Disease, Bigotry and Imperialist Hypocrisy

South Africa Torn by AIDS Crisis

Reprinted from Workers Vanguard No. 749, 5 January 2001.

The catastrophic impact of the AIDS pandemic ravaging South Africa was highlighted in early December when former African National Congress (ANC) leader Nelson Mandela joined with F. W. De Klerk, the last president of the former apartheid regime, in launching a national “HIV/AIDS Day” at a Johannesburg cathedral service on December 5. With grotesque cynicism, De Klerk, who presided over a reign of terror against South Africa’s black majority and whose National Party supported the Nazis in World War II, compared the AIDS scourge to the Nazi Holocaust of the Jews. For his part, Mandela appealed for compassion for the four million South Africans infected with HIV, implicitly rebuking his successor and current ANC president, Thabo Mbeki. Mbeki’s anti-scientific diatribes have encouraged bigoted attacks on people with AIDS and provoked a furor at an international conference on AIDS that met in Durban last July.

Mbeki’s ignorant statements challenging scientific evidence that HIV causes AIDS are aimed in large part at deflecting criticism over the refusal of his “tripartite alliance” government—which includes the Communist Party (SACP) and the Congress of South African Trade Unions (COSATU)—to allocate medical resources to combat the epidemic. Seizing on this, the National Party’s racist successor, the Democratic Alliance, campaigned for December 5 nationwide municipal elections on a promise of distributing anti-HIV drugs to pregnant women who have AIDS and scored unexpected gains, including among black voters. Meanwhile, the Western imperialists who hypocritically denounce Mbeki refuse to lift a finger to provide medical aid to the impoverished masses of sub-Saharan Africa. Last year, the Clinton administration threatened sanctions against South Africa for trying to buy AIDS medication at international prices lower than those set by the extortionate pharmaceutical monopolies. And Tony Blair’s Labour government in Britain, home to the Glaxo Wellcome drug giant, continues to oppose any such effort by South Africa.

We publish below in edited form a talk given in Johannesburg on 18 October 2000 by comrade Karen Cole of Spartacist South Africa.

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The AIDS pandemic that has reached every country on earth touches on a range of social issues. It exposes the most horrible, murderous aspects of capitalism in its death agony. And it underlines the need for international socialist revolution.

Diseases and infection will never completely go away. New diseases will develop: it’s just an aspect of nature that microbes and parasites change, mutate and evolve to find an ecological niche in human beings and other animals. It’s possible that the AIDS virus will elude modern medical technology at its current state. The 1917 Bolshevik Revolution couldn’t do anything immediately about the worldwide influenza pandemic of 1918. Three million people also died of typhus in the Soviet Union between 1917 and 1923. Nevertheless, the Bolshevik Revolution for the first time in history opened the road to get rid of oppression, exploitation and inequality that stand in the way of applying rational approaches to disease research and control and opened the way for massive public health programmes under the direction of a workers state.

The gains of the Russian Revolution could only hint at what a worldwide planned economy could do. The ABCs of Communism, which some of you have read, a book used by the Bolsheviks to train workers in literacy and the principles of communism, significantly devotes its final chapter to public health care. It makes the point that the new dictatorship of the proletariat immediately implemented hygienic techniques for public communal kitchens and training for health care workers to control cholera and typhus. They nationalised all private hospitals, opening them to the masses for the first time.

The Bolshevik Party’s programme was committed to wiping out age-old oppression and elevating Russia out of poverty and ignorance. The Bolsheviks understood that ultimate success required the extension of the revolution to the wealthy and advanced, industrialised capitalist countries. You can’t fight cholera if you don’t have the material resources to build river dams and water purification plants. The International Communist League fights for new October Revolutions in the centres of imperialism in America, Europe and Japan as well as in the “Third World.” In South Africa, that means we fight for a black-centred workers government that would be centrally based on the black majority while guaranteeing full rights for the “coloured” [mixed-race], Indian and Asian populations and those whites who accept the rule of black workers.

Based on the experience of the Russian Revolution and the lessons of the aborted Chinese Revolution of 1925-27, Leon Trotsky and the International Left Opposition taught that the only way forward for the oppressed masses of the economically backward countries was the proletariat seizing power at the head of all the oppressed, linked through its revolutionary leadership to the proletariat in the advanced countries. This is the programme of permanent revolution. National liberation and all the basic democratic rights achieved in the advanced industrial countries in previous centuries are only realisable through the dictatorship of the proletariat and international socialist revolution.

The AIDS Epidemic and Capitalist Oppression

We are historical materialists and scientific socialists. Class struggle is the motor force of history. Throughout history, humanity’s ability to master its environment is determined by the level of the productive forces at each stage. However, scientific progress cannot rise above or be separated from class interests. Here’s an illustration of what I mean, and it is directly relevant to the AIDS pandemic. Penicillin is one of the greatest medical discoveries in the twentieth century. Some of us in this room would be dead today if Alexander Fleming had not identified a mould that could kill staphylococcus bacteria in 1929. All modern antibiotics flow from this discovery. But the development of penicillin was virtually ignored until the U.S. imperialists massively funded and distributed it during World War II, 15 years later. Why then? American imperialism had an interest in keeping its soldiers from dying from battlefield infections.

