HIV/AIDS in Africa: South Africa’s Leadership is Crucial


By Dr. Chinua Akukwe
Washington, DC

The Perspective
Atlanta, Georgia

August 14, 2003

The recent announcement that South Africa’s government will roll out a comprehensive anti-retroviral treatment program by the end of September 2003 is a major step in the right direction for the estimated 5 million South Africans living with HIV/AIDS. It is also a giant step forward for the more than half-a-million South Africans that need immediate access to antiretroviral therapy. A comprehensive and effective treatment plan for South Africa is also welcome news to South African families that dread the death of a loved one from AIDS: Every day, at least 600 South Africans die of AIDS associated illnesses.

That the first ever National AIDS conference only took place in August 2003 in a country with the highest known case load of HIV/AIDS is a testament to the titanic struggle between the government and civil society organizations in South Africa on the best way forward on HIV/AIDS, the Achilles heel of the country’s otherwise rosy economic future. Various reports from the National AIDS conference suggest that South Africa is now entering the “death” phase of the epidemic, with devastating implications for the national economy, work force, and the powerful private sector. One of the reports by the Human Sciences Research Council of South Africa (HRSC) indicated that in a recent survey, 16 percent of 2000 surveyed health workers were HIV positive, with at least 20 percent of those aged 20 to 35, living with the virus.

Although South Africans will benefit immediately from their government’s decision on access to AIDS treatment, the widest implication for the new AIDS policy in South Africa will be the continent of Africa. As the economic juggernaut of Africa, a pre-eminent military power, and an oasis of reasonable democratic traditions, South Africa is a giant in the continent. Today in Africa, South Africa and Nigeria are without exception, the two most powerful and influential nations in Africa. A lot is expected of South Africa as Nigeria grapples with its myriad of problems. For Africa to tackle its number one development emergency, HIV/AIDS, South Africa must not only be on board, but also provide vigorous leadership.

A popular question is why South Africa becomes gun shy when it comes to a vigorous response against HIV/AIDS. Many analysts have noted the influential role South Africa played in the transformation of the increasingly ineffectual Organization of African Unity into a promising African Union. South Africa’s role as the gentle but firm guiding hand in the formulation of the Africa’s recovery plan, NEPAD, is well known. The proposed AIDS comprehensive treatment program may be seen as an attempt by South Africa to reassert its leadership role in the continent.

However, as with other policy announcements in Africa, the devil is in the details, and, saints can only be crowned with evidence of vigorous implementation and sustainability of laudable programs, even for a known and deadly killer such AIDS. South Africa must not only roll out an effective treatment program but it must also expand such services at an accelerated rate to reach those that are clinically qualified for treatment. The current estimate is that out of 500,000 South Africans that can benefit from antiretroviral therapy, only 21,000 are on lifesaving therapy. Medical charities serve more than 95 percent of all those on antiretroviral therapy in South Africa. South Africa, in addition to a comprehensive treatment program, must improve its information, education and information (IEC) campaigns against HIV infection. This will require regular IEC messages on HIV prevention from President Thabo Mbeki.

At the continental level, South Africa should ensure that the African Union and NEPAD not only talk about HIV/AIDS but also devote substantial resources in a continent-wide fight against the disease. If Africa should have a home grown economic recovery plan, why should it not have an African-oriented AIDS remedial effort? An effective African oriented AIDS remedial effort would go beyond conference declarations and resolutions to specific issues such as cross sharing of expertise and resources across borders, strategic priorities on resource sourcing and mobilization, and the role of Africans in the Diaspora.

South Africa’s continental leadership role is also crucial in current efforts to allow poor nations obtain cheaper versions of AIDS drugs using the mandates of the World Trade Organization. In addition, South Africa’s flourishing research institutions have a lot to offer to many African nations that are still developing their capacities for quality scientific research. South Africa, with its well-developed private sector and a sophisticated civil society is also in a position to offer continental leadership on an effective tripartite approach-public, private, civil society-to AIDS remedial efforts. In the area of governance, now emerging as a major handicap in AIDS remedial efforts in Africa, democratic traditions and institutions in South Africa, despite occasional hiccoughs, appear robust and stable, and could provide pointers to other African countries.

I look forward to South Africa’s robust leadership on AIDS remedial efforts in Africa. As a member of the Constituency for Africa’s delegation to NEPAD and South Africa in early 2003, I observed first hand the no-nonsense approach to leadership by South Africa’s leaders. During the delegation’s lengthy audience with the Deputy President of South Africa, Jacob Zuma, he spoke eloquently on how HIV/AIDS had become a major problem for his country. Now, it appears that the government of South Africa is ready to lead its people out of mortal danger from AIDS.
A strong resolve and necessary action against HIV/AIDS in South Africa will not only affect its citizens but will also have far reaching implications for the continent of Africa. The Economic Commission of Africa in its latest report on Africa estimate that HIV/AIDS, on the average, reduces Africa’s GDP growth by 0.5-2.6 percent a year, dealing mortal blows to the expected annual 7 percent GDP needed by Africa to meet the 2015 UN Millennium Development Goals. South Africa, as the economic engine room of Africa and as one of the “big two” politically in Africa (Nigeria is the other country) cannot afford to be missing in action in the fight against the gravest threat to Africa’s renaissance.

About the author: Dr. Chinua Akukwe ( is a member of the Board of Directors of the Constituency for Africa, Washington, DC, and a former Vice Chairman of the National Council for International Health (NCIH) now known as the Global Health Council, Washington, DC. Dr. Akukwe has written extensively on health and development issues in Africa.