Ivan Peter Toms
Authors: Pat Sidley
Journal: BMJ (2008)

Ivan Peter Toms survived a rich array of contradictions in South Africa and could count among his achievements earning the wrath of the apartheid government and the honour of the current president of South Africa.

He was a white (classified by apartheid’s racial bookkeepers) rugby playing, academically high achieving, Christian who was conscripted into the South African Defence Force as a non-combatant doctor and served his two years in the military. He graduated as a doctor at the University of Cape Town, then reserved by law for white people.

But that was where his similarities with most other young white men ended. He was openly gay, fought for gay rights, and opposed continuing army service, accordingly spending time in prison. He built, opened, and ran a clinic in a squatter camp in Cape Town and clashed head on with apartheid’s revulsion at all he stood for.

A devout Anglican, his openness about his gay status was not always warmly greeted by his church. He did, however, have the backing of many prominently anti-apartheid priests and bishops in the church. Chief among these was Archbishop Emeritus and Nobel Laureate Desmond Tutu, who on hearing of his death thanked God for having been able to know him.

Cape Town’s mayor, Ms Helen Zille, pointed to a track record about which less has been written than about his human rights struggles. During his tenure as Cape Town’s executive director of health, many of the city’s dreadful health statistics had improved or stabilised or had begun to show signs of improving. His cooperation with the Medical Research Council of South Africa in charting the statistical evidence and analysis of premature deaths in the area was the subject of published research. It showed among other things a slowing of the increase in HIV infection, improvement in tuberculosis treatment, and the stabilisation of a rising infant mortality.

The improvements in HIV infection and infant mortality were attributed to the use of anti-retroviral drugs, which, as in the Western Cape province, had been offered early to HIV positive pregnant women. This was in direct contravention of the somewhat erratic government policy at the time, which forbade the giving out of anti-retrovirals in public health settings. His championing of a plan to use text messages on mobile phones to remind patients with tuberculosis to take their drugs pushed the treatment rate up from 64% to 73%. The plan, and therefore the finance from the city, had been opposed initially on the grounds that patients with tuberculosis—largely from Cape Town’s poorest communities—were unlikely to have mobile phones. A survey showed, however, that more than 70% had the gadgets, and the purse strings were loosened.

Toms’s appointment as the city’s health boss in 2002 had not been without legal controversy—and contradictions. A black female doctor believed that the job should have been hers and not his as several laws and the constitution promoted equality and affirmative action which had, she contended, been thwarted by the appointment of a white male doctor. She lost her case against the city and Toms—but not before it had reached the Constitutional Court, which refused to hear the appeal of the Labour Court’s findings.

Toms was no stranger to the courts. In the 1980s, after his stint in the army, he opened the only clinic in Crossroads squatter camp in Cape Town, which was home to 60 000 Africans from the Eastern Cape seeking work but who in terms of apartheid’s laws were not allowed to work in Cape Town, an area reserved for the labour supplied by its mixed race inhabitants. Repeated unsuccessful attempts to close Crossroads and demolish the plastic and twig dwellings pushed the then security forces into sponsoring violence between two groups, and keeping it boiling, and then sending in troops to quell the violence.

He testified to the Truth and Reconciliation Commission after apartheid had finally come to an end, describing the defence force arriving in armoured vehicles, ripping down the plastic and branch structures, and then burning them. One morning the women held on to the branches which earned them tear gas, police dogs, and rubber bullets.

He told the commission: “We had kids with severe respiratory distress from the tear gas, people with dog bites. I remember one time having to go out and see a mother who had a 24-hour-old baby that was left in the rain because her structure had been torn down.”

Toms decided then he could no longer serve in the defence force, which demanded regular months of service for a further 20 years. He was tried for refusing and defended by Edwin Cameron, then a human rights advocate but now a judge in the Supreme Court of Appeal. Before his appeal was successful, however, Toms had to spend nine months of his 21 month prison sentence accompanied by sexual taunts and victimisation.

In more recent times he came in for some criticism from AIDS activists for the way in which he decided to handle the government’s opposition to anti-retroviral drugs. He supplied them through the city’s clinics, but was less closely identified with the somewhat louder protests of the Treatment Action Group—the main AIDS activist group. His decision to supply the drugs bore fruit and complemented the equally successful political campaigns led by activist Zackie Achmat.

His open defiance of government policy both before and after apartheid had its own contradictory rewards, and in 2006 he was given the Order of the Baobab by President Mbeki for his devotion to human rights and fight against sexual discrimination. The president’s website biography of Toms points out that he could have relied on a life of privilege and comfort but he decided instead to fight against injustice.

Toms was one of very few people who could have inspired someone to write to the Star newspaper about his opposition to military service, saying: “All these long-haired fairies should be forced to do their military service. Maybe they will become men.” He was one of fewer still who have garnered warm tributes from a vast array of AIDS and gay activists, from academics and members of the community he served, from politicians, priests, bishops, and flamboyant fellow travellers from Cape Town’s gay pride, and from President Thabo Mbeki and his health minister, Dr Manto Tshabalala-Msimang, whose policies on AIDS he had opposed.