And what other new technology was the U.S. funding massively around the same period? The atomic bomb, which killed some 200,000 people in Hiroshima and Nagasaki, Japan, and was intended as a warning to the Soviet Union that the U.S. ruling class would stop at nothing to destroy the first workers state in history. So you see the relationship between the development of science and the class interests of the capitalist class. The bourgeoisie can mobilize when it wants to.

One speaker at the July Durban AIDS conference complained that one-quarter of the U.S. defence budget for one year would provide anti-retroviral treatments for all Africans who needed them. That certainly may be true, but of course it is never going to happen. The underlying assumption of this statement is that if the imperialist bloodsuckers could be pressured to shift their priorities and be more humane, then all will be solved. But the drive to war and plunder—to acquire new markets, raw materials and cheap labour with the aim of amassing profits—is inherent to the capitalist system in this epoch. The AIDS pandemic also exposes the lie of “nation building” rhetoric; it obviously cannot be solved within the borders of one country.

Only world socialist revolution can tear the means of production out of the hands of the greedy capitalist class, ushering in an egalitarian socialist society. Then all the positive gains of modern science can be put at the service of mankind, and all the fake science that is used to justify and defend capitalist rule can be rejected. How we approach this grim epidemic is shaped by our vision of a communist future.

Let me give a few facts up front about HIV and AIDS. You cannot get AIDS from mosquitoes or through casual contact with infected persons. The human immunodeficiency virus, HIV, concentrates in body fluids that are most commonly passed on through any form of sexual intercourse, through blood transfusions, needle sticks and the sharing of hypodermic needles, or from mother to child at birth or through breast milk. Because blood transmission is most efficient, sexually transmitted diseases that cause open sores on the penis or vaginal or anal passages increase the possibility of transmission, as do sexual practices that might tear the anal or vaginal walls. One of the reasons that AIDS has spread so fast in southern Africa is that untreated sexually transmitted diseases like syphilis, gonorrhea and pelvic infections are widespread.

People may have the virus for many years without any symptoms. But eventually the virus will suppress the person’s natural defences against infections, called the immune system, and the person will develop AIDS, Acquired Immune Deficiency Syndrome—that is, they will develop life-threatening illnesses that almost never appear in healthy people with normal immune systems. In Africa, where people are already weakened by many untreated diseases and malnutrition, the virus destroys what’s left of the already weakened immune system more rapidly.

The virus is of a particularly complex variety called a “retrovirus,” which relates to its structure and how it reproduces itself. Anti-retrovirals like AZT and nevirapine suppress and slow down the advance of the virus. An inoculation ideally gives you immunity; that is, it actually prevents you from catching the disease in the first place. But the HIV virus can mutate—change its structure—rapidly. So treatment applied to one strain won’t work on another, somewhat like the influenza virus where a new vaccine must be developed every year to prevent only the most common varieties. Edward Jenner proved the efficacy of vaccination against another worldwide killer, smallpox, in 1796, and the last person on earth who caught the disease recovered, in Somalia, in 1976—almost two centuries later. And smallpox was a very simple virus.

HIV/AIDS is still spreading exponentially worldwide. In Africa, it was initially spread by those who travel a lot for a living such as airline workers, truck drivers, seamen and soldiers and spread rapidly among professionals such as teachers and doctors. Now, infection has become rampant especially in poorer areas and population groups. Less developed countries account for 95 percent of known cases and 70 percent are in Africa. Twenty-four million HIV-infected people live in southern Africa. Predictions of rates of increase must be continually revised upwards. The report of the United Nations Programme on HIV/AIDS that came out in June predicted that half of current 15-year-olds in South Africa and Zimbabwe may die of AIDS. In Botswana up to two-thirds of youth will die of AIDS. The rising number of orphans throughout southern Africa means there are a growing number of households headed by children. It’s difficult to get accurate statistical surveys, which are basic to public health care and would inform development of a cure, because people avoid getting tested for fear of persecution. The vast majority of youth do not even know they are HIV-positive. Also some say, “Why get tested? There is no treatment available.”

More than with any other disease in modern history, every step in the search to control and cure HIV/AIDS has been hampered by the profit-driven capitalist system and all the backward, repressive, racist and anti-woman ideological crap that comes with it. This epidemic has arisen and is spreading in the epoch of capitalism’s decline. The optimism of the scientific revolution that accompanied the rise of the capitalist class has long been on the decline, exemplified by the resurgence of religious fundamentalism, superstitions, prejudices and obscurantism. Even in the most advanced industrial countries, people with AIDS continue to be viciously stereotyped, ostracised and stigmatised. These prejudices are compounded many times over in Africa and other countries of the so-called “Third World” like India. And because it is a sexually transmitted disease, the special oppression that women suffer under capitalism creates a major obstacle to a cure. All the guilt, shame and repressive taboos about sex that are designed to subjugate women via bourgeois morality also play a major role in sabotaging a scientific response to AIDS.

