South Africa

At The Boston Globe Michael Gerson has a column on AIDS in the developing world, focuding on Africa. Embracing neither foolish optimism nor outsized pessimism Gerson argues that a cobination of approaches will be required to stanch a disease that is still spreading at a faster rate than it can be prevented:

Treatment and prevention, in the end, cannot be separated. And the goal of universal access to treatment seems morally unavoidable. However expensive this commitment might be, there is also a cost to letting 40 million people or more die - a cost the world should not be willing to pay. But we also need to be realistic about the nature of this commitment. Defeating AIDS will require major new efforts on prevention. And moving toward universal treatment, according to the United Nations, will require between $32 billion and $51 billion by 2010. America has done much - and still we face an ocean of need.

It’s easy to caricature calls for more money for Africa. But AIDS is one of those issues that shows how aid money really can and does make a difference. The continent needs more financial support to help it to attain very reachable goals. The discussion should never be only about giving money, but such aid should continue be in the equation in light of the West’s persistent underdevelopment of Africa.

Today marks the 30th anniversary of Steve Biko’s death while in police detention.  

Newsweek has a story on the United States’ efforts to step up anti-terrorism activities in the Horn of Africa as embodied in Africom, the military’s planned Africa Command.

The United States lauds the role that South Africa played in helping to bring about the conviction of Gerhard Wisser, who was deeply involved in the notorious Pakistani AQ Khan’s nuclear netowrk.

South Africa appears to have made some laudable progress on achieving a host of targets related to dealing with the country’s AIDS crisis. On the other hand, there is a cloud of mistrust that charecterizes much of the debate over AIDS policy that will have to be addressed for progress to continue to occur. 

Is division within the ANC largely a creation of the media? Or do members of the party agree? The Mail & Guardian has one perspective.

In this week’s New York Times Book Review, John Donnelly, who covers global health and the environment for The Boston Globe, has written a favorable review of Helen Epstein’s The Invisible Cure: Africa, the West, and the Fight Against AIDS. An important book on a vital topic, The Invisible Cure posits that the best solutions to the AIDS crisis in Africa will come from Africans, an argument put forth by many in the development community as well. Of course an Africa for Africans by Africans has been the cri de couer of the continent since independence. But the Pan African dream, the African Renaissance, a solution to the continent’s problems, will not come until good governance, transparency, and democratization are all priorities across the continent, and not just in a few scattered pockets.  

The International AIDS Society (IAS) conference, the biggest of its kind in the world, just closed in Australia. Its most significant conclusion is that the world must find a way to develop and deliver child-specific, side-effect-free (or limited) drugs to allow children with the disease to survive into adulthood (and perhaps to live to see a future in which the disease is eradicated).

Beyond hoary “children are the future” cliches, this proposal makes sense for a number of reasons. For one, call me a cynic, but the cliche is a great selling point. Finding a way to address in AIDS in children will inevitably capture hearts and imaginations in a way that simply addressing AIDS in Africa does not. But beyond the salesmanship, it seems logical to try to stanch the spread of a disease that has proven so fatal for children. Address the disease among its youngest victims while at the same time pushing for antiretroviral drugs geared toward adults and with side effects that can prove as dangerous to children as the disease they intend to attack. This is a strategy that seems both smart from a disease-combating perspective as well as from a marketing and political vantage point.

For whatever reason, Blake Hounshell at Foreign Policy’s “Passport” decided that on Mandela’s birthday he needed to write a blog post declaring that “Nelson Mandela is No Saint.” Let’s leave aside the fact that no one has actually argued that Mandela is a saint, and so Hounshell is heroically creating a straw man to beat him up and then declare victory. Huzzah. And Hounshell’s point would have disappeared into the nether had it not been for the fact that Andrew Sullivan reproduced large portions of Hounshell’s post, including the “No Saint” crack. And he did so uncritically.

