By Ferial Haffajee and Claire Bisseker

Financial Mail (South Africa) 1 March 2002

As the AIDS battle intensifies, so does the battle in the ANC

A simmering battle about AIDS policy in the African National Congress (ANC) that thrust itself into the public arena last week is nothing less than a contest for the soul of the party.

The divisions between those pushing for greater political will to tackle AIDS and those who adopt a more cautious approach are deepening. And the issue is beginning to pose a political challenge to President Thabo Mbeki, particularly as a key party member, MP Peter Mokaba, is conducting a vocal campaign against antiretroviral drugs.

Those intellectuals in the ANC who agree with Mbeki portray the President as a Galileo - a brilliant intellectual, regarded as heretic now, but hero later. Others worry that he's more like Nero.

The AIDS battle in the ANC is taking on a new, rebellious dimension. Yet it is barely above ground in a centralised party where position and policy are decided by national leadership.

The public got a taste of the intensity of the debate last week, when Gauteng and the national government and ruling party fought about the province's plan to extend antiretrovirals to more pregnant women and their babies.

While party chiefs have been working hard to heal the wounds, the fight poses a challenge for Mbeki.

The groundswell of dissatisfaction includes MPs, provincial health MECs and ordinary branch leaders - the ones who are watching the cemeteries fill up. Disaffection is strongest in those provinces where the AIDS toll is greatest. Members have pushed their regional councils, the highest decision-making structures in the provinces between national conferences, to pressure government to do "something"; their immediate call is for anti-AIDS drugs.

In the Western Cape, the ANC has always supported the province's provision of antiretrovirals; the Free State is a new conscript. Mpumalanga, the Northern Cape and Limpopo are more likely to toe the ANC line. "We're seeing death in our constituencies week after week," says an ANC MP who, like most of those interviewed, does not want to be named.

Visibly angry after last week's fall-out between the national ANC and its Gauteng premier, Mbhazima Shilowa, over his decision to expand the province's mother-to-child transmission (MTCT) prevention programme, a young Gauteng ANC leader and health official says: "Leadership cannot ignore the overwhelming pressure from the grassroots. There is no retreat."

Similar passions lie behind the speed with which other ANC premiers announced expansion of their MTCT programmes in the week after Mbeki's State of the Nation address.

Three months ahead of Gauteng's decision, the ANC-led parliamentary committee on the status of women called on government to provide anti-AIDS drugs to pregnant women and babies. It also called for the drugs to be given to rape survivors: "The committee believes outrage at the horror of the rapes has to be converted into action to prevent the additional tragedy of the rape survivor contracting HIV/AIDS."

Led by prominent ANC member Pregs Govender, the report was passed unanimously last November.

But seeking to undercut this new groundswell is an alarming new dissident campaign in the ANC. Led by Mokaba, it aims to get the party to back AIDS dissidents who question whether HIV causes AIDS and eschew the use of antiretrovirals (see box).

Mokaba is also the ANC's national election manager and has the support of ANC secretary-general Kgalema Motlanthe, the party's most senior manager. Judging from their efforts to undermine Shilowa last week, Health Minister Manto Tshabalala-Msimang and the ANC's head of the presidency, Smuts Ngonyama, are at least compliant in this endeavour.

Mokaba has distributed dissident literature to the ANC's leadership , both national and regional, and for months to the ANC's parliamentary caucus.

He says that "people who are sick [with AIDS] must be treated for diseases they present. Antiretrovirals are not a part of the solution; they are a problem." He adds that not a single member of the ANC's leadership has spoken against his view.

"It would be terrible for the public if you took the Peter Mokaba thing too seriously," says a top ANC member. "He is one of 100 NEC members. His views have not been formally raised anywhere. And, no matter what views people hold, both the ANC and government proceed from the position that HIV causes AIDS."

Moreover, senior ANC members who have fought since 1997 for a coherent AIDS strategy believe Mbeki has recently shifted in the right direction. They say his parliamentary address marked that turning point, the moment when he began, albeit falteringly, to listen to the grassroots.

"I truly think the President has changed. I'm convinced he's taken heed of what we've been saying. He listens carefully. I believe we're now at the juncture where we can get it right. In future, things may get easier, but we're not out of the woods yet," says a doctor and prominent ANC member.

Government's official position is that the political corner has been turned, but with one proviso: it will not be held hostage to a narrow treatment agenda as espoused by the influential Treatment Action Campaign. Yes, MTCT research sites will be extended but government says universal access as national policy is only likely to happen in two years.

It says MTCT treatment requires careful planning, especially in a country with a weak health infrastructure (see box).

Such constraints aside, Mbeki told the SABC programme, News Hour, on February 10 that provinces with capacity should go ahead and expand their MTCT programmes. "I don't think they [the health authorities] would say let us wait for the slowest'. They would have to say, let us make sure that the slowest catches up with the rest'."

"In his State of the Nation address and the News Hour programme, the President gave leadership," says government spokesman Joel Netshitenzhe. "What you had, for the first time in many months, was a comprehensive statement by the President to clarify government's and his approach."

If this is so, Mbeki is indeed moving to deal with an issue that's damaged his credibility - and the trebling of the AIDS budget last week signals political will in Cabinet.

But there are three areas of concern. The first is that the ANC is still incoherent on AIDS policy, as the events of last week have shown. An NEC member says this is because "there is a current of dissidence that obviously comes from senior people . . . You cannot run a campaign schizophrenically. You cannot manage contradictory positions."

In this atmosphere, good policies have to be implemented by stealth and linguistic contortion. In ANC circles the term "universal access" is almost a swearword. "We will expand, without too much publicity," says a Gauteng health official. But is this the way to win the war against AIDS?

Secondly, the President continues to speak in code on AIDS. Though nobody expects a policy reversal, his February speech is open to interpretation.

And thirdly, while Mokaba may be just a maverick, he's had a reputation of being Mbeki's lightning rod before - for instance, he spearheaded the position that premiers be appointed by leadership rather than elected. Mokaba's literature on AIDS is by the dissident scientists on the President's AIDS panel, and he and Mbeki seem to have the same muse - freelance journalist Anita Allen. Coincidence? Many in the ANC are praying so.