How Mbeki stoked South Africa's Aids catastrophe
I am quite disappointed to read that Mbeki did not bring up the issue
of AIDS since the beginning of his visits in England.
Christian Labadie, M.S.
How Mbeki stoked South Africa's Aids catastrophe
Britain will fete South Africa's visiting leader, but at home experts
hold him complicit in the deaths of his people
Special report: http://www.guardian.co.uk/aids
Chris McGreal in Cape Town
Tuesday June 12, 2001
The health minister in the province of Mpumalanga said she knew ex-
actly what President Thabo Mbeki would make of the little pills given
to rape survivors in the hope of staving off Aids. They were really a
plot to poison black people, she claimed.
The minister, Sibongile Manana, went further and ordered volunteer
rape counsellors out of the province's public hospitals because she
said they were "trying to overthrow the government".
Their crime was to ensure raped women were quickly given access to
antiretroviral drugs which can prevent HIV infection from taking hold
if taken within hours of the assault. The need for the pills has
taken on added urgency in Mpumalanga province where many rapes are
committed against girls under 15 years old because of a widely held
belief that sex with a virgin is a cure for HIV.
But Ms Manana saw it differently. She said the South African presi-
dent had warned that antiretroviral drugs were poisons, that HIV had
nothing to do with Aids, and no amount of protest from the hospitals
and doctors would convince her otherwise.
Mr Mbeki begins a state visit to Britain today during which he will
face questioning about his presidency, South Africa's rampant crime,
and his handling of the political crisis next door in Zimbabwe. But
nothing has overshadowed the first two years of his rule as much as
the Aids epidemic and his reaction to it.
The South African leader has tried to play down the impact of his
contentious views on the disease by saying he did no more than raise
questions for debate by challenging the link between HIV and Aids,
and contending that antiretroviral drugs may be poisons that kill
more quickly than the disease they are supposed to keep at bay. He
now says he has withdrawn from the controversy after admitting he may
have caused "confusion".
But the country's top medical researchers, high ranking civil ser-
vants, Aids campaigners, and doctors and nurses forced to turn pa-
tients away from underfunded clinics say that Mr Mbeki has done ir-
reparable damage that will cost many lives in a country with the
highest number of HIV positive people in the world: 4.7m, one in nine
people. Most will be dead within a decade.
Among the president's strongest critics is a leading scientist and
political ally who warns that history will conclude that the South
African government is guilty of a moral if not legal genocide for al-
lowing politics to override science.
Professor Malegapuru Makgoba, the head of South Africa's medical re-
search council, ushered the president on to the stage for the launch
of his much vaunted African Renaissance two years ago. Mr Mbeki wrote
the foreword to a book by the professor about the racial barriers
thrown up against him at Witwatersrand University. But the two men
have parted ways over Aids.
"We are acting in a way that could be judged as genocide at a phi-
losophical level," Prof Makgoba said. "The president says he may have
created confusion. I think that's an understatement. I think that has
infected the whole chain from youngsters, who are supposed to be
taught about prevention, to the policies that are very difficult to
interpret at ground level because of the mixed messages."
The fault for the rapid spread of the disease by no means lies en-
tirely with Mr Mbeki's government. When Aids first reared its head,
the old white regime was in power. It viewed HIV as a problem for
blacks and homosexuals, not reason enough to offend the white popula-
tion at large with public discussion of sex. As late as 1992, the
then all-white management of Helen Joseph hospital banned the public
display of condoms on World Aids Day.
Nelson Mandela's government came to power two years later promising
action, but had other priorities. By the time Mr Mbeki took office in
1999 there was no doubt about the scale of the calamity facing South
Mr Mbeki correctly says he has never denied the link between HIV and
Aids. "If I'd known what the response was going to be to questions -
because that's all I did, ask some questions, and say the minister of
health must have a look at [them] - then I'd have dealt with the mat-
ter differently," he told the Guardian last month.
But those on the front line against Aids say that Mr Mbeki did more
than raise questions. He presented alternative theories, such as say-
ing poverty also caused Aids whether or not HIV was present, that
have had profound consequences. And far from retreating from the is-
sue he continues, critics say, to oversee policies which fail to rec-
ognise that this is a crisis.
The president's views have severely undermined the laborious work of
persuading South Africans to use condoms in the face of considerable
cultural resistance, and made it more difficult to persuade people to
test for the virus.
Above all, some of the country's top medical researchers say Mr
Mbeki's decision to "withdraw" from the debate has harmed efforts to
control the HIV epidemic in South Africa.
