The case of the minister and the HIV activists: are we entering denialism 2.0?
'The minister didn't subtract the number of people who were lost from care — those who stopped treatment or died — from the people with HIV who started or restarted treatment. If that was the number we were interested in, we would have reached our targets years ago,' says Rees.
She says that's part of the reason South Africa's total number of people on ART has been lingering between 5.7-million and 5.9-million for the past two years.
'Because of people who fall off treatment, we're seeing static programme growth. So we're not seeing significant increases in the number of people on treatment overall. That means that though the 500,000 people they say they've now put onto treatment may have been added to the treatment group, another 500,000 who had already been on treatment could very well also have stopped their treatment during this time. In many cases, it's possibly the same people cycling in and out of treatment.'
The health department's struggle, even with US government funding, to keep people on HIV treatment throughout their disease is also reflected in the second '95' of the country's 95-95-95 goals. With the aim to stop Aids as a public health threat by 2030, these UN targets require us to, by the end of this year, have diagnosed 95% of people with HIV, have put 95% of diagnosed people onto ART and to make sure those on treatment use their pills each day, so that they have too little virus in their bodies to infect others (scientists call this being 'virally suppressed').
Right now, the minister said at his press conference, South Africa is at 96-79-94, which means we're struggling to get people who know they've got HIV onto treatment, or to prevent people who are on treatment, from defaulting on drugs.
Covid vs the funding crisis
So how did South Africa get to a point where the health department and HIV scientists are yet again at loggerheads?
Not so long ago, on March 5 2020, to be precise, shortly after South Africa's first SARS-CoV-2 infection had been confirmed, then health minister Zweli Mkhize put the epidemiologist Salim Abdool Karim live on national TV. The scientist's task was to explain to the nation what we knew about the unfamiliar new germ — the cause of Covid-19 — that was already causing havoc in the country. For two hours that evening, the nation sat glued to their TV screens to listen to science; an unthinkable scenario a few days before that.
Abdool Karim could do something Mkhize couldn't: break down the cause of Covid, and where we were headed, in language everyone could understand. People were desperate for information and the government used experts — of which there were many — to keep South Africa up to date. The important thing was: Abdool Karim wasn't working for the government. He did chair the Covid ministerial committee, but, like the other scientists who served on it, he wasn't a government employee.
He and others were merely people whose skills the health department was prepared to draw on; ironically, most of these were also HIV scientists, the same people who today feel they're being snubbed by government.
'We saw amazing leadership during Covid,' says Linda-Gail Bekker, an HIV scientist who leads the Desmond Tutu Health Foundation and was a co-chief investigator of the J&J Covid jab in South Africa. '[Because of the leadership] private funding followed. But we're not seeing it this time around. My concern is it doesn't feel like anyone [in the health department] is in charge.'
It's not surprising Bekker feels this way.
The deputy director-general position for HIV and TB has been vacant for five years, empty since Yogan Pillay, who now works for the Gates Foundation, left the position in May 2020. Health department spokesperson Foster Mohale says interviews for the position only started in the past few months.
Why is information so hard to get?
During the pandemic, there were daily press releases, vaccine dashboards and almost daily meetings with experts on the Covid ministerial committee. Now, other than the odd press conference, information that should be public, or opportunities for the government to respond to media or doctor's questions — is non-existent.
We've seen that first hand at Bhekisisa. When we co-hosted a webinar on May 8 with the Southern African HIV Clinicians Society, we invited the current acting deputy director-general, Ramphelane Morewane, to answer clinicians' and journalists' questions. His office told us he was on leave in the days prior, but 'would definitely be there'.
But Morewane didn't turn up, no-one was sent in his place, and no-one explained why the health department couldn't make it.
As a journalist during Covid, I had the numbers of people like the deputy director-general in charge of vaccines on speed dial. This time around, I'm struggling to get mere copies of important government circulars, like the circular that instructed government clinics how to hand out ART for six months at a time, and who qualifies for it.
The health department's February circular with incorrect guidelines:
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