Imperialism and Neo-Apartheid Capitalism

South Africa was built on the superexploitation of black labour, extracting huge profits for the imperialists. And the imperialists and Randlords’ craven junior partners of the capitalist ANC-led Tripartite Alliance can only continue to perpetuate death and misery for the African masses by overseeing neo-apartheid capitalism. In South Africa, the contrasts of uneven and combined development are most sharp. The white ruling class and petty bourgeoisie live as well as anyone in America or Europe while the black masses live in conditions that have not been seen in America or Europe for several centuries.

What incentive is there for the capitalist class to find a speedy cure or to treat those already infected? Internationally, the bourgeoisie views the spread of HIV/AIDS in Africa as a convenient answer to unemployment and low productivity. An article in Business Day (November 1999) outlines the following: Every year the U.S. Investor Responsibility Research Center asks multinationals how they perceive the South African business climate. They reported that AIDS was no problem. The epidemic is mainly confined to those who are economically marginal: women and children, the unemployed and unskilled workers who can be easily replaced given the massive unemployment. Insurance companies are unconcerned because these people are not insured. Mines are closing, so miners are disposable, and due to the many job-related illnesses they suffer, they die quickly once their immune system is compromised. Investors are slightly concerned that the disease is beginning to spread to skilled workers and teachers. But they are most worried that the South African government may choose to spend money on health care for people who, as far as they are concerned, will be dead within a couple of years, rather than spend that money to repay bank loans.

The 17 July edition of the widely circulated American magazine Time featured an editorial comparing the AIDS epidemic with the bubonic plague of 14th-century Europe. A full third of the European population died in what was then called the “Black Death.” The writer says that “every cloud has a silver lining”—good always comes of bad—wiping out much of the population in the 14th century led to an increase in labour productivity and paved the way for progress. Therefore, according to this, killing a third of the African population may be just what Africa needs to modernise!

Recently Clinton has decided to throw a few cents at AIDS programmes in Africa, partly to secure the black vote in the U.S. in an election year. Clinton is also motivated by fear that American soldiers may be exposed to AIDS when they are sent to war-torn African countries to protect American economic interests. During his recent visit to Nigeria, where his real worry is about the potential of militant oil workers interrupting the flow of oil, he promised some token aid. Tell the people of Iraq—where the U.S./UN starvation blockade causes up to 200 children a day to die of malnutrition and lack of medicines—about Clinton and the U.S. bourgeoisie’s concern for health care!

ANC on AIDS: Confusionism and Criminal Neglect

According to the UN report released in June, although Botswana has the highest percentage of HIV-positive people, South Africa has both the greatest absolute number and the highest growth rate in southern Africa. The fastest-growing sector is young women. The government’s response has been to deny that HIV causes AIDS, to deny that AIDS exists at all and to blame pharmaceutical companies and the CIA for spreading such “lies.” They have found endless ways to impede and postpone implementing the most minimal, well-known and tested medical treatments.

When Mbeki called together a panel of discredited researchers and local healers earlier this year to open a discussion on whether HIV causes AIDS, government spokesman Parks Mankahlana ominously warned that any critics of the government on this issue should be silenced. In response to the Durban AIDS conference statement reaffirming that HIV causes AIDS, Mankahlana said the statement “belongs in the dustbin.” Mbeki hailed another recent conference of these AIDS-denying pseudo-scientists in Uganda, which criminally called for stopping all HIV testing and condom distribution!

The confusionism and abject neglect has already resulted in untold deaths and misery. Social workers at Chris Hani Baragwanath Hospital in Soweto have reported that patients, particularly husbands, have stopped coming to the clinics because the president says HIV doesn’t exist. And it also created the atmosphere that allowed a mob in KwaZulu-Natal in December 1998 to stone and knife to death Gugu Dlamini, a courageous young woman who spoke out on the occasion of World AIDS Day about her HIV-positive status. In rural KwaZulu-Natal, where the rate of HIV infection is the highest in South Africa, it is commonly believed that women are the source of the disease and all those infected should be killed. Gugu Dlamini’s body now lies in an unmarked grave.

Why have the bourgeois nationalists latched onto theories which fly in the face of almost 20 years of experience with this disease? Because Mbeki and the black front men for capitalist rule are incapable and unwilling to provide the most basic material needs. The imperialists celebrated Mandela and the ANC coming to power because they counted on Mandela’s moral authority to suppress the just aspirations of the horribly oppressed black masses. Therefore the ANC must lie and rationalise their attacks on the working class in service to their capitalist masters.

