Conventional wisdom portrays President Mugabe as an African dictator; former President Mbeki as a dictator wannabe; and former President Mogae of Botswana as a shining democrat.
That wisdom permeates our thinking in several policy areas. In the area of HIV-AIDS policy, for example,mainstream global media and many South Africans portray Mr. Mbeki as a villain who stands accused of committing genocide against his own people for denying them access to life-saving anti-retroviral drugs (ARVs).
Mr. Mogae, on the other hand, is seen as an enlightened humanist, responsible for saving scores of Botswana AIDS victims with progressive health policies. Of course, no one spares a thought for President Mugabe in the area of HIV-AIDS policy. Yet, the 2008 UN Global Aids report and its 2009 AIDS Epidemic Update released on December 1, 2009 imply that Mugabe has been the most effective of the three leaders in reducing the scourge of HIV-AIDS. Indeed, his success provides many clues about inexpensive ways of tackling this plague.
Turning to statistics, the best measure of progress must be the prevalence rate of HIV among the fraction of a country’s population between the ages of 15 and 49. If the percentage of the most sexually active groups in a country that contracts HIV is shrinking over time, a country is making progress.
How do Botswana, South Africa and Zimbabwe compare? The 2009 UN AIDS Epidemic Update states that the respective HIV prevalence rates for Botswana,South Africa, and Zimbabwe are 25%, 16.9%, and 18.1%. The corresponding rates in 2001 for Botswana,South Africa and Zimbabwe were 26.5%, 16.9%, and 26%.
In summary, the percentage of people suffering from HIV- AIDS has gone down slightly in Botswana, stayed the same in South Africa, and declined dramatically in Zimbabwe.
It is not much good to have a low incidence among the living HIV patients if millions of people die from AIDS, so I took a look at the AIDS deaths. Here, Botswana’s provision of anti-retroviral drugs to more than 80% of its HIV patients has delivered spectacular results. The number of AIDS deaths has declined from 16,000 in 2001 to 7,400 in 2007.
Turning to its neglectful neighbour, only 21% of South Africans with advanced HIV received anti-retroviral drugs by comparison. It is no surprise, then, that South Africa’s AIDS deaths almost doubled from 180,000 to 350,000 in the same period. In contrast, Zimbabwe experienced a modest decline in AIDS deaths from 150,000 in 2001 to 140,000 in 2007 despite providing ARVs to a mere 11% of its AIDS sufferers.
What conclusions can be drawn among these three countries? Botswana is the most humane country for HIV patients, with a life expectancy of 65 years against 45 years in Zimbabwe. But here we have a conundrum.
Despite having the most extensive free anti-retroviral drug program of the three countries, Botswana has made little impact in reducing the scourge of HIV amongst its citizens; while Zimbabwe, stingy in the provision of anti-retroviral drugs and in the midst of an economic collapse, has been far more effective in curbing the spread of the disease.
My explanation for the conundrum starts from the likely impact of Zimbabwe’s economic difficulties on the personal budgets of its citizens. I suspect that Zimbabwe’s economic collapse has reduced the practice of furtive polygamy. Its men can afford neither mistresses nor concubines,hence they have had to change their behaviour.
This is borne out by the UN 2008 report, which cites Zimbabwe as one of the countries, which has experienced a “dramatic change in sexual behaviour” “accompanied by a decline in new HIV infections.” Neither South Africans nor Batswana have had to modify their illicit nocturnal preferences and therefore illegitimate un-condomised congregation by night remains popular.
Should we give President Mugabe the credit for making progress in curbing the spread of HIV in Zimbabwe, in the same way that we condemn former President Mbeki and lionize former President Mogae? I think not! I do not consider a government’s HIV-AIDS policy to be successful merely because it supplies ARVs to a growing number of HIV patients. By the same token, improved AIDS statistics are not a sign of visionary leadership where there is clear evidence of neglect in many areas of health policy. To end this scourge, ordinary African men and women need to change their own behaviour; not heap blame or praise on political leaders with no sway in their bedrooms.