Monday, December 16, 2013

Mandela’s legacy as a health campaigner

Mandela during a visit to HIV program in 2002 (c)
It’s not often that we see politicians celebrated the way former South African president and anti-apartheid icon Nelson Mandela has been celebrated the past two weeks.  As I watched the remains of the 95-year-old activist committed to mother earth last Sunday, something in me wished we had him a little longer.  Many in South Africa would wish same. But alas Madiba’s long walk to freedom has ended.
For quite some time now, South Africans battled with the difficulty of dealing with the prospect of losing the man who not only led the country out of apartheid but saved it from the precipice of a civil war.  So deep is the affection for Mandela among South Africans of all races that the thought of his death seemed incomprehensible.  It seems too high an aspiration to place on one individual, but in the eyes of many in Africa, Mandela represents hope, freedom and peace, virtues that are very short supply on the continent.
Mandela stands out as a human rights icon and a remarkable lesson in leadership.  In no other part of the world is that lesson most needed today than in Africa.  In many ways, what Robert Mugabe is today in Zimbabwe is what Nelson Mandela could have been in South Africa; but he chose a different path. He opted for reconciliation, reconstruction and restoration and in doing so united a broken nation.  His life and the causes that he lived for resonates among people of all race, creed and persuasions.
The Mandela style is a message to tyrants everywhere that there is a greater honor than hanging on to power at all costs.  In fact, it teaches that you can gain more power by giving power away.  I can only imagine where Africa would have been today if the likes of Gaddafi of Libya, Omar Bongo of Gabon, Yaya Jameh of The Gambia, Sani Abacha of Nigeria, Mobutu Sese Seko of Zaire, José Eduardo dos Santos of Angola and Mugabe of Zimbabwe had towed the Mandela path.
For the science community in Africa, Mandela would be remembered among other things, for his contributions to the fight against the spread of HIV/AIDS.  In a continent with a history of poor leadership in the response to the epidemic, Mandela stood out in his ardent campaign for scientific solutions to combating the spread of disease.   Sub-Saharan Africa is home to two-thirds of the world's HIV-positive people, and more than 80% of the AIDS deaths, according to the World Health Organisation.
Though recent progress has been made, HIV/AIDS continues to devastate Africa’s most productive population.  The vast majority of people living with HIV/AIDS on the continent are between the ages of 15 and 49 - in the prime of their working lives.  With 75 per cent of Africa being under 35 years of age, it’s obvious that the disease isn’t just a challenge of the present but a threat to the future.
Among factors that have led to the rise of HIV/AIDS in Africa are ignorance and indifference on the part of political leaders.  Many in Africa still view AIDS as ‘American Invention to Discourage Sex’.  Unfortunately, the South Africa’s incumbent president, Jacob Zuma and his immediate predecessor Thabo Mbeki fall within this category.
During a rape trial in 2006, Zuma infamously stated that taking shower after sex helps to minimize the risk of contracting HIV.  In a region where unprotected sex is thought to be the main way in which AIDS is spread, no one can truly tell how many young people Zuma’s theory on AIDS have made victims.  At least 28 percent of schoolgirls in South Africa are HIV positive according to the country’s health ministry.
Mbeki, another AIDS denier, did even worse damage.  “Mbeki announced repeatedly throughout the late 1990s that AIDS was not fatal, that HIV did not cause AIDS, that home brew treatments could cure AIDS and that life-saving antiretroviral drugs were being promoted so the West could profit at South Africa’s expense,” recalls Arthur Caplan, head, Division of Medical Ethics at New York University Langone Medical Center.
According to a Harvard University research, his retrogressive AIDS policies led to the death of 330,000 South Africans. Mbeki’s policies, influenced largely by denialist scientists such as University of California’s Peter Duesberg, led him to reject offers of free antiretroviral drugs and grants that could have saved the lives of many South Africans.
Soweto's largest cemetery has up to 800 funerals every month, and they're running out of room. The majority of the fresh graves are for AIDS victims, according to CBS News.
Mandela was late to embrace the fight against HIV/AIDS.  “In 1990, when Mandela was released from a 27-year prison sentence, the rate of HIV infection among adult South Africans was less than 1 percent. When the anti-apartheid activist was elected president four years later, AIDS was on it way to being an out-of-control plague, with infection rates doubling every year. In 1998, the rate of HIV infection among adults in South Africa was almost 13 percent, with 2.9 million people HIV positive,” noted Caplan.
When Mandela eventually came on board the fight, his campaigns led to significant changes in attitude at both government and individual levels.  He shocked many in South Africa when he announced that his only surviving son, 54 year-old Makgatho, died of AIDS in 2005. For the rest of his life he will work with other campaigners to fight stigmatization of people living with HIV/AIDS.
"Our country is facing a disaster of immeasurable proportions from HIV/Aids.  We are facing a silent and invisible enemy that is threatening the very fabric of our society,” Mandela said in a message on World AIDS Day in 2000 comparing South Africa’s battle against HIV/AIDS to the fight against apartheid.
On the broader level, Mandela, “understood that exclusion from education was a major limiting factor to development,” says Harvard’s Calestous Juma, and “motivated by this concern, his name to the creation of a new generation of African Institutes of Science and Technology, seen as the beginning of a new generation of African research universities. Two have already been established, in Tanzania and Nigeria, and a third is planned in Burkina Faso.”

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