Edwin Cameron: 2018 World AIDS Day Message

Every year, Constitutional Court Justice Edwin Cameron pens a World AIDs Day message, published by Exit and MambaOnline. In 2018, his message focuses on the devastating and deadly impact of stigma and silence on those who live with HIV.

This World AIDS Day, 2018, we mark the death, twenty years ago, on 1 December 1998, of gay icon and struggle activist Simon Tseko Nkoli. He died of AIDS.

Remembering Simon’s life and struggle, and how he died, offer us powerful pointers to our own lives and struggles today.

For in the dire days before antiretroviral treatment (ARVs) became available, when AIDS inevitably meant death, activists in the United States fighting against hatred, stigma and government hostility came up with a slogan. It was brilliant, beautiful, and also terrible.

The slogan was SILENCE = DEATH.

The slogan was devised for Ronald Reagan’s presidency. Reagan was a narrow homophobe who for years refused even to utter the word “AIDS” as tens of thousands of gay men died across the US.

In the US, as in Europe and also in Asia and Australasia, the AIDS epidemic overwhelmingly afflicted men who have sex with men (MSMs) and those who identified as gay or bisexual.

In this hate-filled atmosphere, to be silent about being gay, to be silent about the suffering of AIDS, to be silent about the pernicious behaviour of the big pharmaceutical companies, to be silent about official hostility to LGBTIs was to embrace death.

The activists refused embrace death. They refused to be silent. They fought for increased funding, for speedy release of new medications, and for dignity and justice for everyone with HIV and AIDS. Their unapologetic campaign revolutionised the way AIDS was treated.

Why is this important here, for us, in Africa, in 2018?

First, because we in SA had our own SILENCE = DEATH campaign. It was bravely and brilliantly started by Zackie Achmat. Zackie announced at Simon’s funeral in December 1998 that he was starting the Treatment Action Campaign.

On the streets of our townships and suburbs and cities, the TAC confronted the big drug companies. It shamed them into dropping their prices. This made ARVs possible for all in Africa.

Then they had to turn their attention to President Mbeki’s horrific denial about AIDS. When they couldn’t shame him or persuade him, they took him to court. They forced him to back off. The courts ordered him to start saving lives by distributing ARVs.

There’s a second reason why the slogan remains crucial. All around us, in South Africa, in our subcontinent, and in the whole of Africa, for LGBTIs silence still means death.

AIDS is now fully medically manageable. In South Africa, no fewer than 4.6 million of us owe our lives and good health to this near-miracle – safe, effective, easy, complication-free ARV treatment.

This November, I celebrate 21 years on ARVs. To them I owe my life and work and wellness and joy.

Yet all across Africa too few have this joy. Three million South Africans living with HIV or AIDS but are undiagnosed – or, if they know their status, they are not yet on treatment.

AIDS deaths in SA remain high – shockingly high. Every single month, some 9 000 or 10 000 of us are still dying of AIDS. It is a terrible statistic. How can so many around us be dying when AIDS is medically fully manageable?

Some of the answer lies in healthcare system failures. Some of the answer lies in poverty. Some of it lies in the lack of information. But most of the answer lies in silence. SILENCE = DEATH.

Silence springs from fear. And fear springs from stigma.

AIDS is probably history’s most stigmatised disease. Stigmatised because it is transmitted through sex, of which all of us are still far too ashamed.

Stigmatised because, in many parts of the world, it affects mostly MSMs and gay men. Stigmatised because the biggest burden of AIDS falls on the world’s poorest continent, Africa. Stigmatised because as racism and contempt for black people are rising in Trump’s America and in many parts of Europe, Africa once more is wrongly branded “the Dark Continent”.

And here African governments do us no favours. Too many of them play directly into this. With malgovernance, corruption, war and conflict.

And also with homophobia. In most of our continent to love another of the same sex is still a crime. To make love is still a crime. Violence, hatred and persecution of LGBTIs is rife.

And MSMs and gay men are particularly vulnerable in the AIDS epidemic. For simple physiological reasons about man-man intercourse, we are highly vulnerable to HIV.

Yet, across most of Africa, gay men and MSMs are denied education and information and treatment. They are treated as enemies. They are treated with contempt and with silence.

This silence means death for too many of us.

But we, in SA can help break this silence. We have a beautiful Constitution. In our new President, Cyril Ramaphosa, we have a competent, dignified and honest leader of purpose and principle. We have much to be proud about, and much to fight for.

But we have no reason at all for self-congratulation or for complacency.

In all parts of our continent, HIV prevalence amongst MSMs and gay men is distressingly high. My guess – which stats support – is that, across most of Africa, HIV prevalence amongst MSMs and gay men is somewhere between 30% and 40%. That’s too high. And we are silent about it. That silence = death.

We do not talk about HIV in our chat rooms, on our websites, or on our dating apps. We do not talk about HIV at our bars and pickup joints and when we socialise.

Why not? There is nothing to be ashamed of. HIV is not a death sentence. It is not a source of shame. It is a viral particle that we, with the help of medical science, can easily beat.

On successful ARV treatment, I am uninfectious. I cannot pass on HIV. My life expectancy is the same as anyone without HIV – perhaps even better, because I try to manage stress and exercise and eat well.

So we should all be talking about HIV and its risks and its treatment without shame and without fear.

The greatest risk is not to have sex with someone you know has HIV. The greatest risk is to have sex with someone that you hope does not have HIV. Again: silence may mean death.

And we cannot be silent about the persecution of our LGBTI brothers and sisters in the rest of Africa. At home, too, lesbian women are more vulnerable than MSMs and gay men. They are targeted for horrific rape and even murder.

Again, our silence = death.

All this is a call to action and to activism. Loud, expressive action and activism.

After the giant constitutional victories of the 1990s, LGBTIs in SA became quiet. Yet there is too much still to fight for.

We must fight for lesbians’ safety, not only in the suburbs, not only in townships, but everywhere. We must fight for LGBTI safety, not only in South Africa, but everywhere. We must fight for everyone’s right to be tested, everyone’s right to information about HIV, everyone’s right to life-saving ARVs, everyone’s right to talk without fear or shame about HIV.

And what stops us talking and acting are often only barriers in our minds.

Fear, inhibition, prejudice, ignorance, stigma. All these are conditions of the mind. We can start eradicating them now.

And the first step is to speak, and let others speaks. Everyone should be tested. Everyone who has HIV/AIDS should be treated. Everyone on ARVs should be virally supressed.

This World AIDS Day, let us speak. Let us speak loudly. Let us speak assertively. In doing these things, we joyfully claim our lives.

Edwin Cameron is a Justice of the Constitutional Court of South Africa.