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. Last Updated: 07/27/2016

AIDS and Democracy

It is sometimes said that democracy doesn't do much to improve the lives of ordinary people. But the past few days in South Africa have suggested something different. That country's pluralism -- a multiparty system, provincial governments that stand up to the center and the existence of at least some debate within the ruling party -- is cracking President Thabo Mbeki's misguided reluctance to confront the AIDS crisis. Democracy holds out the hope that many thousands of deaths may be prevented.

South Africa has more people with HIV than any other country in the world: Some 4.7 million people, or 11 percent of the population, are infected with the virus. Rather than declare all-out war against this scourge, Mbeki has mused about the origins of AIDS and resisted prescribing antiretroviral drugs to women giving birth, a simple intervention that prevents mother-child transmission of HIV in 50 percent of cases. If Mbeki were a dictator, his word would be final. But instead, two of South Africa's nine provinces that are controlled by opposition parties have defied Mbeki and declared their intention to prescribe antiretrovirals at childbirth, and AIDS activists have won a suit requiring the government to expand the program throughout the country. Mbeki's administration has appealed. But now there are signs of shifts within his own party.

The first sign came from Nelson Mandela, the hero of the anti-apartheid struggle, who preceded Mbeki as president. In a newspaper interview published on Sunday, Mandela called for a war against AIDS and declared that South Africans should not continue arguing about the disease when so many are dying from it. The next day a second challenge to Mbeki came from Mbhazima Shilowa, the premier of Gauteng, South Africa's richest province. Shilowa announced that his province would also start using antiretrovirals to limit mother-to-child transmission of HIV. When Mbeki's administration rebuked Shilowa, the powerful Congress of South African Trade Unions sided loudly with the provincial governor.

South Africa's democracy is far from perfect. If opposition parties presented a real challenge to Mbeki at the center, he might have ditched his tragic views on AIDS long ago. But the pressure on Mbeki from political opponents, labor unions, nongovernmental groups and the media is starting to tell. Some 200 babies are born HIV-positive every day in South Africa, meaning that 100 infections could be prevented by using antiretroviral drugs. If the new provincial policies are now implemented, even imperfect democracy will have proved itself superior to the autocratic alternative.

This comment appeared as an editorial in The Washington Post.