South Africa

Mbeki's Tin Ear on Aids

For World AIDS Day on Dec. 1, the South African government promoted the slogan “I care enough to you?” But many South Africans are growing increasingly unhappy with their government’s position on AIDS, and especially with the attitude of President Thabo Mbeki.

Mbeki, who has drawn fire in the past by denying a connection between the HIV virus and AIDS [See “Leadership Crisis,” Regional Reports, July 2001] seems determined to continue his hard-line approach. On Oct. 24, the president publicly reiterated his belief that anti-retroviral drugs (ARV) are dangerously toxic. This stance, which commands little support within the medical community, has resulted in the government’s refusal to increase the availability of nevirapine, an ARV that is believed to cut mother-to-child transmission of HIV by 50 percent.

Mbeki referred his opponents to a report on the Web site of the U.S. Centers for Disease Control (CDC), which highlighted unforseen toxicities in ARVs. But he was quickly accused of using the CDC report for political ends. Quoted in The Star (Oct. 25), Dr. Kobus Gous, the Democratic Alliance’s spokesman on AIDS, said, “It is very, very low, immoral, and hypocritical to use science to make ARV drugs suspect.”

South Africa continues to have the world’s highest per-capita incidence of AIDS, with an estimated 4.2 million people currently infected with HIV. According to South Africa’s Department of Health, nearly 1 million children will lose their mothers to AIDS by 2005. “One could say without exaggeration that the state’s failure to face the facts about AIDS at the expense of human life is approaching criminal levels,” wrote Pumla Gobodo-Madikizela in the Mail & Guardian (Nov. 30). “One gets the feeling that there is an overwhelming sense of paralysis at government level.”

As the controversy swells, Mbeki and his allies are becoming increasingly isolated. On Nov. 17, a parliamentary joint monitoring committee dominated by female African National Congress (ANC) MPs called for the widespread provision of ARVs to pregnant women with HIV. And on Nov. 26, the Treatment Action Campaign took the government to court in Pretoria to demand implementation of a mother-to-child transmission prevention program.

On Dec. 2, the ANC National Executive Committee issued a statement acknowledging a causal link between HIV and AIDS but defended its position on nevirapine. “The ANC is committed to treatment programs which are responsible, effective, and sustainable,” the statement said. Such tepid words are unlikely to impress doctors in the forefront of the crisis. “We’ve been messing around too long,” wrote leading immunologist Ruben Sher in the Sunday Times (Nov. 25). “Everyone who needs anti-retroviral treatment should get it, not only because it will improve quality of life and affect the economy but because it can...break the backbone of this epidemic.” On Dec. 16, in a humiliating defeat for the government, a High Court judge ordered immediate distribution of nevira-pine to HIV-positive women who give birth in public hospitals. The government said it would appeal.