HIV, AIDS, and the South African Government

South Africa: Controversy over AIDS Drugs Continues

Manto Tshabalala-Msimang
South African Minister of Health Manto Tshabalala-Msimang refuses to budge on anti-retroviral drugs.

The controversy over HIV/AIDS policy, long a source of conflict in South Africa, took a few more twists and turns in March and April as the government continued to draw criticism for its negative stance on provision of anti-retroviral (ARV) drugs, then suddenly reversed course and announced its full commitment to their widespread distribution.

In the battle between AIDS activists and dissidents, debate had centered on whether the government should provide the ARV drug Nevirapine to HIV-positive pregnant women. Despite numerous studies showing that Nevirapine can cut HIV mother-to-fetus transmission by up to 50 percent, Thabo Mbeki’s government had consistently denied the drug’s efficacy and appealed high-court rulings ordering it to distribute the ARV widely. On March 24, Minister of Health Dr. Manto Tshabalala-Msimang said on national television that she would not comply if the the Constitutional Court ordered the government to expand its distribution of Nevirapine.

“HIV can cause dementia, but the events of the past week have shown that it can cause mental confusion even among people apparently uninfected by the virus,” wrote Belinda Beresford in the Mail & Guardian (March 28). An editorial in the Sunday Times (March 31) regretted that the minister had been “immersing herself in the gobbledygook that masquerades as the AIDS debate within the African National Congress (ANC).”

The term “gobbledygook” seemed apt to describe a document circulated within the ANC in March, titled “Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth, and Statistics: HIV/AIDS and the Struggle for the Humanization of the African.” The document claimed that the deaths of former presidential spokesman Parks Mankahlana and AIDS activist Nkosi Johnson were caused by ARVs and not by AIDS. One of its authors, senior ANC MP Peter Mokaba, fanned the flames further by stating in a March 31 New York Times interview that ARVs were poisonous and that HIV did not exist.

“The government’s stance on Nevirapine has made South Africa the laughing stock of the world,” said Archbishop Emeritus Desmond Tutu, quoted in the Daily News (March 26). Even Nelson Mandela implicitly criticized Mbeki’s administration by calling for nationwide distribution of Nevirapine.

On April 3, the Constitutional Court ruled that the government must provide Nevirapine at all state hospitals and clinics. After a five-hour cabinet meeting on April 17, the government publicly jettisoned its position on AIDS and pledged to provide Nevirapine to those exposed to HIV and to all HIV-positive pregnant women. “Many pressures have fed into the about-face,” said an editorial in the Mail & Guardian (April 19), “including successful court challenges, international and local media censure, and mounting rebellion within the ruling party, its allies, and the health authorities....One final step is needed, requiring courage and true patriotism. It is the public repudiation of AIDS dissidence by government leaders, and particularly President Thabo Mbeki.”