The neo-apartheid capitalist regime administered by the ANC, COSATU and the SACP—what we call a “nationalist popular front”—speeds up privatisations and retrenchments and is expanding the repressive state apparatus. From their golf clubs and African fashion shows, the government bureaucrats and new entrepreneurs—subcontractors for the capitalist class—exhort the masses that the days of “toyi-toying” [the defiant dance of anti-apartheid marchers] are over; this is your government.

While the imperialists write off Africans as hopeless barbarians, their lapdogs of the national bourgeoisie expound about the “African Renaissance” and laud “African solutions” romanticising tribal societies and conciliating “traditional leaders” in parliament and local government. Meanwhile, the racist hypocrites of the Democratic Alliance and other foul leftovers of apartheid piously shake their fingers at Mbeki for his statements about HIV/AIDS while praising him for toeing the International Monetary Fund (IMF) and World Bank line of slashing jobs and cutting back social services.

The ANC health minister, Tshabalala-Msimang, has pronounced that it is unwise to spend money on AZT for HIV-positive pregnant women (which has proved to protect the fetus against infection) because these women will only create more orphans as a burden on the state. The message here to AIDS sufferers is “Drop dead!”

The South African constitution and the laws passed since 1994 are continually lauded as the most democratic in the world. For example, abortion was made legal. Currently the official position of the government is to leave the legal right to abortion to the “individual choice” of doctors and nurses. We say health care workers who deny women abortions should find jobs in another industry. Health care workers who reflect the anti-scientific prejudices of the ANC government often abuse and harass AIDS patients, pushing bourgeois moralism and blaming them for their illness. In order to maintain one of the most unequal societies on earth, the bourgeoisie must pit one sector of the oppressed against the other to cover its own bankruptcy. Since they cannot provide the facilities for abortions or for care for AIDS patients, they have no interest in fighting backward ideas.

Women are promised full and equal rights in the constitution, but the ANC has never even taken a public stand against female genital mutilation still practised openly in rural areas and secretly in the townships. In some cases, the clitoris and labia are cut off. In others, young girls’ vaginal openings are sewn up and later bloodily torn open when they wed. On top of all the physical and mental damage that accompanies such mutilation, these women are much more susceptible to HIV infection.

The ANC was recently on its knees eulogising the filthy rich Randlord Harry Oppenheimer, one of the latter-day architects of the brutal migrant labour system. A short time later, South Africa became the last country in the world to switch to the modern injected tuberculosis vaccine. Oppenheimer probably knew a lot about TB since it flourished in his congested hostels for migrant miners. Now tuberculosis is on the rise again because it can thrive in the weakened immune systems of people with AIDS. The mine and factory owners who condemned black workers to squalid, congested housing used to complain that blacks were biologically susceptible to TB; therefore, TB was “treated” by sending sick, used-up black workers to the rural bantustans to die. The TB death rate in South Africa is as bad today as a century ago; 10,000 mainly young men and women die every year from TB, which continues to be stigmatised as a disease of “fast living, hard drinking and smoking.”

Apartheid Crimes and Conspiracy Theories

The first recorded cases of AIDS in South Africa were white homosexuals in the 1980s. Considering there were no medical records kept for blacks, coloureds and Indians, it is impossible to trace the history of the disease in this country. The apartheid regime’s campaigns against AIDS in the ’80s included putting stickers on taxis from Jo’burg to Soweto that said, “You can’t get AIDS from swimming pools”—not exactly a relevant issue for the apartheid townships. The campaign used a drawing of a supposedly “neutral coloured” yellow hand. But for black women whose main occupation was as domestic servants, the yellow hand recalled the rubber washing gloves belonging to the hated “madam.” During the early ’90s, the Nationalist Party put up posters in Soweto with crude depictions of black men, warning that returning ANC exiles were bringing AIDS into South Africa.

AIDS conspiracy theories are widely held. There is an understandable mistrust of so-called “Western medicine” and white doctors who historically abused, neglected, poisoned and experimented on black people, and not just here. In the U.S., in the infamous Tuskegee experiments 400 Southern black men with syphilis were left untreated for over 30 years and allowed to die to see its effect on their mortality rate—and on their children. Under apartheid, young women in Botswana were sterilised and given forced injections of the contraceptive Depo-Provera, at that time banned in the U.S. and other countries. South African women were forced into massive birth control programs, sterilised without their knowledge and administered IUDs (contraceptive intrauterine devices) as conditions for employment. Meanwhile, Afrikaner women were told to “Make Babies for Botha.”

Then there is the case of Dr. Wouter Basson. This apartheid regime version of the infamous Dr. Mengele in Hitler’s concentration camps carried out biological and chemical warfare “experiments” on kidnapped township residents in Zimbabwe and poisoned SWAPO prisoners in Namibia and then went along for the helicopter ride to drop them into the ocean. After a cover-up by the security forces in the so-called “Truth and Reconcilation Commission,” the reason Basson is on trial now is to further “reconciliation” with the apartheid butchers. Basson is still a practising cardiologist one day a week at a public hospital in Pretoria, so the ANC is paying for his legal expenses. The workers in power would try him and many other apartheid murderers for their crimes.

