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Opinion

HIV remains a significant public health concern

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Dr Riana van Zyl

World Aids Day has been commemorated on 1 December every year since 1988.

On this day, people around the world unite to show support for people living with HIV and also to remember those who have lost their lives due to Aids-related illnesses.

The red ribbon has become the universal symbol of HIV awareness and symbolises support for and solidarity with people living with HIV.

World Aids Day was the first-ever global health day, and the iconic red ribbon led the way for many other coloured ribbon awareness campaigns, like the pink ribbon for breast cancer.

Each World Aids Day has a specific theme with this year’s theme being “Global solidarity, shared responsibility”.

Like many other public health issues, the COVID-19 pandemic has brought additional challenges to the HIV and Aids programme.

Disruption of service delivery at primary healthcare level – including HIV prevention, testing, treatment and care – will undoubtedly haunt us for years to come.

The call to solidarity is made to re-focus efforts to reach the goal of ending the HIV and Aids epidemic by 2030. 

In the short-term, this means restoring and maintaining essential HIV services that were disrupted during the COVID-19 pandemic.

In the medium term, this means intensified efforts to prevent new infections, while awaiting a breakthrough in the area of developing a vaccine.

Having an HIV-free generation is an attainable goal: it has been proven that when an HIV-infected person’s viral load is undetectable, they cannot transmit the virus via unprotected sex.

HIV viral load refers to the amount of HIV in your blood.

Antiretroviral treatment (ART) suppresses viral replication and, if taken regularly, results in the amount of virus in the blood being undetectable.

The message that undetectable equals untransmittable (U=U) has given people living with HIV (PLHIV) new hope.

Especially women living with HIV can now be almost certain of not transmitting HIV to their unborn child if their viral load is undetectable.

One of the great success stories of the HIV and Aids programme in South Africa is the prevention of mother-to-child transmission (PMTCT) programme.

Vertical transmission (meaning from mother to child) of HIV can happen during pregnancy, during labour or after birth via breastfeeding.

In 2010 the rate of vertical transmissions in South Africa was 16 percent. This decreased to three perecent in 2019, but renewed efforts are now being made to eliminate mother-to-child transmission of HIV.

The current South African consolidated ART guidelines allow access to treatment for all HIV-infected people.

The latest UNAIDS data revealed that 97 percent of pregnant HIV-positive women are accessing HIV treatment.

In order to eliminate vertical transmission, we need to ensure these women attain and maintain full virological suppression, but more importantly, we need to prevent new infections in women.

National prevention strategies include public health education programmes, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and voluntary male medical circumcision (VMMC).

Education on prevention of HIV includes HIV risk reduction counselling and education on the correct use of condoms and lubricants.

Despite all these measures, there were 200 000 new infections recorded in South Africa in 2019.

With complacency setting in, demonstrated by this rise in new HIV infections, it is critical to continue education and awareness programmes.

PEP is offered to individuals after a high-risk exposure with the potential transmission of HIV, e.g. after rape or to healthcare workers sustaining an injury on duty.

Effectiveness of PEP is reliant on early presentation and good adherence.

Due to the advances made in ART, PEP is now also as simple as taking one tablet once a day with minimal side-effects, improving compliance and outcomes.

PrEP is defined by the WHO as the use of ARVs by HIV-negative people who are at substantial risk of acquiring HIV before potential exposure to HIV to prevent HIV acquisition.

Specific populations considered to be at significant risk of HIV infection include, among other, adolescent girls and young women, men who have sex with men, people with more than one sexual partner and sex workers.

South Africa was the first country in sub-Saharan Africa to fully approve PrEP.

The preferred regimen is also a fixed-drug combination containing two ARV drugs in a single tablet taken once daily.

Although we have very effective preventive strategies as well as excellent treatment available for PLHIV, a cure still has to be found.

A cure is either defined as “sterilising” or “functional”.

A sterilising cure would remove HIV from the body altogether.

A functional cure means that HIV is not entirely eradicated from the body, but the virus is no longer increasing; thus, treatment is not needed.

So far, two people have been cured of HIV.

