There was a good deal to commend in President Thabo Mbeki’s speech opening Parliament this month. But in one particular at least he fell woefully short of giving South Africans the reasoned leadership and guidance that the State of the Nation address is meant to embody.
This is the issue of the HIV/Aids pandemic, identified the month before in United Nations proceedings as the single greatest threat to Africa’s future. Southern Africa stands at the epicentre of the scourge.
Mbeki’s treatment in his address was wispy at best, and deeply disturbing at worst. His catalogue of current government health initiatives – changing sexual behaviours, encouraging the use of condoms, looking at ways of coping with the opportunistic illnesses associated with the epidemic, and (without including any progress report) searching for vaccines – reads more like an admission of failure than a meaningful strategy.
The government’s track record on the subject is somewhat less than distinguished. It will be remembered that, together with former minister of health Nkosazana Zuma, Mbeki criticised those who questioned the use of the industrial solvent Virodene.
More recently Mbeki set alarm bells ringing by resisting the use of the drug AZT – especially in the prevention of mother-to-foetus transmission – first on the grounds of expense, and then (somewhat ironically for a former proponent of Virodene) on the grounds of its supposed toxicity.
Even more worrying for Aids activists, Mbeki has of late been berating the scientific community for its failure to register the work of a group of scientists and pseudo-scientists who want variously to deny outright the existence of the HIV virus, or to blame it on treatments like AZT.
We have visited the websites which provide alternative explanations of the pandemic. And though we do not presume to second-guess the scientific community, it is surely worth noting some of their bizarre contents. For instance, there is the baffling assertion that the Aids dissident position has been vindicated by the “fact” that the incidence of HIV is on the decrease.
Similarly, the work of a group of scientists from Perth who want to blame treatments like AZT for immuno-deficiency is somewhat undermined by the horrific incidence of Aids-associated deaths in Africa, where few such treatments are available. This as opposed to the containment of the pandemic in the developed world, where such treatments are freely available.
It is also worth mentioning here that in three cases around the world where the administration of AZT to children was challenged on the grounds of toxicity, courts ruled in favour of the treatment. In more than 100 countries around the world statutory research bodies looking at the use of anti-retrovirals have found that the risk is outweighed by the benefits. Mbeki has done no service to the fight against Aids by invoking such dubious schools of research.
Nor this week did Minister of Health Manto Tshabalala-Msimang assist by announcing her rejection of two reports by the statutory Medicines Control Council into the efficacy or otherwise of anti- retroviral treatments like AZT. The minister said her rejection was on the grounds of unsatisfactory findings on benefits measured against the risk associated with anti-retrovirals.
What she didn’t mention is that the government is sitting on two other research reports which also conclude in favour of the use of anti-retrovirals, one commissioned from the Medicines Research Council and the other by the World Health Organisation.
Ian Roberts, special adviser to the Ministry of Health, explained that the problem that government was grappling with was as follows: that even accepting the efficacy of anti-retroviral treatments in the prevention of mother-to-child transmission, there was nothing to suggest that, in impoverished rural areas, saving the life of the child would affect mortality statistics later on. In other words, the government’s questions are based on the cynical observation that poverty and malnutrition could lead to the same result as HIV in the motherless and impoverished child.
Statistically this may well be true, but we cannot help feeling that it highlights dangerously muddled thinking on the part of government. Poverty and HIV, though connected, are not the same thing. Both of them need to be addressed on their own terms, not yoked together to justify inaction.
The government also needs to deal with a rift growing between itself and the Aids activist community – a rift which was widened last month when a National Aids Council was announced which effectively excluded the entire NGO and activist community. More recently, we have learned that an international advisory body has been cobbled together to assist the government in the fight against the pandemic. None of the leading (and internationally respected) South African immunologists, activists and scientists has been approached.
Such omissions merely feed suspicions that the government is not willing to enter into meaningful co-operation and debate, and that it has its own agendas that will be pursued come hell or high water.
NO ONE IS QUESTIONING THE SINCERITY OF THE GOVERNMENT’S DESIRE TO COUNTER THE AIDS CRISIS, BUT THE APPROACH THUS FAR HAS BEEN DIVISIVE. IT IS UP TO MBEKI TO PROVIDE THE KIND OF LEADERSHIP THAT WILL DRAW ALL SOUTH AFRICANS TOGETHER TO COMBAT WHAT IS OUR GREATEST COMMON ENEMY.