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South Africa Chasing 'Zero Deaths, Zero Stigma'


This is TELL ME MORE, from NPR News. I'm Michel Martin. As we've mentioned a couple of times in the past few days, the 19th International AIDS Conference is underway this week here in Washington, D.C. We're spending this week looking at the epidemic in different ways. And today, we wanted to focus on Africa.

Later in the program, we are going to speak with Dr. Teguest Guerma. She is the head of an African-led organization that aims to find, quote, "African solutions to African problems," unquote. But first, we want to turn to South Africa, where the HIV and AIDS statistics are staggering.

More than five million people there are living with AIDS, more than in any other country, even though South Africa's population is just about 50 million. But things may be changing for the better. A rise in condom use has slowed down infection rates, and different attitudes about medical treatment have eased the death rates.

Joining us to talk more about this, we are pleased to have with us Dr. Aaron Motsoaledi. He is South Africa's minister of health. He's in town for the International AIDS Conference, and was kind enough to break away for a few minutes to join us in our Washington, D.C. studios. Dr. Motsoaledi, thank you so much for speaking with us.

AARON MOTSOALEDI: Thank you, Michel, and thank you to the listeners.

MARTIN: Well, what is the benefit of a conference like this? I mean, obviously, it's very time consuming for you to come and be here. Why do you think this is important to do?

MOTSOALEDI: Well, since I became minister, this is the second time I'm attending such a conference. And I must say it was a baptism of fire, because you've got all sorts of presentations from civil society to NGOs to academics deep into science. So it's exciting. It makes you, you know, become part of the family around the whole world which is working together to find a solution to this pandemic.

MARTIN: One of the issues that many people have raised for years is the prevalence of sexual assault. According to a 2009 study released by South Africa's Medical Research Council, something like 28 percent of men reporting having raped a woman or girl in their lifetimes. Your government's crime report for 2010 and 2011 said more than 56,000 rapes were reported. And I wondered if you think this complicates your efforts to combat the spread of HIV.

MOTSOALEDI: Well, of course it will be, because it does contribute. When HIV/AIDS started spreading in the '90s, there were lots of rumors. Like, one of the most damaging rumors was that if you sleep with a virgin, then you get cured of the disease. And we think that is what led to those onslaughts of rapes, because every man becomes selfish and say look, I've just tested positive and I understand this can be a cure. Why not try it, then, you know?

The issue of sexual assault on women is something that the country is looking at. It started during the era of apartheid. That's why, in South Africa, we're seeing women are terribly oppressed. I was an oppressed person in South Africa until Nelson Mandela got out of jail and we started afresh, but women are terribly oppressed.

Physically, they're oppressed as women. Secondly, they're oppressed as blacks, and secondly, they were oppressed as people in a low socioeconomic ladder. When you add those things together, you'll find incidents like those.

MARTIN: You know, doctor, it's an awkward question, given that you are an appointed minister in the government, but many international health observers say that the HIV situation would not be this bad in South Africa were it not for the attitudes of the leadership of the country. The former president, Thabo Mbeki, dismissed the importance of antiretrovirals. Now he's out of office.

But the current president, Jacob Zuma, cleared of a rape charge in 2006, but in the course of that case, stated that he took a shower after what he said was consensual sex with a woman to protect himself from HIV. Is President Zuma better informed now about how HIV/AIDS is transmitted? Is he better informed, in your view, about what it needs to - what needs to happen to combat this?

MOTSOALEDI: Well, Michel, in this type of crisis, leadership is always important. He launched the biggest HIV council and testing campaign, the biggest in the world, to test 15 million South Africans.

MARTIN: Including getting tested himself.

MOTSOALEDI: He started.


MOTSOALEDI: He got tested himself...

MARTIN: So what you seem to...

MOTSOALEDI: On that day...


MOTSOALEDI: ...he tested. Michel Sidibe tested in public. I tested. From there, we set each - you call them governors here.


MOTSOALEDI: Each one of them, we said: Go back to your province, lead the campaign, test first.

MARTIN: Test publicly.


MARTIN: And be seen to be tested.

MOTSOALEDI: And be seen to be testing. And then I went to call all the traditional leaders, the chiefs and kings. South Africa is an area where we still have kings and chiefs. I brought them together in a meeting. I spoke to them. We launched a campaign for the villages. We said they must test publicly.

MARTIN: You seem to be saying, doctor, that whatever Mr. Zuma may have said in the past, he should be judged by his conduct now. And in this view you're saying he's been...

MOTSOALEDI: Precisely.

MARTIN: ...very aggressive in pushing forward...

MOTSOALEDI: Precisely.

MARTIN: ...a testing and teaching regiment.

MOTSOALEDI: Precisely.

MARTIN: But may I ask you: What do you think changed his mind about this?

MOTSOALEDI: Well, all I did in South Africa as the minister. I went back to 2001. I realized that there's been a lot of information for the past decade from international conferences like this, from WHO, from UNAIDS, from Medical Research Council in South Africa. From all the searches, there's been pieces of information, here and there.

And I describe them like - you know, parts of an animal, which are sitting in different corners. And the people don't know what the animal looks like. All I did was to get those pieces together, and I asked for an audience with the president. I sat with him and took him some of this, the material on mortality, the child mortality rates, the prevalence rates. All those informations were lying there.

And I sat with him for 45 minutes, and I showed him. He then said oh, my God. Is this what's happening in the country? Yes. And, of course, he said, look. He was a chairperson of South African National AIDS Council, because he was a deputy president. But there was no real way all that information was put together, all of this.