Andrew Sullivan is a huge driving force in the blog world, and even though he has never given any indication that he has any real concern, interest, or understanding of Africa, if he grants his imprimatur to an argument, it will have a huge ripple effect. Thus I wrote him an email (which has gone unacknowledged), which I would like to excerpt here (I have edited the email slightly without changing the meaning at all):

Andrew –
 I really wish you had been a little more fair to Mandela, especially on his 89th birthday, even in using someone else’s article. Was his tenure in office as ahead of the curve as it ought to have been on AIDS? No. But let’s keep in mind a few salient points — as important and devastating as the AIDS scourge has been in Subsaharan Africa and in South Africa, Mandela had a few things on his plate in his one term in office (and serving just one term, given the context of African politics, is itself incredibly laudable). He took over from a loathsome regime during a time when the idea of reconciliation was not some quaint idea but a real need in his country. The transformation which he oversaw was a tremendous accomplishment. He had to deal with not only foreign affairs as newly elected head of state, he had to do so as the first legitimate leader of the region’s only superpower. He had economic issues to address. In other words, his AIDS policy may have left a lot to be desired, but let’s keep in mind that the man had a few things on his plate.
 
But furthermore, your glib “no saint” characterization also reveals a static understanding of contemporary history. Mandela’s life, even his public life, did not end in 1999 when he gave way to Thabo Mbeki. His foundation has made AIDS a central issue and Mandela has often been forthright that as president he did not do enough. Can one imagine many other leaders being that candid about their shortcomings so soon after leaving office? And then taking the issue on which he or she fell short and making it a centerpiece of an active and profoundly important foundation?
 
I know that blogging sometimes invites glibness. I am the blogger and writer on Africa and especially South African issues for the Foreign Policy Association and I have a blog of my own,  in addition to my normal writing duties and responsibilities as a professor. But we, and especially someone with your profile, must avoid an unfair glibness in which nuance gives way to a “gotcha” approach. Mandela is not beyond reproach, but he warrants more than a dismissive treatment, even if you can cover it by saying you are using someone else’s words.

The problem with taking a one-issue focus on Mandela, who certainly is not beyoind reproach, is that doing so is myopic. But furthermore almost all of the examples of irresponsibility Hounshell cites and Sullivan uncritically replicates fall in the lap of Thabo Mbeki. And while Sarafina II proved to be a disaster, but at its essence the idea was not necessarily a bad one even if its execution proved a disaster – have a playwright with an international education produce a show that will serve as a public educational tool in the fight against AIDS. Every major public health crisis that I can think of has been accompanied by a major education component. The idea of such an endeavor is not the problem — the misallocation of scarce resources and the execution is what doomed Sarafina II to the status of an unfunny punchline.

 It seems unseemly to me to publish a post declaring Mandela not to be a saint on his 89th birthday when there is so much to celebrate. But that unseemliness is multiplied when the criticisms are repeated by people who have not otherwise shown themselves to be especially dedicated to South Africa or to African issues generally. 

On Tuesday Bill Clinton announced that his foundation has brokered a deal with Indian pharmaceutical companies to provide generic AIDS drugs in developing countries. Sub-Saharan Afria will obviously provide a huge market for these drugs.

There are perhaps a few of lessons to learn here. The first is that it is unlikely that these Indian companies, Cipla and Matrix, would be doing this were it not in the long run going to be profitable. Doing good and doing well do not have to be mutually exclusive concepts. The second lesson is that serious global leadership — from Clinton, from France — clearly played a significant, deciding role in brokering this deal. In an era when debates over the efficacy of development policies are strident and harsh, it is useful to see a clearcut example of policies that almost assuredly will have some direct positive effect in Africa and elsewhere. Finally, good for Bill Clinton. If this is the sort of thing that his foundation does, this might be a sign of a long and successful post-presidential career.

