African President Thabo Mbeki, who succeeded Nelson Mandela in office, looms over the South African political landscape, Hume said. The constitution established an extremely strong presidency that, when combined with the parliamentary government structure, gives Mbeki political influence across the country.
Mbeki, who spent years in exile before returning to South Africa, has a governing style consistent with the small groups and individual cells within which exiled South African dissidents operated. Hume said Mbeki isn’t a charismatic leader whose power derives from popular appeal. Rather, Hume said, Mbeki is more of a down-to-business guy who flexes his political muscles through the party structure.
South African elections are planned for April, Hume said, but there is little suspense. Mbeki is expected to run for a second five-year term and win handily. In fact, Mbeki’s re-election is so assured, Hume said, that the real speculation is focused not on April, but on the next presidential election, when the constitution bars Mbeki from a third term.
“People are really thinking who will be elected five and a half years from now,” Hume said.