Both of these patients received bone marrow transplants as part of blood cancer treatment.

In both cases, the donor cells were naturally resistant to HIV.

The cancer treatment eliminated the already HIV-infected cells from the body, and because the new cells were not susceptible to HIV, no more new viruses were produced.

Unfortunately, the first patient, Timothy Ray Brown, passed away this year due to a recurrence of cancer.

A sterilising cure of this nature is clearly not the answer and, therefore, intensive research in this area is ongoing.

Despite the enormous scientific strides made since the identification of HIV in 1984, HIV remains a significant public health concern.

Globally, millions of lives are still lost every year due to Aids-related illnesses.

In South Africa, 72 000 deaths were recorded during 2019.

This number is substantially higher than the deaths due to COVID-19 in 2020.

World Aids Day remains as relevant today as always, reminding people and governments that HIV has not gone away.

It is a public responsibility to continue to fight the epidemic together as a society.

  • Dr Riana van Zyl is a senior lecturer and medical specialist: paediatrics and child health at the University of the Free State

 

Opinion

An attack on student activism is an attack on our democracy

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Universities remain one of the most unequal and untransformed spaces in South Africa.

One may argue that the country itself is one of the world’s youngest democracies and faces many of the challenges that new democratic states face.

After all, the apartheid regime was “demolished” just over five quinquennials ago.

However, one may also argue that after 27 years the country should not be facing the same challenges it was facing at the dawn of democracy.

One of the most urgent issues that South Africa is facing is the failure to invest in active youth empowerment in order to enable young people to be active citizens who may tackle our country’s wide array of issues.

This is characterised by the attack of active citizenship by student activists at South African universities.

At most institutions throughout the country, university management has criminalised activism so as to easily get away with the failed project of transformation and social injustice.

The last seven years and a half have been defined by mass protests of the ongoing #FeesMustFall movement.

As we may all know, the #FeesMustFall movement is a student-led protest movement which began in 2015.

This saw a massive eruption of protests at universities across the country in a movement that redefined politics in post-apartheid South Africa and presented the evidence of a “born-free” generation telling their own story and leading discourse as well as action on transforming South Africa through the quest of free and accessible education.

After seven years, the concerns of the first #FeesMustFall generation of students are still very visible in society.

Although relative accessibility has increased due to a slight boost in public and private sector funding, many issues such as accessible, safe and secure student accommodation, food insecurity on campuses, decolonised university curricula and first-generation entry into universities still remain present.

But why has the #FeesMustFall movement lost momentum over the years?

Universities in South Africa as well as the government successfully quashed the movement by harassing and victimising student leaders and activists.

A 2019 investigation report by the Independent Police Investigative Directorate revealed that over 33 million South African rand was spent spying on #FeesMustFall activists during the 2016-17 academic calendars.

Many student activists also attested to their phones being tapped and their places of residence and those of their loved ones being put under surveillance during the period.

In order to win the fight against the #FeesMustFall movement, universities such as the University of the Free State (UFS) adopted strategies to intimidate and victimise student leaders.

In this way, they were actively infringing upon the right to protest which is enshrined in Section 17 of the Constitution, which states: “Everyone has the right, peacefully and unarmed, to assemble, to demonstrate, to picket and to present petitions.”

This is to be done peacefully and without weapons.

On March 30, 2022, UFS vice chancellor Professor Francis Petersen wrote an article titled ‘When a protest is not a protest but a crime’.

In the article, Petersen narrates the challenges faced by South African universities while strongly condemning student protests on the UFS and University of Kwazulu-Natal campuses.

On the surface level, it may seem as if this article is a genuine expression of concern about issues faced by universities throughout the country.

Unfortunately, for many student activists and student leaders, the article in subject is a manifestation of the continued attack on student activism and the victimisation of student activists at South African universities.

This article serves to outline the strategic and organised syndicate by the “old guard” collective, which seeks to crush student activism on all fronts on its campuses in order to replace it with prefect-like anointed leadership in student representation.

This collective includes government and university officials in different capacities.