IRIN reports that there is yet another impediment to effective AIDS treatment in South Africa. Apparently rape survivors tend to get left out in prevention and treatment programs. In a normal society this might pass as a loose end left untied. but in a country beset by both AIDS and abominably high rape figures it goes down as a huge gap that, left unaddressed will leave a vulnerable segment of the population abandoned, hopeless, and staring at death.  

Given it’s role as the largest anti-apartheid liberation organization, its central role in the transition to democracy, and its virtually insuperable status in the country’s politics today it should come as no suprise that the African National Congress is far and away the most scrutinized (and criticized) political party in South Africa. From issues of politics and policy that some fault Thabo Mbeki’s party for not addressing satisfactorily (crime, AIDS, poverty, continuing inequality) to internal strife (the myriad crises surrounding Jacob Zuma) to the natural backlash against the party in power, it is not always easy to sit in power, even if in each national election from 1994th ANC has actually consolodated its hold. Even as the party garners greater criticism, it seems to draw more support. At least in large part this can be explained by the lack of a viable opposition party.

This past week some of the ANC’s brightest lights met n Durban to try to smooth out some ruffles that have emerged between the national party leadership and the party’s hierarchy and rank-and-file in KwaZulu-Natal, where Zuma’s sacking hits closest to home. The leadership emerged proclaiming unity, but some observers, (see, for example, this analysis) take a more cynical approach, believing that the Durban meeting reveals fissures within the party and an ANC that is “troubled,” and perhaps in a state of crisis. Naturally, at least some observers, notably from the South African Communist Party (SACP) and the Congress of South African Trade Unions (COSATU) want to use the opportunity that the times provide to push the ANC to move its politics leftward.

I have long argued that if a viable challenge to the ANC ever emerges in South Africa it will not come from the old recidivist challenges from the white right, but rather will come from a splintering of the ANC-SACP-COSATU alliance. Perhaps South Africa approaches a time when the ANC will either swing to the left or else it will fracture, with SACP-COSATU forming a new party.

But as a new boook by Padraig O’Malley, Shades of Difference: Mac Maharaj and the Struggle for South Africa, indicates, the ANC has always dealt with internal division. The party’s leadership has always shown itself to be imaginative and clever when responding to crises. My guess is that Mbeki and company will be able to convince dissidents in SACP-COSATU and in KwaZulu-Natal that their interests are best served within the party, not operating from outside of it.     

Over at The New Republic John Talbott has a rather radical suggestion for how to end AIDS in Africa: “Compulsory testing and notification of every citizen.” Talbott is not a medical doctor nor is he an Africanist — his tagline lists him as “an author, former investman banker for Goldman Sachs, and former visiting scholar at UCLA’s Anderson School in Los Angeles,” and his solution seems a bit simplistic and pie in the sky. The example he uses is Botswana, where there is a strong civil society and fairly wide access to antiretroviral drugs. he surmises that once people know they are infected, they will know to get service, which in Botswana might be more readily available than elsewhere.

His solution is an provocative one on the theoretical level, though it does not take an especially fertile imagination to understand why compulsory medical exams, whether imposed from white outsiders or African leaders, might be construed as more than a little bit problematic. And what if, after diagnosing someone, the state does not follow up with a guarantee of treatment? Be sure to look at the discussion comments, in which an infectious disease doctor who is about to head to Namibia to deal with AIDS patients addresses Talbott’s article, calling his solution “interesting if half-baked.”

The news on AIDS from Africa is rarely good, and southern Africa usually offers the grimmest tidings. Nonetheless, the feedback from what is being billed as “the most representative HIV/AIDS meeting ever held in” South Africa hints that perhaps things will improve. The meeting,  opened in Pretoria today, and will debate the new HIV/AIDS national strategic plan for 2007-2011, which the AIDS Law Project’s Mark Heywood hails as “one of the most far-sighted strategic plans on the globe at the moment.” Plans, however celebrated, are one thing, follow-up another, but surely these developments mark a significant step forward in the one region of the world that cannot afford anything else.