Mbeki's Legacy

The August issue of Obstetrics and Gynecology contains a chilling report on the impact of HIV treatment (or lack thereof) on maternal mortality in a Johannesburg hospital over five years. The news is grim: HIV-infected pregnant women faced a mortality risk more than six times higher than that of women who didn't carry the HIV virus. HIV was the leading cause of maternal mortality, responsible for nearly half of the deaths reported in the study. Even worse -- many of these deaths could have been prevented through the use of antiretrovirals, which became available at the hospital only in 2004. Only two of the HIV-positive women in the study initiated antiretroviral treatment, demonstrating the need to integrate treatment with prenatal care and pursue more active follow-up processes. Perhaps more importantly, over 40% of the women were "of unknown HIV status", meaning that they had not taken an HIV test. The legacy of Mbeki's AIDS policy is clear: the late introduction of antiretrovirals and the missed opportunity for a public health campaign to educate pregnant women about the need for testing and treatment have contributed to an unacceptably high maternal death rate.
An article in last December's Journal of Acquired Immune Deficiency Syndromes paints an even starker picture:

At the peak of the [HIV/AIDS] epidemic, the [South African] government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral (ARV) drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund. . . More than 330,000 lives or approximately 2.2 million person-years were lost because a feasible and timely ARV treatment program was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005.

In September 2003, I visited Lusikisiki, a rural town in South Africa's Eastern Cape, where a Médecins Sans Frontières program was awaiting the government's decision as to whether it could provide antiretrovirals. Approval came a month later, and the project's final report demonstrates significant success -- for example, voluntary counseling and testing during pre-natal care visits increased from 26% in 2003 to 89% in 2006. Lessons to be drawn from that study include the importance of adherence counsellors and community support as well as service user empowerment. It's not too late to undo Mbeki's legacy, though the human cost has already been far too high.

Sex and politics in South Africa

A demand that all government offices be filled equally by women and men is roiling the Republic of South Africa.
Earlier this month in Pretoria, "[h]undreds of women brought traffic in the capital to a standstill" as "they marched ... to hand over a memorandum demanding an equal gender representation in all state sectors." Among those who voiced their support for the proposal was the country's Minister of Communications, Dr. Ivy Matsepe-Casaburri (left), who urged the crowd: "Let's work collectively and confront hierarchy, no compromise and no going back."
The 50-50 proposal seems now to have fallen prey to the power struggle between factions of the African National Congress. Among those in the midst of that struggle is Dr. Nkosazana Dlamini-Zuma (right). Appointed the 1st woman Minister of Foreign Affairs for the Republic by President Thabo Mbeki, she is a reputed candidate to succeed Mbeki, and also the ex-wife of Mbeki's rival, Jacob Zuma. At a public meeting yesterday Dlamini-Zuma slammed opponents of the equity plan. Her core point in favor of equity:

Women in the majority of countries, if not in all, form more than half the population. And they produced the other half.

Mbeki, Mugabe, and the Politics of Migration

In severe political crises, such as the one we see in Zimbabwe today, forced migrants often become enmeshed in complex political games, sometimes in unexpected ways. South Africa's Thabo Mbeki has been roundly criticized for his failure to impose sanctions against or even publicly condemn Zimbabwe's Robert Mugabe despite leadership so astronomically poor that last month saw inflation over 4500% and unemployment exceeding 80%. Earlier this year, the Southern African Development Community selected Mbeki to mediate between Mugabe and the opposition Movement for Democratic Change party. While Mbeki has kept details of the negotiation out of the media, rumors abound that he intends to set up a transitional government between Mugabe and the opposition. Critics are skeptical of the plan, which in any case comes too late for the estimated 3.4 million Zimbabweans, one quarter of the population, who have already fled the country. Despite severe obstacles including crocodiles and lions, thousands of Zimbabweans pour across the border into South Africa each week. But because Mbeki's government will not recognize the human rights abuses of Mugabe's regime, it refuses to protect these forced migrants, deporting almost 16,000 Zimbabweans each month. (Almost half of these deportees immediately turn around and try to re-enter South Africa, in some cases jumping off moving trains to avoid being returned to Zimbabwe.) And these numbers don't include the uncounted masses of Zimbabweans who remain in South Africa. Hard as it is to imagine, Zimbabwe's economy would be in even worse condition without the remittances sent by these forced migrants, who may be inadvertently propping up the Mugabe regime. In turn, this means that Mbeki's deportation policy, grounded in his refusal to recognize the human rights abuses perpetrated by Mugabe, likely has a negative impact on Zimbabwe's economy, similar to the sanctions that he refuses to impose. A newspaper run by Zimbabwean exiles goes so far as to speculate that if Mugabe fails to agree to Mbeki's transitional government proposal, South Africa will speed up mass deportations of Zimbabweans just before the 2008 elections in Zimbabwe in order to vote Mugabe out of office. Whether or not this particular tidbit is true, it is high time for Mbeki to stop playing political games and protect these forced migrants as South Africa's obligations under the UN and OAU refugee conventions require.