They have used and are using different tools and tactics to quell activism on campuses.

As part of the fourth generation of #FeesMustFall activists, I have seen first-hand the unfair university managements’ response during peaceful demonstrations and protests at the UFS campus.

Private security companies are hired and they brutalise students engaging in peaceful protests.

It is needless to say that most universities face the same issues every year.

While we may attest that some of the issues leading to protests are sector challenges that have little to do with registration, most of the issues are operational challenges that are created by universities themselves in light of incompetence.

Issues such as on-campus and off-campus accommodation for students have been prominent during registration periods.

The UFS itself has only 5 790 beds on the Bloemfontein campus while it has over 32 000 students enrolled.

Very little has been done to fix this matter.

Accreditation of off-campus student accommodation has also been failing at the UFS for over three years.

Other issues such as verification of funding of students between the financial aid office and the finance office are always prominent every year and affect predominantly disadvantaged students.

These operational issues could easily be solved through consultative dialogue with activists and student leaders to find sustainable and efficient models.

But, no!

Universities continue to criminalise activism and harass student leaders.

The UFS has guidelines to operationalise the right to protest.

According to the said guidelines, “the UFS is committed to not only protecting or tolerating, but also enabling and indeed fostering protest.”

Yet, in 2021, the UFS took out a court interdict to ensure that student activists, including those affiliated to the South African Students Congress (SASCO), EFF Student Command and even the Student Representative Council (SRC) could not carry out their fundamental purpose of representing students views and protecting their interests.

Twenty-four students were arrested at a protest on campus and spent time in prison.

Although the university withdrew the charges in February 2022, the intention was not to serve justice against criminals, but to intimidate and victimise students and their leaders into silence.

On February 23, 13 student activists including myself were arrested at a peaceful demonstration regarding late allocation of students’ allowances.

We spent multiple days in holding.

Contrary to what Petersen claims, the situation on South African university campuses is not a situation of criminality.

It is a result of the old-guard tactics that have made it difficult for organised activism to continue, leaving students and their leaders with no option except adopting guerrilla activism for their voices to be heard.

Such tactics should be seen as nothing more than institutionalised vigilantism that seeks to undermine the highest law in the land through legal means.

Although Section 35 of the Higher Education Act, No. 101 of 1997, as amended, compels all institutions of public higher education in South Africa to have SRCs as part of their governing structures, they do not compel universities to have capacitated and conscious representatives of students.

For this reason, universities in South Africa are attacking and quelling all forms of organised activism in order for the SRC to be merely a box to tick on their campuses.

In this way, they can do as they please with the lives and future of students, with no capacitated student activists to keep them accountable or ensure sustainable transformation.

These efforts by universities are part of their fight against the #FeesMustFall movement, which continues to this day in many forms and shapes.

Stances such as those of Petersen are a danger to society because they threaten the fundamental principles upon which our democracy is built.

Such views threaten free speech, the right to education, expression and organised protest.

There is no question that student movements have played an important role in South Africa’s path to and development as a democracy throughout the years.

Organisations such as NUSAS, SASO and SASCO ensured that South Africa’s gross apartheid policies were kept on the agenda in international advocacy spaces.

In addition to this, the #FeesMustFall movement ensured that relative access to higher education is not only for the rich and privileged in South Africa.

In conclusion, institutions of higher learning that criminalise activism directly render freedom and democracy immaterial.

If solutions to the country’s sector problems in higher education are to be found, it will be through collaborative and sustainable engagements with stakeholders in the sector alongside student activists and leaders.

Any other means that claim to be putting forward solutions by criminalising the expression of those issues are mere criminality.

  • Siphilangenkosi Dlamini is an undergraduate student in political governance and transformation at the University of the Free State. A student activist and researcher, he is also the author of the book ‘Magic and Other Authentic Experiences’.

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Opinion

Time to protest against protests

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It is becoming increasingly difficult for institutions of higher learning in South Africa to maintain the delicate balancing act of finding sustainable funding solutions amid mounting pressures caused by rapidly altering learning and teaching environments, dwindling government subsidies and the massification of higher education.