With all the stigmas attached to AIDS, mothers are afraid to admit they are bottle-feeding their babies for fear they will be ostracised. The international manufacturers of milk and baby formulas have been remarkably silent regarding affordable bottle milk for babies at risk. Back in 1976, we supported international protest when Nestlé’s dressed up its salespeople in nurses’ uniforms to fool impoverished women and push expensive manufactured milk. While breast-feeding is more desirable than bottle-feeding because of the immunities it passes on from mother to child, the real issue with the former is malnutrition and with the latter access to clean water. However, now that it has been proven that HIV is conveyed by breast milk, a basic preventive measure would be to provide free formula to all infected women.

Volunteer Cuban doctors are sometimes the only doctors who will service the rural areas, and are embraced by the population. That doctors from the Cuban deformed workers state do this service underscores why we defend the enormous gains embodied in the Cuban Revolution—the collectivised property forms and planned economy—as we do in China, Vietnam and North Korea against internal counterrevolution and imperialist attack. After the 1949 Revolution in China, large public health campaigns were launched, women were freed from slavery and concubinage. To this day, the standard of living in China is higher than in capitalist India, a country which achieved political independence from Britain at about the same time as the Chinese Revolution, but which is devastated by imperialist neglect.

Union Tops, Fake Lefts Front for ANC

In South Africa, health care in rural areas is often a container car or a van that may arrive once a week. As we speak, there is a cholera outbreak in KwaZulu-Natal not far from Durban, which has been out of control for two months. Over 20 people have died so far; more than 2,000 people have been hospitalised. Every day there are newly reported cases, and many more go unreported because people have not gone to clinics for treatment. Cholera is an example of a completely understood disease that is totally preventable and treatable—and has been for over a century.

Unemployment is at 50 percent or higher, and latest reports are that the gap between wealthy and poor is increasing. It’s election time, so Mbeki has been double-talking about providing some token amount of free electricity, while always calling to get rid of the so-called freeloaders. This is happening while fuel wood is diminishing. Rural labourers are still paid in kind—for black and coloured workers in the Western Cape’s money-making vineyards, this means a high rate of infant alcohol syndrome. The development of water resources is planned for livestock, not for women who have to haul water back to their dwellings.

The SACP-dominated COSATU leadership sabotaged the national protest called the day before the AIDS conference in Durban by mobilising the most token presence. Why? They could not embarrass Mbeki, their alliance partner. The pro-capitalist COSATU leadership’s treacherous role in the nationalist popular front is to keep the lid on the explosive and powerful South African proletariat, to tie the oppressed masses to the bourgeois-nationalist ANC. In the Metalworkers [auto, steel, etc.] union, NUMSA, discussion of AIDS is tabled to the “Gender Committee,” which is the code word for “toss it to the women.” The recent national COSATU congress supposedly did their big act of defiance of Mbeki by declaring it is “morally wrong” to deny drugs to pregnant women and rape victims. They buy the moralistic line that only some are innocent. How about everybody else infected? Teenagers, IV drug users, truckers, prostitutes, miners? Do they deserve it?

The SACP played its role at the conference of slavishly shoring up the class-collaborationist alliance against any opposition. After the conference, the SACP made a declaration on AIDS which cravenly capitulated to Mbeki, stating they have “not sufficiently studied the complex issues about anti-retroviral HIV/AIDS drugs so as to comment.” Meanwhile, those already infected continue to suffer miserable deaths. The fake left—from the International Socialist Movement and Keep Left [a group buried inside the SACP linked to the U.S. International Socialist Organization] to WIVL [Workers International Vanguard League] and WOSA [Workers Organisation for Socialist Action]—also echo the moralism, and deflect all criticism away from the nationalists by appealing to the multinational drug companies and the World Bank. At the 26 September protests here in Jo’burg in conjunction with the protests in Prague at the IMF/World Bank meeting, the fake left channelled the anger of the protesters into begging the imperialists to “cancel the debt.”

Militant South African workers, like the workers at the Volkswagen plant in Uitenhague, are looking for an alternative to the class-collaborationist national popular front. However, the South African proletariat cannot go forward on a narrow trade-union programme which accepts capitalism. The proletariat must take up the fight for permanent revolution by building a Leninist vanguard party, based on the most advanced layers, that will be a tribune of all the people, that will defend the Gugu Dlaminis and all the oppressed.

Free, Quality Health Care for All!

