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HIV/AIDS Community Mourns Passing of Nelson Mandela

Numerous HIV/AIDS activists and organizations have joined the worldwide chorus of acclaim for former South African president Nelson Mandela, who in his later years was credited with strengthening that country's response to AIDS, especially after his son died of the disease.

"Nelson Mandela was a central figure in the AIDS movement. He was instrumental in laying the foundations of the modern AIDS response," said Michel Sidibé, Executive Director of UNAIDS. "His actions helped save millions of lives and transformed health in Africa. He broke the conspiracy of silence and gave hope that all people should live with dignity."

Born in 1918 in a village on the Eastern Cape, Mandela spent 27 years in prison following his arrest in 1962 due to his work with the African National Congress against racial apartheid. He was released in 1990 and 4 years later became South Africa's first democratically elected president.

Mandela -- affectionately called by his tribal name, Madiba -- is widely lauded for his emphasis on reconciliation as the country reintegrated. In 1993 Mandela and former president F. W. de Klerk were jointly awarded the Nobel Peace Prize.

Mandela focused little on AIDS during his single term in office. He was also slow to criticize when his African National Congress deputy and successor Thabo Mbeki fell under the sway of AIDS dissidents, suggesting that HIV did not cause AIDS and refusing to implement antiretroviral therapy (ART) programs that could have saved countless lives. Today, South Africa has the highest burden of HIV in the world, with an estimated 6 million people infected.

"The most outstanding moral figure of our age did not do what was needed as HIV began to destroy the country he loved," said Arthur Caplan of the Division of Medical Ethics at NYU Langone Medical Center. "Perhaps Mandela and his people -- like United States President Ronald Reagan and his administration in the 1980s -- found the disease and its modes of transmission too repellent to acknowledge. Maybe they did not want to tarnish the new state with a problem that at the time carried so much stigma and shame."

"But his actions after he realized his failures are an important part of his legacy," Caplan continued. "Our greatest ethical leaders like Mandela are never more instructive than when we learn not just from their triumphs, but also from how they recognize and respond to a mistake."

Mandela spoke at the International AIDS Conferences in Durban in 2000, Barcelona in 2002, and Bangkok in 2004. The 2000 conference saw a groundswell of people with HIV and their advocates demanding ART, which was turning around the epidemic in high-income countries.  While advising against "worthless ridicule" of Mbeki and the denialists, Mandela forcefully called for a stronger effort against the disease.

"AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly diseases as malaria," he said. "It is devastating families and communities, overwhelming and depleting health care services, and robbing schools of both students and teachers...AIDS is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future."

"As a direct result of his speech, mother-to-child transmission in the region almost immediately became a priority and so did access to antiretrovirals," recalled International AIDS Society President Françoise Barré-Sinoussi. "I have no doubt that his words that day did indeed save the lives of so many people and continues to do so."

In 2002, during a visit to the Treatment Action Campaign and Médecins Sans Frontières in Khayelitsha township near Cape Town, Mandela donned a T-shirt with the words "HIV Positive."

"In that moment he became one of us and made a powerful statement against stigma, at the same time sending a message to the then denialist government that people living with HIV are part of this country and should be given lifesaving treatment," TAC said in a statement.

Mandela, by then retired and growing frail, spoke out publicly after his son Makgatho died of complications related to HIV in 2005.

"Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like tuberculosis, like cancer, is always to come out and to say somebody has died because of HIV/AIDS. And people will stop regarding it as something extraordinary," he said at a news conference.

During his remaining years, Mandela became a prominent figure in the global AIDS and tuberculosis movements, battling the stigma and discrimination directed at people with HIV as much as the virus itself. He started the Nelson Mandela Foundation and the 46664 organization (named after his Robben Island prison number) to focus attention and resources on AIDS. Mandela ultimately died of lung complications related to TB he contracted during his long imprisonment.

"With a dignified defiance, Nelson Mandela never compromised his political principles or the mission of the anti-apartheid movement, fighting the global AIDS pandemic, ending poverty and preserving human rights," said Rep. Barbara Lee (R-CA).

"His leadership by example, his courage and his will to act helped mobilize the world against HIV and tuberculosis as well as against injustice," wrote HIVMA Chair Joel Gallant and IDSA Center for Global Health Policy Chair Ken Mayer in a joint statement. "His commitment to human rights will leave a lasting legacy in global health."

"Mr. Mandela had the power to change hearts and minds, change policies and above all change the public's perception of the virus in the most affected region of sub-Saharan Africa," said Bertrand Audoin, Executive Director of the International AIDS Society. "His shoes cannot be filled, but others can turn his legacy into reality by making sure that all the progress being made in HIV Science translates into universal access to prevention, treatment and care in every corner of the globe."

"Nelson Mandela's leadership as both an anti-apartheid campaigner and an AIDS activist was imbued with an unrivalled moral authority," said amfAR Founding Chairman Mathilde Krim. "He was a humanitarian in the purest sense of the word and his gentle presence in our turbulent world will be sorely missed."

12/12/13

Sources

amfAR. amfAR Mourns the Loss of Former South African President Nelson Mandela. Press release. December 6, 2013.

International AIDS Society. The IAS mourns the passing of Nelson Mandela.Press release (undated).

Treatment Action Campaign. TAC mourns the passing of Nelson Mandela. Press release. December 6, 2013.

UNAIDS. UNAIDS and the entire AIDS community are heartbroken by the passing of the global statesman Nelson Mandela. Press release. December 5, 2013.

A Caplan. Mandela's AIDS legacy of silence and courage. NBC News. December 8, 2013.

Rep. Barbara Lee. Congresswoman Lee on Nelson Mandela’s Passing. Press release. December 5, 2013.

S Boseley. How Nelson Mandela changed the Aids agenda in South Africa. The Guardian. December 5, 2013.