tribute edwin

In the first heady years of South Africa's democracy, as the HIV/Aids epidemic gathered force, leaders in Aids policy joined the throngs jostling for President Mandela's precious attention. During the negotiations leading up to the democratic transition, he had after all lent his personal impress to the development of a non-partisan national approach to Aids. In October 1992, he launched an initiative that joined ANC-aligned health professionals and policy-makers with officials of the outgoing apartheid government in a venture to construct a comprehensive approach to Aids.

His backing at that time was particularly telling since, shortly before, a bloody massacre in the Vaal township of Boipatong, near Sharpeville, which apartheid agents were suspected of instigating, had derailed negotiations with the outgoing government. While responsibility for the bloodshed was investigated, the ANC called off constitutional discussions. Yet speaking just four months later at a showground venue near Soweto, during the breach in negotiations, Mandela gave his personal endorsement to the call for national coordination and special exertion on Aids. The meeting mandated the creation of a national Aids coordinating body, NACOSA, which was tasked to draw up a national Aids policy for the new government.

This it did. Yet after he took office in April 1994, the other calls on President Mandela's time were too many. The transition was not yet secure. The South African economy had to be rescued from the inordinate profligacy of the outgoing regime. Despite the new government's magnanimity, many privileged whites seemed insensitive to the largesse that had befallen them, and race relations remained precarious. And there was the mundane but critical and overriding task of providing jobs, water, housing, education and other services for the black majority after more than three centuries of racial exclusion.

The task was vast. No human could give attention to all of it. And then there was also the large international stage, on which Mandela justly cut a larger-than-life figure. It was here, at the influential leaders' and economists' think-tank at Davos in Switzerland, and not in South Africa or even Africa, that Mandela made his first significant statement on Aids. That was in February 1997, nearly three years after he took office. The word had only lightly featured in his speeches until then.

Long before, we had made strenuous efforts to enlist his immense personal stature for Aids awareness and anti-discrimination campaigns. Soon after the democratic changeover in April 1994, my co-chair and I, leading the national convention of government, non-government, business and activist Aids groupings that that had sprung from the 1992 initiative, and which comprised NACOSA, sought urgent time with the new president to enjoin him to make Aids a priority. We held a preliminary meeting with a senior official in the presidency, Reverend Frank Chikane, a former head of the South African Council of Churches (who later became head of President Mbeki's office). He listened sympathetically. But when he got back to us, it was to say that President Mandela had delegated our request for a meeting to his second deputy president, FW de Klerk. Though disappointed, we appreciated that Mandela had ensured that the issue stayed at executive level.

But little more happened. And, within a few years after President Mbeki succeeded President Mandela, certain dogmas of Aids dissidence seemed somehow to have gained perhaps irremovable purchase within the response by South Africa's democratic leadership to Aids. Denialist attitudes appeared to be behind the hideous wavering of President Mbeki on the issue of drug treatment in the critical years of 2000, 2001 and 2002. Only in August 2003 did the government finally say that it would gear up to provide anti-retroviral drugs through the public health services - a step much poorer, far less resourced African countries had taken years before.

Right until the surprise announcement, many feared that a public programme of anti-retroviral provision might never form part of government's Aids response: that the scepticism induced by Aids denialism might have taken root so firmly in the upper echelons of government that anti-retroviral treatment would remain anathema. Fortunately that was not to be. The change was not easily wrought. It took concentrated work by many leaders and opinion-formers and Aids activists, led by the Treatment Action Campaign.

Most signally, it also took the intervention of former President Mandela.

Seven years after the meeting at the Union Buildings with deputy presidents Mbeki and De Klerk, I received a significant call. In the first few days of December 2001, my telephone at my office at the law school of the University of the Witwatersrand rang. Across the line came the unmistakably distinctive tones of former President Mandela. Did I have time to come and see him? It was rather urgent. He wondered if I could make myself available to discuss an important and delicate matter privately with him. He did not want to impose on what he knew was my busy schedule. The former President speaks with such generous civility that it is at times impossible not to conclude that he enjoys gently teasing one.

The next evening I went to his home in Houghton, Johannesburg. In his living room he took his seat in a large armchair and gestured me to sit on his right, where he could best hear. Apart from two little boys who bustled in to say goodnight to their grandfather, we were alone. Madiba wanted to talk about Aids, and about ways in which he could help ensure a response that would save lives in our country. Though the former President spoke with tactful allusiveness, two things seemed unmistakably clear to me: he would do nothing to impair or impugn the authority and standing of President Mbeki as his successor; but he was determined to play an unequivocal part in asserting the vital significance of securing anti-retroviral treatment as part of the remedy for the growing numbers of those dying from Aids in South Africa.

He would throw his immense weight and stature behind the desperate campaign to secure a rational response to Aids from President Mbeki's government.

As I was leaving, Madiba made a special request. Would I let him have a personal statement that set out the facts relating to Aids as they had affected my life? I drafted it that evening, and took it to him the next day. He also asked me to call Prof Malegapuru William Makgoba, to pass on a request that he should similarly pay a call at the Houghton house. From the car I phoned the professor immediately. He was in Cape Town: he flew to Johannesburg the next day. On his way to Madiba, he stopped off at my home to discuss the implications of our meetings with the former President.

It was evident to both of us that Madiba was determined to make a significant intervention on Aids. During his presidency I had criticised his leadership on the issue. Now it was plain that, at the age of 83, he was deliberately assuming responsibility for an entirely new and unforeseen task - to assert the need, within the ANC and more widely, for anti-retroviral treatment to form part of the government's overall response to Aids. It was clear that his intervention would be momentous. Perhaps it would be he who could set right the anguished debate about Aids in our country.

