HIV/AIDS, South Africa And Democracy

By Chinua Akukwe
Washington, DC

The Perspective
Atlanta, Georgia

April 27, 2004

The African National Congress (ANC) and Thabo Mbeki’s government won a resounding mandate from South African voters, April 2004. With this renewed mandate, Thabo Mbeki will serve his second and final term as president until 2009. Despite the anticipated margin of victory by the ANC, a visitor to South Africa in the last few weeks would have noticed how Thabo Mbeki and his senior colleagues in ANC campaigned vigorously throughout the country. A major reason for the vigorous campaign was to repair breach of trust between the government and South Africans over the country’s HIV/AIDS policies and programs.

That the government of South Africa miscalculated in the war against HIV/AIDS is not news. What is really newsworthy is that for the first time, the issue of HIV/AIDS forced a popular government and a popular political party to backtrack and engage in major reversals of public policy. From initial skeptical public postulations on AIDS etiology and specific clinical treatment protocols, the government of South Africa read the mood of its citizens on the epidemic and acted by rolling out the most comprehensive and ambitious treatment plan in Africa. Furthermore, the government faced the unenviable task of re-introducing itself to hard-core supporters who have been at the receiving end of the HIV/AIDS epidemic. The treatment program is at its infancy but the government’s commitment to HIV/AIDS remedial efforts is no longer in doubt.

The gravest challenge to South Africa’s future in the next two decades is likely to be the fallout of HIV/AIDS. As the country with the largest concentration of individuals living with HIV/AIDS, at least 5 million, South Africa faces a future that will herald untimely deaths of its most productive citizens, a potential spiraling cost of private enterprise in the country due to sickness and death of skilled workers, and a devastating epidemic that targets the poor in South Africa. According to various estimates by multilateral agencies and South Africa research institutions, the HIV/AIDS epidemic in South Africa is going to take its toll even if the government does every thing right. Thus, any delay in executing decisive remedial efforts, is potentially dangerous.

The April 2004 election reaffirmed the faith of South Africans in ANC and its government led by Thabo Mbeki. On HIV/AIDS, South Africans gave the government the benefit of the doubt. By the next election in 2009, South Africans will have enough evidence to assess its government’s commitment on HIV/AIDS.

For other African nations preparing for elections in the next few years that have a growing number of individuals living with HIV/AIDS, the die is cast. These countries may wish to learn from the recent predicament of the ruling party in South Africa. Nigeria, Zambia and Kenya should take particular note of the South Africa’s situation since they have growing rates of HIV/AIDS, limited government remedial efforts, high rates of poverty, and a polity that is far from stable.

Forthcoming elections for post-conflict Democratic Republic of Congo, Liberia and Sierra Leone may also revolve around the fate of infected returnees and those families that bore the atrocities of the conflict, including rape. These countries in the next few years will get to know the full extent of their HIV/AIDS epidemic, the socioeconomic impact, and the potential degrading of law and security apparatus.

As politicians and policy makers become increasingly aware that HIV/AIDS is a major development emergency and a potential political deal breaker between citizens and their governments, the future of remedial efforts looks bright in Africa. Some may argue that South Africa’s government respects the majesty of the ballot box and may have fought scared in a credible election to reclaim a mandate that could not have gone elsewhere, at least for now. However, for governments that have ‘less respect’ for the ballot, they must be prepared to deal with the consequences of an enraged citizenry hobbled by grinding poverty, incensed by growing suffering and death from AIDS, and exasperated by lack luster response from their leaders on remedial efforts.

If the most powerful government in Africa, controlling the most powerful economy and arguably the best army, had to work hard to regain the trust of its citizens on HIV/AIDS, then less powerful African governments must be wary. HIV/AIDS once crossed the Rubicon from health care into the development arena. HIV/AIDS has made another move, and is now firmly ensconced in the political arena in Africa.

A report on the eve of the election in South Africa by the Governance and AIDS Program (GAP) of the Institute for Democracy in South Africa suggested that HIV/AIDS is already threatening democracy in the country since most eligible voters are within the same age range of individuals most affected by the epidemic. GAP even suggests that the integrity of the next South Africa election in 2009 may be compromised by high rates of HIV/AIDS among prospective voters and electoral staff. If millions of individuals become sick or are dying of AIDS in future elections, then, who will campaign, vote or oversee the elections? Without doubt, HIV/AIDS in Africa is now out of the shadows, forever ending two decades of deafening silence in the continent.

Chinua Akukwe ( is a member of the Board of Directors of the Constituency for Africa (CFA) and a former Vice Chairman of the National Council for International Health (NCIH) now known as the Global Health Council, Washington, DC.

Selected Bibliography
1. Akukwe, C (2003). HIV/AIDS in Africa: South Africa’s Leadership is Crucial. THE PERSPECTIVE, Atlanta, GA.
2. UN Integrated Regional Information Network (IRIN) (April 9, 2004). South Africa: Special Report on a decade of democracy-HIV/AIDS. Johannesburg. Available at ID=3252. This is a comprehensive policy, program, research and chronological update of the HIV/AIDS situation in South Africa.
3. UN Integrated Regional Information Network (IRIN) (April 9, 2004). South Africa: HIV/AIDS Threatens to Undermine Democracy. Johannesburg. Available at ID=3251.
4. Haacker, M (2003). Providing Health Care to HIV Patients in Southern Africa. IMF Discussion Paper. PDP/01/3. Washington, DC.
5. Topozis D (2003). Addressing the impact of HIV/AIDS on ministries of agriculture: focus on eastern and southern Africa. Joint FAO/UNAIDS Publication, Rome, Italy.
6. South Africa Business Coalition on HIV/AIDS (SABCOHA), South Africa Bureau for Economic Research (2004). The Economic Impact of HIV/AIDS on Business in South Africa, 2003. Johannesburg, South Africa.
7. South Africa Consulate General, New York (2003). Cabinet’s Decision on the Operational Plan for Comprehensive Care and Treatment of People Living with HIV/AIDS and AIDS. Questions and Answers. Available at
8. South Africa Bureau for Economic Research (2001). The Macro-Economic Impact of HIV/AIDS in South Africa. No. 10. Available at