Thursday, 23 June 2011 07:04

The 5th Durban AIDS Conference – a reflection

Written by  Pierre Brouard

It is now 30 years since AIDS-defining illnesses were identified in gay men in the United States and it is 11 years since the first international AIDS conference was held in Durban. Both these milestones deserve a reflection at the conclusion of the 5th South African AIDS conference in Durban on Friday.

The discovery of a new disease, first called Gay-Related Immune Deficiency because the gay community was first vulnerable to HIV in the west, led not only to personal despair and community fear, it was also accompanied by very high levels of social shame and internalised blame. In the 16 years until a combination of anti-HIV drugs was found to prolong life and empty hospices, many, many people died, lives of friends and caregivers were profoundly changed, and the epidemic took on the dimensions of a genocide. As it became clear that AIDS was a world-wide phenomenon, and our continent bore a heavy burden of disease and death, it seemed that the only way to frame this was in the language of hopelessness and loss.

Yet as combination anti-retroviral therapy (ART) began to change this picture, South Africa became embroiled in a new battle, where the link between HIV and AIDS was challenged, the efficacy of ART was questioned, and AIDS programmers scrambled to continue their work without formal blessing from the state. This was a dark time for South Africa’s AIDS establishment, and the state had to be forced, through legal interventions, to provide drugs to prevent maternal transmission of HIV to babies, and ultimately to roll out what has become the largest ART programme in the world.

The conference in Durban in 2000 marked turning point, because even though the then president was dabbling in dissidence and his presidential panel of “experts” from the dissident and orthodox camp were given the impossible task of trying to reconcile completely divergent points of view, a young boy with AIDS, Nkosi Johnson, gave a moving speech to remind delegates that AIDS was not abstract, but real. And scientist after scientist chipped away at doubts about the HIV-AIDS link, and activists, policymakers and clinicians began to form a broad alliance.

Today, there is a unique consensus between government and civil society about AIDS plans, programmes and policies. The current minister of health has won support across many sectors and there is urgency, political will and funding for AIDS work.

But as the latest Durban conference has shown, there are still vestiges of the past in the way we talk about AIDS. Of course an HIV diagnosis, even in the context of excellent treatment, is still traumatic and life changing. Yes there has been an extraordinary disease burden in South Africa, and even today many people go undiagnosed and untreated. And it is still true to say that stigma, shame and silence are common.

But without glossing over these challenges, or disrespecting the hurdles many people, often the poor and less resourced, face every day in relation to AIDS, it is also possible to find a new language that can shift the debates and reconfigure how we frame the epidemic.

In short, AIDS has the power to reveal the fault lines in society, providing us with insights into problematic gender power relations, our discomfort with sexuality and people who have different sexual orientations and practices, the shortcomings and possibilities of the health care system, the way that our social glue has become unstuck, and the stark differences in access to power and resources between poorer and more well off communities.

Using these insights to re-engineer the health care system, invigorate the education sector, rebuild the stability of communities, and challenge hypocrisy at personal, social and political levels means that AIDS is also about possibility and change. Rather than focusing only on the tragedy of AIDS, as tragic as aspects of it still are, it is possible to see how it has enabled us to have new and interesting conversations about the kind of South Africa we are trying to build.


This article was first published in the Sunday Tribune on 12 June 2011.

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