And uncontrolled, violent student protests might just be the final blow that sends many tertiary institutions over the precipice.

There is no doubt that student protests have over the years played a vital part in South Africa’s journey towards and maturation as a democracy.

During the anti-apartheid struggle, student organisations such as NUSAS, SASO and later SASCO kept South Africa’s human rights violations on the international agenda through unrelenting campaigns and protests.

And more recently, the #FeesMustFall movement in 2015 and 2016 has raised important awareness around ensuring access to education for students from the lowest-earning households.

The recent spate of violent protests on some university campuses, however, seems to transcend the boundaries of what can rightfully be termed as “protest action”.

When students at the University of KwaZulu-Natal (UKZN) and the Durban University of Technology caused severe physical damage and disrupted classes at the beginning of the year, UKZN vice-chancellor, Professor Nana Poku, condemned their actions in no uncertain terms as “organised crime”.

And he is right.

This kind of behaviour is nothing but opportunistic criminality in the guise of legitimate protest.

A few weeks after the violence erupted on campuses in KwaZulu-Natal, students on the University of the Free State (UFS) Qwaqwa campus went on a similar rampage, throwing stones at protection officers, vandalising buildings and raiding the university dining hall.

There are distinct differences between these acts and the majority of past student protests.

In most cases, current issues represent a much narrower interest than in the past, affecting only a certain section of the student population, and often revolving around the administrative processes concerning funding.

At UKZN, the main issue seems to have been students demanding to register even though they had historical debt.

At the UFS Qwaqwa campus, it was about a decision by the National Student Financial Aid Scheme (NSFAS) to pay accommodation allowances for students residing off campus directly to landlords and not to students themselves.

Apart from affecting a relatively small number of students, the “fight” was not per se with university management.

Universities South Africa (USAf) pointed out that many of the issues raised by students this year were actually sector challenges and fell outside the control of tertiary institutions.

Regardless of this, institutions regularly bend over backwards in an attempt to find workable interim solutions and making financial concessions to accommodate affected students.

Professor Poku relates how at UKZN the concessions made towards students with historical debts amounted to more than R1 billion.

At the UFS, apart from similar concessions, we also offered students allowances for food and books amounting to more than R71 million this year, while they are waiting for their NSFAS subsidies to be released – a major impact on cashflow management.

Despite these gestures of goodwill, a small group of aggrieved students still went ahead with violent acts, causing millions of rands of damage on campus and creating an atmosphere of intimidation and fear.

University campuses today are vastly different spaces from what they used to be in the 1970s and 1980s, as a result of drastic and far-reaching changes in the educational landscape over the past few decades.

Access to higher education has opened up and is no longer restricted to high-income households.

The total number of students enrolled at higher education institutions increased by almost 70 percent between 2002 and 2020, growing to just more than one million in number.

Coupled with that, tertiary institutions have gone through radical transformation processes, ensuring that they not only embrace diversity, but respect human rights and social justice through fair process and policy.

At the UFS, for example, we have had well-considered, comprehensive transformation over several years in all spheres of operation, enabling us to become an institution where diverse people feel a sense of common purpose and where the symbols and spaces, systems and daily practices all reflect commitment to openness and engagement.

We also have various initiatives to ensure that students are successful in their studies, ranging from tutorial programmes to language, writing and psychological support.

Policies and structures are continuously being implemented and reviewed to embrace social justice in all its forms, with deliberate dialogue opportunities and avenues created for raising concerns and addressing them.

At the UFS, student success is a social justice imperative.

Great care is also taken to involve our student leadership in governance on all levels, with a high level of student participation in all UFS governing structures.

Despite all the different recourses available to them, and a genuine culture of participation and caring cultivated on our campuses, disgruntled splinter groups in the student body still routinely reach for the most destructive weapon in their arsenal of options, namely violent protests.

These protest actions also often seem to jump the gun, as they happen in tandem with and despite fruitful, progressive negotiations with elected student leaders.

Not only is this incredibly frustrating – it disrespects the rights and wishes of the overwhelming majority of students, and completely challenges the notion of “negotiation and engagement in good faith”.