MARTIN: So you walked him through it.



MOTSOALEDI: I walked him through it, and I said, look. I want you to walk the Cabinet through this, the whole Cabinet. Go and walk them through this information. And we worked them on, and we agreed that South Africa's (unintelligible) direction we're taking is completely wrong. We need to change direction, and that's why. He fought very hard on World AIDS Day, December, the first of December. I only made this presentation to him in October, and two months later, in December, the whole country changed.

MARTIN: I'm speaking with Dr. Aaron Motsoaledi. He is South Africa's health minister. He's in Washington, D.C. for the International AIDS Conference. We're speaking with him about the AIDS crisis in South Africa. Do you feel that you are making headway against the stigma of HIV/AIDS? Which is, of course, is certainly not unknown in this country.

I mean, there have been some very poignant and important stories around people and the stigma they've experienced in having - living with HIV and AIDS. But do you think that you're making headway there?

MOTSOALEDI: It used to be worse. It used to be worse, and we're making headway. Coincidentally, in this conference, there is a study that's going to be released which was commissioned by an NGO about communication. It shows, according to their findings, that leadership has played a role in South Africa, political leadership, to turn the situation around, that when people on the ground see everybody testing - from the president to members of parliament, religious leaders, chiefs, kings, ministers - they all realize that this is everybody's problem. It's not only me, because maybe I'm inferior or what.

Then they come out very openly and realize every human being can get this. For instance, I told farm workers that I'm going to test with you today. I have just had it three months previously. I'm doing it again. I said, do you know why? Because I'm a human being. I'm also weak. I don't trust myself. Everybody who's a human being has got weaknesses, so to protect ourselves, let's test not once a year, but as many times as possible.

MARTIN: But what about education, like, more broadly in how to prevent HIV/AIDS and the kinds of behaviors that contribute to it? Is that part of that educational mission that you were talking about here?

MOTSOALEDI: You know, I came here with the vice president of my country. Every person who becomes a vice president of South Africa becomes a chairperson of something, a big structure called SANAC, South African National AIDS Council. Theoretically speaking, everybody living in South Africa is represented.

We have now agreed that SANAC must be split into groups. In each and every state or province, the premier must become the chairperson of the AIDS council. In each district, the district mayor becomes the chairperson.

MARTIN: So, wait. Well...

MOTSOALEDI: So it's spreading.

MARTIN: Let me see what I - what I think I hear you saying is that, for example, you came here as part of the official delegation led by the vice president of South Africa. And what you're saying is, by extension, anybody in a position of leadership in every community is, by extension, appointed to the South African AIDS Council.


MARTIN: And that's important because why?

MOTSOALEDI: Because then it reaches to the ground. It goes from the top, from the vice president, right up to the ground. People know that there is this problem. They meet quite often. When the AIDS Council meet, it includes people within that locality, and they talk about their problems, their plans. What do they need to do? Who needs to be educated? Where are problems? How do they need to be solved?

In fact, in some of the AIDS councils, when they meet, they even include editors of newspapers and radio personalities like you. They sit there and listen, and they tell them that, look, the other day, over the radio, this is what you said. It's misleading people, because, on the radio, sometimes, they advertise things wrongly. They say, please, if you say this, this is what's going to happen to the people in the ground. Don't do it. You are actually erasing our gains. Then they discuss on how it needs to be done. So it involves the whole society.

MARTIN: Doctor, before we let you go - and thank you for taking the time to speak with us - I did want to ask your greatest hope and expectation for progress in South Africa. Let's say, if you and I were to speak again in five years, what do you hope will have happened in that time? What kind of conversation do you think we will be having about the state of HIV and AIDS in South Africa?

MOTSOALEDI: Well, firstly, we are chasing the three zeros from United Nations that were declared in the high level meeting at UN last year: zero new infections, zero deaths from HIV and AIDS, zero stigma. We're chasing those, but in South Africa, we went back and added a fourth zero: zero vertical transmission from mother to child.

And, last week, we just announced very good news. In 2008, mother-to-child transmission was eight percent. By 2010, we had cut it by half to 3.5 percent. Last week, we announced that, in 2011, it was cut down to 2.7 percent. So it's going down. Our time is, by 2015, we should be having (unintelligible) zero children who are born HIV-positive because of their mothers. So...

MARTIN: You think you can virtually eliminate mother-to-child transmission...

MOTSOALEDI: We're trying. When...

MARTIN: ...by 2015?

MOTSOALEDI: When you deal with human beings...

MARTIN: You're on track.

MOTSOALEDI: Elimination can't be exactly zero, because you are dealing with human beings, but we want it to be a negligible figure, something that will say, look. We accept that it's virtually negligible. That's our target. But we're also targeting to put more people on ARVs. While we have got 1.7 million people, we believe, by 2015, we must have two million people who are on treatment, because the more people that are on treatment, the better for all of us. So we're hoping that we'll have turned the corner.

MARTIN: That was Dr. Aaron Motsoaledi. He is South Africa's minister of health. He's in Washington, D.C. for the International AIDS Conference, and he was kind enough to take time away from the conference to join us in our Washington, D.C. studios.

Dr. Motsoaledi, minister, thank you so much for speaking with us.

MOTSOALEDI: Thanks a lot. Thanks a lot, Michel. Pleasure. Transcript provided by NPR, Copyright NPR.