Under the ANC regime, hospitals have been closed in the name of reducing duplicate services segregated under apartheid. Kempton Park Hospital outside Johannesburg was shut down. In Johannesburg, Hillbrow Hospital stands empty for years while the AIDS epidemic grows among the destitute immigrant population of the area and patients lie on the floor in Jo’burg Hospital and outside Chris Hani Bara admitting area waiting for beds. Retrenchments and privatisations are causing ward closings and cutbacks. The 26-year-old singer and star of the widely acclaimed movie Sarafina, Wendy Mseleku, recently died after being turned away three times from public hospitals for lack of beds. In large parts of rural areas, where health care is solely in the hands of nurses, many of these nurses are the same young women who are being devastated by the disease.

Nurses and health care workers were among the first targets of the ANC’s anti-working-class programme. In 1996, the Mandela government was to decree free health care for all children under the age of six at local clinics and hospitals. As we wrote at the time, that was a cynical lie. No additional funds were allocated to hire more nurses and other health care workers. There was no equipment or medicines. When nurses went on strike, the SACP/COSATU bureaucrats called the nurses’ action “counterrevolutionary.” Isolated by COSATU, the strike eventually ended, and 6,000 nurses were dismissed by the provincial government of the Eastern Cape, headed at that time by Raymond Mhlaba of the SACP.

Black nurses and student nurses have been in the forefront of protests for decent health care for decades. Health care was totally segregated under apartheid—white hospitals were built in urban areas, and no hospitals were built in the rural areas where the majority of the black population lives. No matter how much experience a black nurse had, she was always under the direction of white nurses, often young Afrikaners who were incompetently trained in backwater Calvinist Dutch Reformed platteland schools. In the 1950s, black nurses were at the centre of protests against carrying passbooks, since they were almost the only black working women in urban areas. The police were turned on them in Soweto and Durban.

Back when the apartheid government decided to forcibly move the first black nurses from the all-black Baragwanath Hospital to the all-white Jo’burg Hospital because of a supposed “shortage of nurses,” the black nurses protested because the white hospital was at 50 percent capacity and Bara was over 100 percent. In 1985, hospital workers at Baragwanath went out on strike. Student nurses were assaulted by security guards, 700 workers were arrested and 1,700 dismissed, sparking solidarity actions across South Africa and international protest. Today Chris Hani Bara services a population of 3.5 million blacks. The hospital is falling apart. In Khayelitsha Day Hospital in the Western Cape, doctors see up to 96 patients a day each. In most hospitals white doctors and black patients do not speak the same language, making diagnoses slow and difficult.

We sell our newspaper at Jo’burg Hospital, mainly to black nurses and hospital workers. The unionised staff is constantly threatened with being replaced by non-union contract labour, and some have been already. We talked to a doctor who staffs the Casualty Unit. He said that on an average day, two-thirds of the people coming into the unit have symptoms of full-blown AIDS. Many come in with ritual cuts on their bodies administered by inyangas and sangomas [traditional healers]. Doctors must treat people who are suffering from self-induced vomiting caused by herbs and from repeated enemas prescribed by traditional healers. When I asked the doctor what he thought of the latest vaccine trials, he answered despondently, “There’s no electricity. You can’t distribute a vaccine without refrigeration.”

Anti-retroviral drugs have extended the lives of those who can afford them, mainly in the advanced capitalist countries. The pharmaceutical companies make more profits on chronic illnesses like diabetes or AIDS which require a continual variety of medications and procedures and have no cure, so they have a marketing policy of pumping out copy-cat anti-retroviral drugs rather than engaging in long-term vaccine research with uncertain results. Years have been wasted because basic research for vaccines just does not turn a fast buck. Provincial hospitals have been defying the government to take limited handouts of drugs from different charitable sources.

What can we say about Uganda’s so-called reversal of AIDS? Uganda’s much-acclaimed campaign was centred around the “ABCs”—Abstinence, Be faithful to your spouse, use Condoms. A United Nations report claims that the prevalence of HIV in Uganda has fallen from a high of 14 percent in the early ’90s to 8 percent today. But to call Uganda a “success story” captures how bankrupt current programmes are, how hopeless are policies based on “don’t have sex” and how venal are the bourgeois nationalists. In Uganda, there are no medicines to treat AIDS-related illnesses, and there are 20,300 people for every doctor. Last year, President Yoweri Museveni called for the arrest of homosexuals. Uganda’s terribly low life expectancy, only 40-41 years, is all attributed to preventable conditions: childbirth circumstances, malaria, pneumonia, diarrhea, poor nutrition and unsanitary water. The average annual income is 1,850 Rand [US$250]. As the bloody imperialist carve-up of the Congo [where Uganda has intervened] heats up, bullets will surely be a rising cause of death.

Imperialism, Nationalism and Social Backwardness

One example lauded as an “African solution” to AIDS is where thousands of unmarried women and children attend monthly virginity testing “ceremonies” in KwaZulu-Natal. This was a virtually extinct centuries-old custom that has been revived in the last four years. Girls are stripped naked and endure a humiliating half-hour examination by older girls to ascertain if their hymen is intact. There has been much favorable coverage of this in the media. Nomagugu Ngobese, who has just completed a book, Fertility and Customs, spoke recently at a government-sponsored Gender Equality and National Youth Commission meeting advocating these procedures. She stated, “Moral values are possibly the only solution we have to curb the rising HIV/AIDS statistics.”

