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South Africa’s government has come under fierce attack for failing to
tackle the country’s deepening HIV crisis. At a time when there are an estimated
500 new infections every day, the government is spending just 21 million
rand ( £4.2 million) on its AIDS programme, bringing accusations of
‘inexcusable neglect and unwarrantable underfunding’.

HIV is spreading rapidly in South Africa, overwhelmingly within the
black population. Estimates from anonymous screening programmes in antenatal
clinics, blood donors and other groups suggest the number of infections
doubled in less than a year during 1991. By the end of 1992, more than 1
in 40 young women was estimated to be infected.

A group of academics and actuaries called the AIDS Modelling Group,
led by Peter Doyle of the insurance company Metropolitan Life in Cape Town,
has estimated that even under the most optimistic conditions, 1 in 12 young
adults could be infected by the year 2010. If no action is taken to slow
the spread of infection, and if people do not change their sexual behaviour,
one in four adults could be infected by then.

Edwin Cameron, a lawyer at the University of Witwatersrand and coordinator
of the AIDS Consortium, a group of charities, says the government’s AIDS
allocation is ‘a travesty’. ‘There has been inexcusable neglect and unwarrantable
underfunding,’ he says. Cameron says the country’s failure to act until
now is comparable to the inaction of other African governments in the early
years of the AIDS epidemic. But in South Africa’s case it is ‘less excusable’,
he says, because AIDS is better understood now than in the mid-1980s and
the country has a sophisticated infrastructure.

The country’s AIDS programme is part of the Department of National Health
and Population Development. The department has a policy of ‘lifestyle education
rather than HIV/AIDS education’. It says it aims to prepare children and
young people to make ‘responsible decisions’ about health and develop ‘a
personal value system within a specific moral framework’.

Critics say this approach ignores the poverty, violence and inequalities
that reduce many people’s choices and increase their vulnerability to HIV
infection. They argue that the policy allows the government to deny responsibility
for reducing the impact of the disease. Wilson Carswell, former medical
adviser to the AIDS programme, says that the emphasis on personal responsibility
is a ‘thinly veiled moral stance of the kind that (says) they deserve all
that is coming to them’.

The health department rejects these criticisms saying that the present
budget of 21 million rand represents an increase of more than 115 per cent
since 1990. The department also says it funds 19 training organisations
in local authorities and church groups, and has run various other activities,
including AIDS telephone advice lines and publicity campaigns about AIDS.
It has also distributed 40 million condoms. NACOSA, a liaison group set
up to mediate between the government in Pretoria, the ANC and other organisations,
is drawing up a national strategy for AIDS which is due to be finalised
in October.

Carswell, however, claims that school education and campaigns in the
media have ‘stopped’ since last spring. He resigned last August after a
row with senior management in the health department when he accused them
of neglecting AIDS. Since then the former head of the AIDS programme, Manda
Holmshaw, has also been sacked.

During early 1992, says Carswell, the programme launched an AIDS education
package for schools. He says 3000 schools immediately requested it, mainly
in black communities. After 800 had been distributed, the health department
stopped production of the package without giving any reason. Also last spring,
he says, money was removed from the AIDS budget without consulting its staff.
The findings of an independent inquiry into this allegation about funds
has not been published.

The health department says it has ‘regular contact’ with the education
departments but does not list any schools projects among its own activities.
It has conducted research into how much people know about AIDS which suggests
teachers omitted explicit parts of the education package because they were
too embarrassed (This Week, 3 July).

Adrian Woudstra of NACOSA says there is ‘a large degree of denial’ in
the education departments. ‘They are very conservative, rooted in the past,’
he says. ‘You definitely do not talk about sex.’

The Township AIDS Project in Soweto has produced its own educational
material for adults and children. Sibongile Jack, the TAP’s coordinator,
says she has been told by the AIDS programme’s new director, Natalie Stockton,
that a new government programme is planned for schools. ‘So far we have
received nothing,’ she says. Jack stresses that South Africa’s political
disorder is hampering education efforts.