South Africa becomes an unlikely leader in fighting AIDS

From The NY Times:

CAPE TOWN, South Africa — In a nation ravaged by AIDS, a disease still hidden in shadows of stigma and shame, President Jacob Zuma of South Africa (pictured) has begun to engage in an extraordinarily open conversation about sex, AIDS and H.I.V. prevention, one ignited in part by his own recent admission that he had unprotected sex during an extramarital affair.

Last month, as he announced a vast expansion of H.I.V. testing and AIDS services, he publicly took an H.I.V. test and disclosed that he had tested negative for the virus. Then in a frank interview on Thursday, Mr. Zuma said that he had been circumcised and had encouraged his sons to undergo the procedure, which can reduce a man’s risk of contracting H.I.V. by more than half.

As an influential leader and a Zulu, South Africa’s largest ethnic group and one that had abandoned circumcision in the 19th century, Mr. Zuma could encourage other men to be circumcised through his personal endorsement of the procedure, scientists and public health officials say.

Despite being the center of the epidemic — with 5.7 million H.I.V.-positive people, more than any other country — South Africa had lagged behind some other African nations in promoting circumcision and making it available to the public, steps that experts say could help reduce the spread of new infections in the long run.

South Africa now plans to circumcise millions of men in the coming years and started its drive last month in the Zulu heartland, where infection rates are highest. The burden of the disease has strained the public health system here and led to falling life expectancies and ballooning costs for treatment, prompting health officials to act more aggressively to reduce the pace of new H.I.V. infections.

“It has been my style that I don’t hide things,” Mr. Zuma said, adding that he had been circumcised “some time ago” but hoped, by going public about it, to encourage other men to follow his lead. “I thought it was important because that could help quite a few other people who, if I did not do it, they would be hesitant and not knowing what to do.”

During a 45-minute interview on Thursday, Mr. Zuma, who has three wives and a fiancée, talked about his personal relationships with startling directness and laid out his belief that a polygamous marriage in which H.I.V. is openly discussed is safer than a monogamous union in which a man has hidden mistresses.

His comments seemed intended to counter critics who argue that Mr. Zuma’s own behavior has undermined the government’s push for safe sex. Helen Zille, leader of the opposition Democratic Alliance, wrote this month about Mr. Zuma’s latest affair: “He has now sent out the message that risky sexual behavior can be consequence-free. Many impressionable young people will rationalize: if the president can get away with it, why can’t I?”

The debate about Mr. Zuma’s affair — and his own increasingly open comments about H.I.V. prevention — has brought the subject into the open to an unusual degree. When Nelson Mandela was president, he rarely spoke about AIDS. His successor, Thabo Mbeki, who once famously said he never knew anyone who had AIDS and questioned whether H.I.V. caused it, is now generally seen as having impeded South Africa’s fight against the disease.

“Everyone said we need a leader who can set an example,” said Jonny Steinberg, author of “Sizwe’s Test,” which showed the deep stigma still associated with AIDS in rural South Africa. “It just so happens we’ve thrown up a leader who makes a negative example, but it’s good enough. It’s started a conversation among ordinary people.”

Mr. Zuma’s personal choices have long transfixed the nation. Well before winning the presidency, he was charged with raping the H.I.V.-positive daughter of a family friend. He was acquitted in 2006, but AIDS activists were furious that Mr. Zuma had said he tried to minimize his risk of contracting H.I.V. by showering after sex.

In office for a year, Mr. Zuma is now leading a national effort to test broad segments of the population and extend AIDS treatment to every corner of the country. United Nations officials have called it the largest and fastest increase in AIDS services ever attempted.

But Mr. Zuma’s reputation took another hard knock when news broke in February of what the South African news media dubbed his “love child” from the extramarital affair. TNS Research Surveys, a market research company, conducts surveys among urban residents of South Africa and tracks the job approval ratings of South African presidents. In its last poll, conducted during the week Mr. Zuma’s affair became public, his approval rating fell to 43 percent, down from 58 percent in November 2009.

Mr. Zuma said that many of his critics had wrongly assumed he had carelessly risked H.I.V. infection in his recently revealed extramarital relationship. He said he had told his own children that couples must openly discuss their H.I.V. status to make informed choices.

“That’s why, after the child was born, I tested negative,” he said. “And by the way, I did say it was my fourth time to test, which indicates I’ve been very careful.” He added, “Nobody’s ever asked me that. Everyone jumped to conclusions.”

While some scientists and advocates have criticized South Africa for being slow in adopting circumcision to prevent H.I.V., Mr. Zuma said that he and the premier of KwaZulu-Natal Province had approached the Zulu king, Goodwill Zwelithini, on the issue because they felt he should take the lead.

The king issued a call to restore the tradition of circumcision — though performed medically, rather than by traditional practitioners — in December. Mr. Zuma explained that since it was King Shaka who had stopped circumcisions many years ago, “It could only be another king who says, ‘I’m now opening it.’ ”

As with his disclosure that he was H.I.V.-negative, Mr. Zuma’s latest comments are likely to be greeted by commentators, scientists and advocates here with a mixture of praise and skepticism. But there is little doubt that the poor villages of KwaZulu-Natal are paying attention to him.

People in Sorave, whose clinic had just gotten a nurse qualified to prescribe AIDS drugs, offered a nuanced view of the president’s record.

Makhosi Nyawo, 36, who carried her baby boy on her shoulder and has taken three H.I.V. tests, heard the president speaking on the radio on World AIDS Day, encouraging everyone to take an H.I.V. test. “I see that helping us a lot because we are staying home sick without knowing what we’ve got,” she said.

Still, she did not approve of his behavior. “It’s not acceptable for him to have a child outside of marriage,” she said. “He is our role model. But if he’s been with a woman outside marriage, he could get infected. It’s not safe.”