AIDS conference opening ceremonies are usually a buzzing cacophony of noise, protest and activity. But the 17th International Conference on AIDS and sexually transmitted infections (STIs) in Africa, held in Cape Town, South Africa, has kicked off on a more sombre note. The death of Nelson Mandela, former President of South Africa and noted AIDS activist, had speakers at the opening ceremony reflecting on his contribution to the global AIDS response.
Admittedly, Mandela paid very little attention to the country’s growing AIDS burden when he became president in 1994. It was only once he had left office that he grew much more vocal and active in the fight against HIV/AIDS, and his involvement inspired scientists, activists and other political leaders to do more, noted Robert Soudré, the conference chairperson.
When UNAIDS Executive Director Michel Sidibe took up his position in 2009, he decided to hold his first official event in Khayelitsha, the township outside Cape Town, where Mandela had visited AIDS lobby group the Treatment Action Campaign and international medical charity Médecins Sans Frontières (MSF) in 2002.
"This was when he started to challenge the status quo; and this was where he also started talking about integrating TB and HIV at a time when we were still not doing this… he was a pathfinder," Sidibe told journalists ahead of the opening ceremony on 7 December.
MSF had recently begun providing free antiretrovirals (ARVs) at a public health clinic in Khayelitsha, despite the South African government's refusal to introduce HIV treatment in the public sector. "These were truly dark times," recalled singer and UNAIDS Goodwill Ambassador Annie Lennox. AIDS was so stigmatizing, no-one wanted to acknowledge its existence, rumours and misinformation about the disease were rife, and the high number of AIDS-related deaths was overwhelming, she said.
Mandela's decision to put on a t-shirt emblazoned with the words "HIV Positive" when he met activists in Khayelitsha was a turning point. The head of South Africa's National AIDS Council, Dr Fareed Abdullah, was a director general in the Western Cape health department, the first province to defy national government by offering ARVs to HIV-positive pregnant women, and he recalled the impact of Mandela’s gesture. “With Nelson Mandela behind us – doctors, nurses and people living with HIV – then who could be against us?”
According to Abdullah, Nelson Mandela also worked behind the scenes to get the government to change South Africa’s heavily discredited HIV policy. He clashed with his successor, Thabo Mbeki, over Mbeki’s denialist views, which questioned the link between HIV and AIDS.
After the South African government finally announced in 2003 that it would introduce free HIV treatment at state facilities, Mandela invited musicians such as Annie Lennox and Alicia Keys to perform at the launch of his 46664 campaign to raise awareness of the global pandemic.
Lennox admitted that when Mandela invited her and other artists to Robben island and told them that AIDS was a genocide affecting mainly women and children, she was “ashamed” at how little she knew about the condition.
Another key moment came in 2005, when Mandela became one of the first leaders in the region to openly acknowledge the impact of AIDS on their family by disclosing that his only surviving son had died of an AIDS-related illness – an announcement still viewed as taboo in most communities.
Africa has come a long way since then. “Even the cynics and sceptics cannot say we are not making progress,” Sidibe commented. New infections have fallen by 38 percent in sub-Saharan Africa, and AIDS-related deaths by more than 34 percent, since 2001.
Nevertheless, there is still work to be done. Although 7.6 million people are now on treatment in Africa, 14 million more are still waiting for life-prolonging medicines. Children with HIV are still falling through the treatment cracks, and it is “unacceptable” that countries are still experiencing problems with drug supplies, causing frequent shortages and stockouts, Sidibe said.
Vulnerable groups such as men who have sex with men, injecting drug users, and prisoners are still being criminalized and marginalized in most countries, and are often unable to access basic HIV services, the conference heard.
Lennox threw down a challenge to the more than 5,000 delegates attending the event to make sure that Mandela’s legacy of addressing HIV/AIDS did not become a “static piece of history…Rhetoric comes cheaply, action is what truly counts… Madiba categorically walked his talk, now we must do the same.”