At an educational conference in Pretoria, the deputy education minister said the “African Renaissance” should be founded on “a recovery of moral values and ethical conduct.” Mary Crewe, director of the AIDS study centre at the University of Pretoria, responded that linking AIDS with religion and morality has fed into denial and apathy around the disease and to marginalisation and social rejection of sufferers. The teaching of “right and wrong” related to AIDS was detracting from, as she put it, “the overriding moral imperative to save lives.” The only “morals” that the capitalist class has is to rake in profits, backed up in blood by the state—the cops, the courts, the prisons, the army—and ideologically by the conservatising force of religion.

Traditional healers are hailed by the government as the front line against AIDS. They are the only “health care” many people ever see. People are poisoned, murdered and raped by these “healers,” who encourage the revival of beliefs in witchcraft, beliefs which have caused mob killings of mainly old rural women. In fact, to be a woman and old is suspect in conditions where life is normally cut short by violence and “inexplicable” deaths from preventable diseases.

The Gauteng Health Department funds AIDS education for the Traditional Healers Organisation. Since bloodletting through razor cuts to communicate with ancestors is a common cure for witchcraft, the ANC “educates” these healers to use different razors for each client. Demonstrations through downtown Johannesburg feature banners reading, “One Man, One Razor.” Beside their role in furthering ignorance, these traditional healers are part of the repressive political structure that runs from the community “sangoma” straight up to CONTRELESA, the House of Traditional Leaders, which is officially part of the bourgeois state.

These bastions of reaction, former apartheid bantustan collaborators, are murderous remnants of pre-capitalist society. Throughout southern Africa, they fight tooth and nail to deny women abortion, inheritance and property rights. They are courted by the ANC just as they were courted by the original colonialists and the apartheid regime. They run much of KwaZulu-Natal, the epicenter of the epidemic in South Africa, and many parts of the most impoverished Eastern Cape. Bourgeois-nationalist ideology has always relegated women to being baby-makers. The capitalists and their lackeys are the enemies of women’s liberation.

We fight for women’s liberation through socialist revolution. Since the beginning of class society thousands of years ago, the institution of the family has been the fundamental source of the subjugation of women as dependent domestic slaves. In a socialist planned economy, the family as a social unit will be transcended by socialisation of childcare and household duties. Only then can relationships be entered into freely and without economic compulsion.

The oppression of women in Africa cannot begin to change and the drudgery and hardships women suffer cannot begin to be alleviated without a socialist revolution extending to the advanced capitalist countries. Women in southern Africa are still largely deemed minors with few enforceable rights of ownership or inheritance. Widows are still inherited by their husband’s brothers. Polygamy based on the economic subordination of women still occurs. Women are under tremendous economic pressure to demonstrate their fertility. And children are, in fact, the only potential means of support in old age.

Lobola [bride price] is pervasive, and lobola basically means women are property like cattle. Children are considered illegitimate and have no rights under customary law if lobola payments have not been completed. And most significantly for the spread of AIDS, the man pays for the woman to provide him with sex. Women are afraid to ask their husbands to wear condoms, and are beaten and turned out for refusing sex. Rape is rampant in South Africa. Rape and “dry sex” practices (where women apply detergent or herbs to dry out their vagina, which supposedly increases a man’s pleasure) multiply the possibility of infection. Moreover, it is widely believed that sleeping with a virgin will cure AIDS.

The Christian missionaries who accompanied the imperialist plunderers imposed on women a conservative, restrictive family ideology against which their lives were judged, enforcing their subjugation. Many women traders and entrepreneurs in urban and port areas were driven back into domestic slavery. The apartheid migrant labour system that historically tore apart families continues and has been called the “engine of the epidemic” because it encourages multiple sex partners. The migrant labour system, which permeates all of sub-Saharan Africa, is perpetuated under neo-apartheid capitalism because it is the backbone of the superexploitation of black labour.

Foreign workers desperately seeking jobs in South Africa are targeted by the government. The apartheid regime used to send South African miners back to the rural areas to die from TB; now the neo-apartheid state carries on the same policy with workers from bordering countries—HIV-positive Mozambican miners are deported to die without even being informed of their status. The health minister recently argued that they cannot distribute nevirapine lest people from neighbouring countries flock to South Africa for treatment. We demand full citizenship rights for all immigrants, including access to schools and medical care.

