South African president urges war against AIDS

JOHANNESBURG — Culminating his party's momentous shift on AIDS, a disease that has led to plunging life expectancies here, President Jacob Zuma last week definitively rejected his predecessor's denial of the viral cause of AIDS and of the critical role of antiretroviral drugs in treating it.

Almost 10 years to the day President Thabo Mbeki first suggested AIDS drugs could pose "a danger to health" in an Oct. 28, 1999, speech in Parliament, Zuma declared Thursday in the same chamber, "Knowledge will help us to confront denialism and the stigma attached to the disease."

In a country that now has more HIV-infected people and annual AIDS deaths than any other, Zuma's clarion call for a battle against the disease, six months into his term as president, led to rejoicing among advocates who had long sought such national leadership.

Zuma said in his address: "All South Africans must know that they are at risk and must take informed decisions to reduce their vulnerability to infection or, if infected, to slow the advance of the disease. Most importantly, all South Africans need to know their HIV status, and be informed of the treatment options available to them."

After his own party, the African National Congress, ousted Mbeki as president a year ago, a caretaker president appointed a new health minister, Barbara Hogan, who said in an interview that what she called "the era of denialism" was over.

Dr. Aaron Motsoaledi, her successor as health minister under Zuma, has accepted the government's responsibility for past failings and begun to chart a more comprehensive approach to the AIDS crisis.

Plain-spoken national leadership has proved critical to combating the disease in Uganda, Kenya and Botswana — and disastrous where it was lacking, as in South Africa.

Harvard researchers estimated that South Africa could have prevented 365,000 premature deaths if it had acted sooner to provide antiretroviral drugs to treat people with AIDS and to prevent HIV-positive women from infecting their newborns.

In his speech, Zuma laid out the horrifying toll.

Overall deaths registered in South Africa in 2008 jumped to 756,000 from 573,000 the year before, posing the real possibility, he said, that the number of deaths annually could eventually outnumber births.

The electoral commission had to remove 396,336 dead voters from the rolls in September 2008 and August 2009.

Life expectancy for South African men is 51, compared with 70 in Algeria and 60 in Senegal, Zuma said.

"These are some of the chilling statistics that demonstrate the devastating impact that HIV and AIDS is having on our nation," he said. "Not even the youngest are spared."

And though the country now has a strategy to fight the disease and the world's largest antiretroviral treatment program, he said: "We are not yet winning this battle. We must come to terms with this reality as South Africans."

He called for "a massive mobilization campaign" that spurs South Africans to safeguard their health, educates them about the risks and converts "knowledge into a change of behavior."

Zuma did not go into detail about the behavior changes that were needed. Many anti-AIDS advocates hope he will speak out about the dangers of multiple sexual partners and urge people to take the difficult, and in some cases culturally charged, steps that could help prevent the spread of HIV: condom use and male circumcision, which more than halves the risk of infection for men, among other things.

Zuma is Zulu, the country's largest ethnic group, which does not generally practice circumcision.

He said the country was developing additional measures to strengthen its AIDS programs and vowed that on World AIDS day, Dec. 1, it would begin a "renewed onslaught against this epidemic."