There are no winners in the wake of ill-considered, violent acts of vandalism.

Offending students are no closer to a solution – in fact, they may find themselves suspended and in trouble with the law to boot.

By disrupting classes and preventing access to campuses, they are effectively robbing their fellow students of the opportunity to work towards obtaining a qualification.

Affected institutions are impacted in their ability to provide quality education to students and in fulfilling their wider society-focused mandate.

On top of that, potential donors and investors in the South African higher education sector are discouraged.

The sustainability and very survival of higher education institutions are ultimately at stake, as especially small and medium-sized universities simply cannot continue to bear the financial and operational burden that each violent protest brings.

It has become necessary to take a tough stance against offenders who perpetrate senseless acts of violence and place students and staff members in danger on our campuses.

At the UFS, we have always been very accommodating towards protesting students, not only as a constitutional right, but our approach in dealing with student misconduct has a strong element of restorative justice.

But we have decided to take a hard-line approach against the offenders in these latest acts of violence and destruction – opposing bail and instituting emergency disciplinary processes against them, resulting in immediate suspensions and sanctions which could lead to expulsion.

We need to send a clear message that blatant acts of criminality will simply not be tolerated on university campuses.

We also appeal to political parties under whose banners many of these destructive activities are undertaken to publicly condemn these acts and to call their members to order.

Throughout the course of history, we have come to associate university campuses with arenas where free speech is encouraged, and social ills are pointed out.

This role should be cherished, continued and encouraged – “reclaiming” back the university campuses as spaces for discourse.

But equally important is the responsibility to use your right to freedom of expression in such a way that you do not violate the rights of other individuals or jeopardise the continued operation of the very institution you all form part of – and, by implication, negatively affecting the wider interests of the society it serves.

The role of universities is, after all, not only to provide good workers and innovative thinkers for the job market.

We need to cultivate good citizens, who can make a meaningful difference to society.

Teaching and encouraging mutual respect should be a vital part of any university curriculum.

By letting criminality go unpunished and not speaking out to these acts, we are contributing towards a culture of entitlement, where people readily resort to criminal acts when they do not get what they believe they are entitled to.

This cuts directly across what institutions for higher learning aim to achieve and bodes for a dangerous future.

  • Professor Francis Petersen is the rector and vice-chancellor of the University of the Free State

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Opinion

Operation Dudula confirms we are a country in real trouble

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Unbidden, the spectre of a failed state haunts the contemporary imagination of South Africa.

State responsibility and accountability have been piecemeal, with the citizenry of South Africa is left to fend for itself, as organs of state have grounded to a halt due to historical missteps in securing our physical and knowledge infrastructures, and contemporary endemic mismanagement of vital resources.

Many have warned us of the spiralling road to purgatory – Justice Malala, the Arch, Kader Asmal, Thabo Mbeki, Athol Williams.

And many social phenomena have been harbingers of a South Africa in violent transition – the Marikana massacre; roiling xenophobic attacks that have maimed particularly African transnationals; rising unemployment, particularly among the youth; and the militarisation of the state in “defence of order and the rule of law” during COVID-19.

In this firepit of uncertainty exacerbated by a lengthy state of emergency in response to a global pandemic, South Africa’s destitute have been embattled psychologically, physically, emotionally and financially.

Survival – life – is not guaranteed.

A multivalent and multipronged response has been constrained, as various government departments lack the political will, knowledge and sense of deep responsibility and accountability towards the people.

The gravity and sheer overwhelm that comes with recognising this thin knife-edge we are teetering on has led to South Africa cycling between mass inertia and rabble-rousing rebellions, literally and otherwise, that agitate for a reorganisation of the social order.

How do we uphold the value of life?

Operation Dudula, like many other social movements in the country, foregrounds the vast, seemingly insurmountable obstacles we face in living lives of and with dignity in South Africa.

They respond to the question: “How do we uphold the value of life, no matter race, creed, nationality or religion, when we as South Africans are annihilated on the throne of a hetero-patriarchal, capitalist democratic state that has lost favour among those who matter – the people?”

