When politics is bad for your health: AIDS in South Africa.
South Africa, with a population of 50 million, has nearly 6 million people infected with HIV — more than any other country in the world. AIDS-related diseases kill nearly 1,000 South Africans every day.
Antiretroviral therapy (ART) has been available since the late 1980s, but even in 2009, ART is not available to many people with HIV/AIDS in poorer countries. Since the beginning of the epidemic, South Africa has been the hotbed for political activism and human rights campaigns to address the massive inequalities in AIDS management in the developing world. For example, the Treatment Action Campaign (TAC), led by Zackie Achmat, successfully sued the Ministry of Health in South Africa in 2002 to ensure access to ART for HIV-infected pregnant mothers, so that mother-to-child transmission was reduced. The TAC even took Merck and other pharma companies to court to force them to make their patents available to generic drug-producing companies so that cheaper antiretroviral drugs could be available in South Africa. This type of action massively forced the price of ART down in the last decade, and meant that generic companies are the main suppliers of ART in this country, and across Africa.
In the past, the relationship between politicians and the public health community of South Africa, particularly relating to HIV/AIDS, has been confrontational at worst, and lukewarm at best. Past President, Thabo Mbeki, famously denied the association between HIV and AIDS and instead focused mainly on poverty as a powerful co-factor in AIDS diagnosis. His successor, the current President Jacob Zuma, went on trial in 2006 for allegedly raping an HIV-positive woman. He earned wide criticism and incredulity when he admitted that he had unprotected sex and stated his belief that showering after sex would prevent HIV transmission. We do not need a clearer illustration of what happens when ill-informed politics and lay beliefs inform health policy and practice, instead of science and evidence. More than 330,000 lives were lost to HIV/AIDS in South Africa from 2000 and 2005, due to the policies of the South African government. In the UK and most countries of the world, we have similar instances of ill-informed health policy based on beliefs or poorly interpreted evidence, which have led to negative impact on health. For example, the Lancet publication of a case series of only 12 patients with autism led to greatly reduced uptake of the MMR vaccine in the UK with far-reaching consequences, even though the research was discredited years later.
Thankfully, a new era is being heralded in South Africa with a huge shift in direction in terms of HIV/AIDS policy. This week’s Lancet describes President Zuma’s change of heart, leading his country with the slogan, “I am responsible, we are responsible, South Africa is taking responsibility”. Unsurprisingly, the story has not received much coverage in the world press, but the message is clear. Good health policy must rest on good evidence and government action to the contrary is irresponsible and often bad for the health of the population.