I spoke to almost no one about my meeting. But eight months later, in his closing address at the Barcelona Aids conference in July 2002, Madiba himself told delegates how he had called me in and discussed my anti-retroviral regimen with me. His public statements on Aids, starting in December 2001, added his massive moral stature to pleas for good sense and rationality in the debate about anti-retroviral treatment in dealing with Aids in South Africa.

Within a few months of our meeting, Mandela agreed personally to hand over the Nelson Mandela Prize for Health and Human Rights to two University of the Witwatersrand researchers, Prof James McIntyre and Dr Glenda Gray, who in the face of overt opposition from President Mbeki's government played a leading role in researching and introducing peri-natal HIV transmission strategies to Africa.

As a past winner of the award (my co-laureate was the distinguished paediatrician, Prof Hoosen "Jerry" Coovadia, who chaired the 2000 international Durban Aids conference), I had the privilege of being flown down to the smart Mount Nelson Hotel in Cape Town on Thursday 7 February 2002 to hear him speak. The next day, just a few hundred metres away, Parliament was to open ceremonially, and President Mbeki was to deliver his state of the nation address.

The juxtaposition was unmistakable, and the audience gathered electric with anticipation of Madiba's speech. And as he delivered his address what many had noted in the choice of date and venue became incontrovertible.

It was classic Madiba - light-hearted, passionate, elliptical and plain speaking, all at the same time. He lauded McIntyre and Gray, and - contrasting with President Mbeki's deliberate silence - spoke with sombre intensity about the plight of mothers and babies with HIV. Then, as often in a Mandela speech, he became personal - and as always the personal digression carried a powerful political punch:

"Many of you will know that some time last year I was diagnosed to be ... [pause] Are you listening' I was diagnosed to be a cancer sufferer. I was shocked. And then there was a dispute among the various urologists in the country. My urologist who operated on me in prison said, ‘You must have your hormone and radiotherapy.' Others said, ‘No, this man is too old to have radiotherapy', and this debate raged. They did come together at the University of Wits, but they could not agree. Then I said, ‘Now you must come together and have this debate in front of me', and they came. Of course I couldn't follow the technical terms at all and I said, ‘Now I've listened to you, thank you.' Now they spelt out in detail the problems I'm going to have if I have a combination of the hormone as well as the radiotherapy, but I am confident in my urologist and those who supported him. And when the dissidents were gone, I wondered whether it was proper for me to undergo this treatment."

Mandela went on to describe how he had then taken the treatment despite the risk that "doctors can make a mistake". And yet now, as a result of treatment, he was clear of cancer: the medical intervention, supported by non-dissident medical science, had triumphed.

Madiba's parable was personal and powerful: when life is at stake, trust medical science, even when debate may rage; ignore sceptical dissidents; choose reason and hope above scepticism.

It was powerful and suggestive, and politically explosive. Madiba had embarked on a course of supporting scientific and medical rationality in the face of dissident scepticism, and he would not be deflected.

A few months later, shortly after leaving Barcelona in July 2002, Madiba paid a pointed visit to Treatment Action Campaign leader Zackie Achmat at his home in Muizenberg. Though increasingly vulnerable himself to HIV-related illnesses, Zackie had pledged not to take the drugs until they were available to everyone. Madiba went to cheer him. He also went to exhort Zackie to take the drugs. This Zackie eventually started doing just more than a year later, shortly after the government's August 2003 pledge that it would provide anti-retroviral treatments through the public health services.

Before his visit to Zackie concluded, Madiba donned the now internationally famous T-shirt Zackie had designed. Emblazoned "HIV POSITIVE", it has become far beyond South Africa's borders a symbol of the struggle for justice and reason and openness in the Aids debate. It is worn casually and widely by many thousands of people - positive and negative - in marches, on the street, at work and at home. It has done more to lessen stigma than innumerable speeches and workshops and think tanks. It says, like the Danish king did in the fable of the yellow star during the Nazi persecution of the Danish Jews: We all bear this condition. We are all HIV POSITIVE. We all need treatment to be made available.

Madiba too. His smiling famous features atop the white cotton HIV POSITIVE T-shirt may have marked a turning point in our national struggle about the meaning of Aids. Perhaps his intervening moral voice and political stature made it inevitable that President Mbeki's government would yield in its resistance to anti-retrovirals.

For the debate about anti-retroviral drugs and the causes of Aids was not a minor political skirmish or a difference in policy or emphasis. It was a debate literally about life and death. And it was a debate about how our new democracy dealt with truth. It also involved fundamental and troubling questions about truth-telling in our new society. How we handled it would surely determine how we as a nation grappled with other, equally profound, issues of truth.

On these critical issues, former President Mandela's intervention - deft, skilled, politically astute, but unmistakable in its colossal implications - helped ensure that rationality and justice ultimately prevailed over dissident paralysis. Though he had skirted the issue during his own presidency, he returned from retirement during that of his successor to engage with the crisis of truth and policy that President Mbeki's apparent attraction to tenets of AIDS denialism provoked.

Now, as Madiba is in his 90th year, South Africa has a sound national strategic plan on Aids. Governmental commitment to it is still far less than ideal, but 300 000 people who would certainly otherwise be dead or dying from Aids are now receiving anti-retroviral drugs through the public health system. That is a victory for the activists, for the brave media commentators who castigated President Mbeki while he refused to act, and for the courts, which forced an unwilling president and government to offer anti-retroviral therapy to mothers with HIV asking for it.

But it is also a significant part of Madiba's legacy.