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South Africa needs an HIV truth and reconciliation commission

2006; Elsevier BV; Volume: 367; Issue: 9523 Linguagem: Inglês

10.1016/s0140-6736(06)68705-9

1474-547X

The Lancet,

International Human Rights and Reproductive Law

When, on May 8, the former South African Deputy President Jacob Zuma was acquitted of raping a 31-year-old HIV-positive AIDS activist, many felt that his extraordinary statements during the trial had set back by years the half-hearted attempts of the South African Government to combat its raging AIDS epidemic. He said that he did not use a condom during sex, despite knowing the woman's HIV status, and stated his belief that men do not often get HIV from women, adding that he had a shower afterwards to minimise the chance of infection. Health workers, who struggle to educate the population against a backdrop of continuing mixed messages from government leaders, had to answer calls by people confused about whether such measures are recommended.South Africa has some of the world's highest rates of rape, intimate partner violence including murder, and HIV infection. The trial and its ramifications, irrespective of its outcome, have brought the deep-seated problems in South African society that perpetuate and aggravate these scourges into the limelight. Beyond the widespread indignation, this effect may ultimately lead to a greater benefit to South Africa's people than is currently apparent.Zuma's supporters had threatened and derided the complainant woman and she has now reportedly fled the country. Zuma's own explanations that he took the woman's way of dressing and sitting as an invitation to sexual intercourse, which in his Zulu culture he could not ignore, show an unashamedly male-dominated society, additionally divided by ethnicity, with alarmingly little insight into or regard for consequences. The vilification of the woman in this rape case by Zuma's supporters will make it less likely that such cases are brought to court, let alone lead to a conviction, under current legislation.South African non-governmental organisations, such as People Opposing Women Abuse, estimate that only one in every nine rape cases is reported, for every 400 rapes reported in 2005, 17 became official cases, and only one perpetrator was convicted. However, the long awaited new Sexual Offences Bill, which has been dragging on for almost a decade, was finally approved by the Cabinet last week and is expected to be passed later this month, perhaps as a response to public pressure in the wake of the Zuma trial.The damage undoubtedly done to HIV education and prevention will lead to renewed scrutiny and public interest in the South African Government's stand, when it presents its Progress Report on Declaration of Commitment on HIV and AIDS to the United Nations General Assembly Special Session on HIV/AIDS, to be held in New York, May 31–June 2. The report is littered with references to AIDS as a poverty-related disease; puts an equal emphasis on nutrition, traditional African therapies, and antiretroviral treatment; and has almost no figures on actual numbers of people given antiretroviral drugs, stating difficulties with collecting data as the underlying reason.Consultation for this report was almost non-existent. And the Department of Health gave everyone one week to comment. In a strongly worded letter to UN Secretary General Kofi Annan, the Joint Civil Society Monitoring Forum—a group of NGOs, campaigners, and academic institutions—distanced itself from the report and drew attention to its shortcomings. When the Government announced its operational plan to provide antiretroviral treatment in 2003, the largest such plan in Africa, the reactions were mixed. Some, including The Lancet, were hopeful, others more sceptical.The sceptics were unfortunately right. South Africa continues to drag its feet and the roll-out of antiretroviral treatment is pitifully poor. Apart from lack of infrastructure and health-care personnel, one of the major stumbling blocks remains the lack of a strong leadership that delivers clear messages. South Africa's government officials, including Thabo Mbeki, Jacob Zuma, and Health Minister Manto Tshabalala-Msimang, need to overcome their complacency, their unscientific opinions and reactions to the HIV/AIDS epidemic, and rediscover their spirit as antiapartheid freedom fighters.A nation, previously divided by race, now threatens to be destabilised by gender inequality, violence, and disease. A truly African solution would be to set up an HIV truth and reconciliation commission, where under strong health policy and scientific leadership, everyone could come together and reach a consensus on how best to draw a line under past misguided views and to move forward with convincing strategies. Only then can South Africa's leaders give hope to future generations. When, on May 8, the former South African Deputy President Jacob Zuma was acquitted of raping a 31-year-old HIV-positive AIDS activist, many felt that his extraordinary statements during the trial had set back by years the half-hearted attempts of the South African Government to combat its raging AIDS epidemic. He said that he did not use a condom during sex, despite knowing the woman's HIV status, and stated his belief that men do not often get HIV from women, adding that he had a shower afterwards to minimise the chance of infection. Health workers, who struggle to educate the population against a backdrop of continuing mixed messages from government leaders, had to answer calls by people confused about whether such measures are recommended. South Africa has some of the world's highest rates of rape, intimate partner violence including murder, and HIV infection. The trial and its ramifications, irrespective of its outcome, have brought the deep-seated problems in South African society that perpetuate and aggravate these scourges into the limelight. Beyond the widespread indignation, this effect may ultimately lead to a greater benefit to South Africa's people than is currently apparent. Zuma's supporters had threatened and derided the complainant woman and she has now reportedly fled the country. Zuma's own explanations that he took the woman's way of dressing and sitting as an invitation to sexual intercourse, which in his Zulu culture he could not ignore, show an unashamedly male-dominated society, additionally divided by ethnicity, with alarmingly little insight into or regard for consequences. The vilification of the woman in this rape case by Zuma's supporters will make it less likely that such cases are brought to court, let alone lead to a conviction, under current legislation. South African non-governmental organisations, such as People Opposing Women Abuse, estimate that only one in every nine rape cases is reported, for every 400 rapes reported in 2005, 17 became official cases, and only one perpetrator was convicted. However, the long awaited new Sexual Offences Bill, which has been dragging on for almost a decade, was finally approved by the Cabinet last week and is expected to be passed later this month, perhaps as a response to public pressure in the wake of the Zuma trial. The damage undoubtedly done to HIV education and prevention will lead to renewed scrutiny and public interest in the South African Government's stand, when it presents its Progress Report on Declaration of Commitment on HIV and AIDS to the United Nations General Assembly Special Session on HIV/AIDS, to be held in New York, May 31–June 2. The report is littered with references to AIDS as a poverty-related disease; puts an equal emphasis on nutrition, traditional African therapies, and antiretroviral treatment; and has almost no figures on actual numbers of people given antiretroviral drugs, stating difficulties with collecting data as the underlying reason. Consultation for this report was almost non-existent. And the Department of Health gave everyone one week to comment. In a strongly worded letter to UN Secretary General Kofi Annan, the Joint Civil Society Monitoring Forum—a group of NGOs, campaigners, and academic institutions—distanced itself from the report and drew attention to its shortcomings. When the Government announced its operational plan to provide antiretroviral treatment in 2003, the largest such plan in Africa, the reactions were mixed. Some, including The Lancet, were hopeful, others more sceptical. The sceptics were unfortunately right. South Africa continues to drag its feet and the roll-out of antiretroviral treatment is pitifully poor. Apart from lack of infrastructure and health-care personnel, one of the major stumbling blocks remains the lack of a strong leadership that delivers clear messages. South Africa's government officials, including Thabo Mbeki, Jacob Zuma, and Health Minister Manto Tshabalala-Msimang, need to overcome their complacency, their unscientific opinions and reactions to the HIV/AIDS epidemic, and rediscover their spirit as antiapartheid freedom fighters. A nation, previously divided by race, now threatens to be destabilised by gender inequality, violence, and disease. A truly African solution would be to set up an HIV truth and reconciliation commission, where under strong health policy and scientific leadership, everyone could come together and reach a consensus on how best to draw a line under past misguided views and to move forward with convincing strategies. Only then can South Africa's leaders give hope to future generations.