"It's dealt a mortal blow to our efforts," says Professor Salim
Karim, an internationally recognised Aids researcher who has been ac-
cused of "disloyalty" by the country's health minister. "We are not
dealing with just another disease. Aids is destroying the very fabric
of our society. It's consuming everything that is good that we have
The sharpest protest has been over the government's failure to supply
drugs to HIV positive pregnant women which could save the lives of
tens of thousands of babies each year. The risk of HIV positive moth-
ers passing on the virus to their babies is as much as halved with a
single dose of nevirapine shortly before birth and another for the
The government had promised a series of studies to develop the infra-
structure for mother-to-child prevention programmes across the coun-
try, but in April, the health minister, Manto Tshabalala-Msimang,
suddenly announced that the scheme had been referred back to the
cabinet for approval - an unheard of involvement of ministers in what
should be routine drug trials.
Then the government - at Mr Mbeki's behest - moved the goalposts
again, saying the focus of the tests would be extended to see whether
the drugs were too toxic or would create a resistance that could make
it harder to combat the disease. Those studies could take up to two
years. Scientists question the motive for the "research" given that
similar data is readily available from Uganda and America.
"I have often asked myself why did the government even get itself in-
volved in trying to understand antiretrovirals when it doesn't get
involved in, say, the treatment of leukaemia which uses toxic treat-
ment all the time," Prof Makgoba said.
Johannesburg General is one of the largest hospitals in a city where
Aids is rampant and the morgues are staying open longer to cope with
the consequences. Yet the hospital's HIV clinic opens for just four
hours a week and is so overwhelmed that it is sending new patients to
nearby hospitals such as Helen Joseph, where there is a three-month
waiting list to join the HIV clinic.
"The situation in the hospitals is very difficult," said one senior
nurse who did not want to be identified because she is employed by
the state. "They are simply not training enough doctors to deal with
HIV, and those they do train, it is not well enough. If the govern-
ment is not taking HIV seriously, why should the hospitals? It allows
hospitals with hard-pressed budgets to shun their responsibilities
for people with HIV and Aids."
Men like Ernest Ncube try to pick up the pieces. He is black, HIV
positive and an Aids counsellor at Helen Joseph hospital. Not many
people come to him for advice before they contract the virus. Usually
it is an act of desperation in search of a promise of survival once
they have tested positive.
"People feel abandoned. They come thinking you can tell them where
they can get medicines, where they can get help but all you can do is
tell them there is hope and how to look after themselves and eat
properly and what diseases to watch out for," Mr Ncube said. "They
soon lose hope and then they start denying. They say the president
says HIV doesn't cause Aids so I'm not going to die. They say they
won't use a condom. They say they will go to the sangoma (traditional
healer) who is promising to cure them. Usually they don't come back
to the hospital."
The HIV positive patients at Helen Joseph are lucky to see anyone at
all. Doctors say that in some rural areas primary health clinics do
not tell people they have HIV because there is nothing they can do
for them and it is tantamount to a death sentence hanging over their
South Africa's health ministry is divided. Influential senior civil
servants privately say that the president's position is unscientific
and irresponsible. One top official recently wept in public when a
prominent Aids activist said her policies were killing people.
"There are very committed people working in the government," said
Prof Karim. "They don't want people to die of Aids, but there is an
inability to act because they don't want to be seen to be contradict-
ing the president."
Critical scientists and researchers have also been publicly vilified
for "getting rich" through a "corrupt Aids industry", and of being in
the pay of the multinational pharmaceutical companies.
Mr Mbeki says he wants all the evidence to hand before deciding how
to combat Aids. And he continues to defend his view that there is
much more to the disease than HIV. "There is no doubt that there are
many factors that result in the breakdown of the body's immune sys-
tem. Repeated infections, malnutrition, lack of access to clean wa-
ter, impact negatively on the immune system. There may well be a vi-
rus that also results in a breakdown of the immune system," he said
in one speech.
"We need to look at the question that is posed, understandably I sup-
pose: does HIV cause Aids?" he asked in parliament. "Aids, the acro-
nym, stands for Acquired Immune Deficiency Syndrome. Now I do not be-
lieve that it is a sensible thing to ask: does one virus cause a syn-
drome? A virus cannot cause a syndrome. A virus will cause a dis-
But Prof Makgoba accuses the president of playing with words and asks
what would have happened if America or Uganda had waited until every-
thing was known about Aids to respond.
Guardian Unlimited (c) Guardian Newspapers Limited 2001
[reproduced under 'fair use']
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