Listening closely to the rhetoric from the face of Operation Dudula, Nhlanhla Lux Dlamini, one hears the lion roaring and, like so many before him, he uses hyper-masculine and performative tropes of protector, provider, hustler and gangster as swirling metaphors tempered by “the rule of law” to assert that South Africa is for South Africans.

Using unsubstantiated claims that pit illegal foreigners against local South Africans, the messiness and complex contextual nature of criminal activity, inclusive of intent, range of crimes and the identity of perpetrators, are reduced to legality or illegality of citizenship.

Yet statistics do not support the suggestion that crime is being driven by illegal foreigners or undocumented migrants – the leading majority of our male prison population is South African.

While the existence of Operation Dudula is becoming a sustained and vocal threat to the veneer of “business as usual” in the country and to the lives of non-nationals, there are seeds of potential cast among the operation’s challenges.

However, this potential will be wasted and destroyed if we do not recognise and collectively respond to the:

* inter-related and inter-dependent nature of South Africa’s contemporary state of affairs;

* power inherent in an active citizenry that understands that I am my brothers’ and sisters’ keeper, irrespective of socially constructed, performed and maintained markers of difference; and

* collective psychological and emotional trauma that undergirds our interactions with each other, and “the other”.

We are a country in trouble

Our xenophobic responses to perceived and real threats in South Africa over the past two decades confirm that stereotyping and scapegoating are part of rudimentary attempts to eradicate these threats to self, and to effectively disarm them.

However, history also shows that annihilation of the other does not secure one’s self.

Instead, the sublimation and vanquishing of the other has detrimental effects on a thinking-feeling human being whose righteous logic of “being right” cannot withstand the internal reckoning that will come from annihilating another.

As Hemphill states, “each death and each riot activate another memory of another life lost without justice or reason; this is how trauma unhealed haunts and accumulates, re-emerging and reanimating the body. It does not disappear.”

We are a country in trouble. We are a world troubled.

And if we are to survive this as a collective, not as divided parts of the collective, we will have to critically question and consciously resist years of indoctrination and socialisation that assert that “might is right” – that fighting and going to war (on local and on foreign soil) is a righteous endeavour if one does so to protect the sovereignty of land, borders, bodies and ideologies.

The revolution will not be televised, for it is an internal one.

We have no map to chart the way forward as old-world orders dissolve; as the earth implodes under the heaviness of human waste and damage; and as humans continue to live desperate lives separated from the life-giving forces of nature and the divine feminine.

Moving forward, those resident in South Africa will have to fashion new social compacts that uphold the sovereignty of individuals and their right to dignified life, supported by collective and individual interventions that supersede the state.

Ordinary citizens will have to free themselves from mental shackles as they actively re-root and reroute themselves in ancient philosophies and ways of being that extend beyond one originary myth.

We will have to trust and grow the potential that exists within an uncertain world and trust the humanness within self and others to guide us to each other; to draw closer when every fibre of our being rages against that shattering of physical and ideological distance.

We are not without ordinary examples of this work.

My research and those of my students among African transnational migrants demonstrate alternative ways of interacting that support rather than degrade the financial, emotional and spiritual well-being of citizen and non-citizen.

Born out of need, acts of connection and micro-resistance reorder, question and negate the jarring and dissonant narratives and realities of difference that were part of South Africa’s foundations.

Through love, kindness and mutual support and guidance, South Africans and other nationals reframe the reality of living in South Africa, exposing an ethic of care and commitment to a collective well-being that is not based on socially constructed forms of inclusion and exclusion, or politically orchestrated forms of responsibility.

The existence of Operation Dudula and the Gift of the Givers, for example, confirms that we have work to do across generations in this country.

Our work includes the painstaking process of healing our individual and collective psyches and the re-envisioning of a future that is supportive of all life.

We need to serve life and make our country and “the world safe for human differences” (Benedict).

The time to evolve, consciously, is upon us.

  • Professor Joy Owen is the head of the Department of Anthropology at the University of the Free State.

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