Prostitutes should not be afraid to get health care and education and should not be at the mercy of gang violence. We are for the de-criminalisation of prostitution. Professional prostitution is actually a minor business compared to all the ways women living in poverty must sell sex for survival. Teenagers and young women need money and gifts to get through secondary and tertiary institutions. Women acquire “sugar daddies” to survive, and for money for their children. Youths hang out where trucks lay over along the highways of southern Africa to earn a bit of money. Domestic work is still the largest category of legal employment for women—sex for money is the only other option to housework. So-called educational campaigns about the sins of promiscuity are not only false and reactionary but also absurd in a situation where you are having sex so you can buy some maize for you and your child to eat. At the Durban AIDS conference, advocates of vaginally applied anti-viral foams—which may afford easy and private protection—protested that they are not being adequately researched and funded. Underlying the lack of interest in the foams is the morality issue again—sex for any reason but reproduction is deemed sinful.

Full Democratic Rights for Homosexuals!

Homosexuals continue to be scorned and threatened everywhere. In the ’80s anti-apartheid activists who struggled also for democratic rights for gays often had to fight their way into the political organisations. Tseko Simon Nkoli, a young gay COSAS [Congress of South African Students] and ANC activist, was arrested in 1984 for speaking out in defence of the massive stayaway strikes that fall. He was kept in detention for 16 months and then brought to trial as part of the world-famous Delmas treason trial which started in 1985, along with Mosiuoa Patrick “Terror” Lekota and Popo Molefe [who are now respectively minister of defence and premier of North West Province]. He had to argue against the anti-gay bigotry of the other ANC defendants who wanted to throw him out of the case. On 30 November 1998, Simon Nkoli died of AIDS.

In at least 30 African countries it is illegal for a man to have sex with another man. In South Africa, the constitution, on paper, opposes discrimination based on sexual orientation. However, when Mbeki launched his so-called research panel, he motivated questioning the connection of HIV and AIDS by saying, “Are you aware, whereas in the West, HIV and AIDS is said to be largely homosexually transmitted, in Africa, including our country, it is transmitted heterosexually?” So instead of scientific investigation and understanding, there is vilification and prejudice. HIV/AIDS is not a “homosexual disease” or a “heterosexual disease.” HIV is a virus. Mugabe of Zimbabwe has called homosexuals “pigs,” “perverts” and “worse than beasts.” Until 1989 in Zimbabwe, putting AIDS as cause of death on a death certificate was banned. The heads of state of Zambia, Namibia, Kenya and Swaziland have all made public their contempt for homosexuals, citing both “African traditions” and “biblical teachings.” This month, the minister of home affairs of Namibia called on the police to eliminate homosexual men and women from Namibia.

Evidence as far back as ancient San [Bushmen, nomadic hunters of southern Africa] cave paintings shows that homosexual relations have been around forever in Africa, just like everywhere else in the world. The suppression of gays is directly related to the suppression of sexuality and the subordination of women and youth in the social unit of the family, the main institution for the oppression of women and children in class society. Democratic rights are indivisible. Communists fight for full democratic rights for homosexuals. We fight against anti-gay bigotry and we are for the legalisation of all “crimes without victims.” The guiding principle for sexual relations should be that of effective consent—that is, mutual agreement and understanding as opposed to coercion—and the state has no business interfering.

We are for free, quality health care and treatment for all and for massive medical research programmes. It certainly means that the working class must expropriate the pharmaceutical companies. It means education—including in scientific matters—which begins with teaching basic health care, medical precautions and sex education. Education here also means literacy. We are for expropriating the capitalist class as a whole without compensation—that means the land, the banks, the mines and industry. Free medical care requires building up the infrastructure, training nurses and doctors, construction of hospitals and clinics, as well as uncongested housing, clean running water, electricity and paved roads. All of southern Africa needs a genuine socialist construction programme.

The organised and combative South African proletariat must take the lead under the leadership of a revolutionary internationalist Trotskyist vanguard party. This is why you must become a communist. Only the communist party we are building here and internationally has the programme to be the tribune of all people—women, gays, immigrants and the rural poor. We look forward to the day when all socialist humanity, using the knowledge and science of the past, will have the freedom to go forward and explore all the difficult questions of life. In summary, I would like to read a passage from a 1925 speech by Trotsky on “Dialectical Materialism and Science”:

“There are two aspects of by no means equal merit to the scientific contributions of the past which are now ours and upon which we pride ourselves. Science as a whole has been directed toward acquiring knowledge of reality, research into the laws of evolution, and discovery of the properties and qualities of matter, in order to gain greater mastery over it. But knowledge did not develop within the four walls of a laboratory or a lecture hall. No, it remained a function of human society and reflected the structure of human society. For its needs, society requires knowledge of nature. But at the same time, society demands an affirmation of its right to be what it is, a justification of its particular institutions—first and foremost, the institutions of class domination—just as in the past it demanded the justification of serfdom, class privileges, monarchical prerogatives, national exceptionalism, etc. Socialist society accepts with utmost gratitude the heritage of the positive sciences, discarding, as is the right of inventorial choice, everything that is useless in acquiring knowledge of nature but only useful in justifying class inequality and all other kinds of historical untruth.”

Problems of Everyday Life (1973)

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