The words were stark and taut with pain. On Jan. 6, 2005, Nelson Mandela shocked the world when he summoned reporters to his Johannesburg home and announced: “My son has died from AIDS.”
By disclosing just how 54-year-old Makgatho, his sole surviving son, had died that morning, Mr. Mandela tried to rectify – to atone, some said – for what had emerged as the singular failure of his time as South Africa’s leader.
Then a few days later, at the funeral, his grandson, Mandla, revealed, with Mr. Mandela beside him, that the virus also had killed Makgatho’s wife a few months earlier.
With these public statements, Mr. Mandela defied the stigma and shame that kept AIDS deaths cloaked in euphemism across Africa – because, even though by that point 800 people were dying of AIDS in South Africa every day, no one would say so out loud.
“Let us give publicity to HIV-AIDS and not hide it, because the only way to make it appear like a normal illness, like TB, like cancer, is always to come out and to say somebody has died because of HIV,” Mr. Mandela said that morning. “And people will stop regarding it as something extraordinary.”
This was an act of courage, although the near-sanctity accorded Mr. Mandela across Africa insulated him from approbation. It was also an act of generosity, the most intimate way he had of reaching out to the 26 million Africans living with HIV-AIDS. And it was, in its way, an act of political retribution: In a land where the government – the government he had fought for – insisted on denying AIDS, he said in the most irrefutable of ways that it was real.
Mr. Mandela’s career – as an activist, a guerrilla, a political prisoner and a president – was characterized by vision, his ability to see long-term implications and solutions for immediate problems. But his foresight failed him (or, at best, was clouded by competing demands) on the threat posed by HIV-AIDS.
The virus has done more than anything to undermine the bright future Mr. Mandela envisioned for South Africa. He spent much of his retirement in a quiet, impassioned and largely unsuccessful effort to reverse the damage that took place on his watch.
When he took office in 1994, the infection rate already had reached 10 per cent of sexually active adults. Yet, in five years as president, he never made the illness a priority, an oversight that is hard to fathom today.
But South Africa was still relatively early in the “death curve” that is peculiar to HIV, in which infected people take as much as a decade to become very ill. The economic and social effects were imminent but not yet evident. Although some public-health experts were sounding the warning, they seemed alarmist.
The new republic’s health ministry had the mammoth job of trying to deliver basic care to a vast majority that had been denied it under white rule. AIDS was seen as just one of many competing challenges, and Mr. Mandela knew too little about it to foresee the impact.
His wife, Graça Machel, explained in a 2006 interview that, in those early days Mr. Mandela was focused on keeping the country’s tenuous peace. “Everything was so fragile,” she said. “We have a tendency to read history afterward. … Now, because things are much better, they say, ‘Oh, why he didn't do this, why didn't he do that?’ – that's human nature.”
Neither was Mr. Mandela comfortable, as a Xhosa elder, with talking publicly about a sexually transmitted infection – only very late in life did he begin to speak frankly about condoms and fidelity.
As president, he delegated the handling of HIV to Thabo Mbeki, the brilliant deputy who was clearly to be his successor. But Mr. Mbeki, a passionate champion of “an African renaissance,” emerged as the world's most prominent HIV denier: He questioned whether the virus is what causes AIDS and alleged that life-saving anti-retroviral medication was toxic, pressing the government to pursue African remedies instead.
By the time Mr. Mandela left office after five years, otherwise lauded for his performance, the infection rate had grown monstrously – to more than 20 per cent of adults. The impact of the disease was clear, with up to 500 deaths a day, and still the country lacked a coherent response.
The situation went from bad to worse, as Mr. Mbeki’s government went to court to fight activists who wanted treatment, turning AIDS into a political battleground – and the dominant issue of Mr. Mandela’s retirement. Ms. Machel, whom he had married in 1998, was an impassioned anti-AIDS campaigner, but most of all, he suddenly became horribly aware that the disease was more than just another health problem.
Mr. Mandela felt “genuine devastation at the way people were dying,” Jakes Gerwel, who ran his presidential office, recalled in an interview. He also became increasingly alarmed at the effect of Mr. Mbeki’s position on South Africa’s international reputation.
For the first time in 65 years as a loyal member of the African National Congress, he was driven to challenge the party, according to Mark Gevisser, author of an exhaustive biography of Mr. Mbeki that charts his relationship with Mr. Mandela.
“He was deeply distressed by his perception of the inability of serving ANC members to take Mbeki on, and was determined to set an example to them – or at the very least provide some cover so they could take action themselves,” Mr. Gevisser explained.
“Most of all, he believed Mbeki was wrong, morally and politically.”
Mr. Mandela tried repeatedly to get his successor – now aloof and dismissive – to discuss AIDS with him. Finally, he gave up. In 2001, he declared Mr. Mbeki derelict in his duty for failing to act: “We must not continue to be debating, to be arguing, when people are dying.”
A new generation in the ANC leadership rebuked him sharply for meddling. He was heckled at a national executive meeting and left despondent after being told, “Sit down, old man.”
He no longer held a key party position – he hadn’t wanted to overshadow his successor – but there was still a considerable amount he could do.
Under the auspices of his well-endowed charitable foundation, he gathered the most prominent AIDS scientists and activists to discuss a plan for South Africa and, in so doing, conspicuously validated the mainstream view of HIV.
He had the foundation pay for the first substantive surveillance research into South African HIV infection, then put up the money for two public anti-retroviral-treatment programs. He met the government’s bête noire – treatment activist Zackie Achmat – and publicly donned the highly politicized “HIV-positive” T-shirt.
“A lot of people were thinking of doing the same thing,” said Bridgette Prince, the first director of the Nelson Mandela Foundation, but they didn’t have the vision or moral clout to match the former president.
Ostensibly he had retired, but Mr. Mandela became an active AIDS campaigner. He and Ms. Machel started a charity for HIV awareness, called 46664 after his Robben Island prison number, that held high-profile benefit concerts, and he mentioned AIDS nearly every time he spoke.
Finally the government was driven to provide anti-retroviral treatment, but the rate and impact of new HIV infections continued to grow. Mr. Mandela never saw it vanquished or even slowed – all he saw was the insidious way it undermined the many things he had fought for.
“This is too much; this is unfair,” Ms. Machel said of the shadow that AIDS cast over the free South Africa where they had planned to spend their old age.
“We deserved to have a good time, in terms of now putting all our energy, all our capacity into building our nations, to rebuilding our lives, to putting all the troubles of the past really to rest.”
Now based in Rio de Janeiro, Stephanie Nolen was The Globe and Mail's correspondent in Johannesburg from 2003 to 2008 and the author of 28: Stories of AIDS in Africa (Random House, 2007).