The ANC has made its clearest statement yet of the ‘denialist’ position on HIV/Aids associated with President Thabo Mbeki
Jaspreet Kindra
In a briefing document posted on its website last week, the African National Congress says there are still disputes about whether an infective agent exists, whether it is a virus, and whether a virus “is the main cause of immune-suppression seen in patients who have tested HIV-positive”.
It implicitly questions whether HIV tests measure infection and whether they are reliable. It asks what definition South Africa should use for an Aids diagnosis.
The ANC describes these as “questions of science”, when orthodox scientists have long regarded them as resolved. It also claims “people are dying more of starvation than from the actual infection”.
Conceding that “there is a correlation between positive HIV tests and a weakening immune system and rapid disease progression”, it says it remains important for the government to pursue answers to these questions through the presidential Aids review panel staffed with orthodox and dissident scientists “to ensure that our response is informed by documented evidence that is relevant to the African context”.
In sharp contrast, Zwelinzima Vavi, general secretary of the ANC’s alliance partner the Congress of South African Trade Unions, this week accused the government of sending “confused signals” to the people, adding that this was not “very helpful”.
The ANC briefing document forms a background to the strong support given by the ANC national executive committee (NEC) at the weekend to the government’s existing treatment policy, which limits anti-retroviral therapy for HIV-positive pregnant women to 18 sites across the country.
An NEC statement viewed as “unfortunate” the court case brought against the government by the Treatment Action Campaign, which is demanding that the government widely rolls out anti-retroviral treatment to prevent mother-to-child transmission.
The statement said the NEC agreed that the government’s current approach to prevention of mother-to-child transmission is correct “given that so little is currently known about the longer-term effects of the drug; the extent of infrastructure and resources required to administer it; and that the level of counselling and monitoring required to ensure its potential benefits are not reversed”.
Some party members, however, saw as “a small victory” the fact that the NEC declaration also included that government strategies are based on the “assumption” that HIV causes Aids. The party’s national health secretary, Dr Saadiq Kariem, this week commended the NEC for recognising a correlation between HIV and Aids. He called it a “major policy milestone given all the unnecessary uncertainty that this debate has caused”.
The NEC statement, however, clearly makes allowances for Mbeki’s dissident views. “It [the NEC] further supported ongoing scientific inquiry to address the many areas in which our knowledge of the syndrome, its development and its treatment are still deficient.”
Sources said Minister of Health Manto Tshabalala-Msimang read out a prepared statement on HIV/Aids at the NEC meeting, including “new information” on the toxicity of antiretroviral drugs. “The statement did not reflect the wide range of views in the discussion on anti-retroviral treatment. There was no vote,” said one NEC source. Another source said a small minority of members had raised questions relating to President Thabo Mbeki’s stance on the disease.
A source said that when Tshabalala-Msimang produced new “facts” on the toxicity of anti-retroviral drugs, “we did not know what to say. We don’t have the knowledge.” Mbeki had then called for “a cautious approach” on the distribution of anti-retrovirals.
In the absence of knowledge, the majority had silently gone along with Tshabalala-Msimang’s position.
A senior ANC member this week said there was widespread support within the movement for a more rapid expansion of drug treatment. The Gauteng government, for example, had decided to move towards comprehensive roll-out. “We have a long tradition of loyalty and support for the leadership. People don’t know how to deal with Thabo’s more than eccentric views on Aids.”
Tshabalala-Msimang and others in the government are said by some to harbour “genuine fears” about the long-term effects of nevirapine, which they feel could expose them to lawsuits.
This is also cited by senior ANC members of the Durban metro council, who, despite recommendations by its health department that nevirapine be supplied in all 112 municipal clinics, were preparing late this week to vote against the measure. Said one ANC member: “We can never embarrass the national government, which has adopted a wait and see approach.”
However, on Tuesday Tshabalala-Msimang reverted to the cost argument, saying the state could not afford to provide the drugs. She added that they could not guarantee HIV was not transmitted from mother to child.
The decision to provide the limited roll-out of a nevirapine programme at 18 national sites was finally agreed to in May this year after a long battle, reflecting the diversity of views in the party. Sources said party members from the health sector battled for almost two years for political approval to introduce the programmes in at least two sites in every province, after its success in the Western Cape.
Party members stress that it was an ANC MEC, Ebrahim Rasool, who provided political support for the first project, launched in Khayelitsha in January 1999. The project was conceptualised under Kariem’s leadership.
Kariem said they took the initial project was taken to the national health department in 1998 after reports of high success rates in HIV-infected women in Thailand. The drug had already become standard care for HIV-positive pregnant women in the United States and Europe, reducing transmission to newborns by nearly 70%.
Until the Thailand studies, the treatment had been considered impractical for the developing world, he said.
The programme, ironically run under Peter Marais’s leadership, who took over as health MEC in January 1999 after the ANC withdrew from the coalition government, was a success. Kariem continued with it for the next 12 months. “We wanted to show that the developing world could do it without help,” he said.