Lost Opportunity



DURBAN, SOUTH AFRICA, JULY 9—South African president Thabo Mbeki fumbled a prime opportunity tonight to galvanize his country against its greatest threat. HIV has infected almost a fifth of the adult population here. Yet, in an eagerly awaited speech opening the XIII International AIDS Conference tonight and televised live to his nation, Mbeki offered no new proposals to fight the epidemic, sidestepped the question of what causes AIDS, and defended his decision to convene a panel of experts including so-called “AIDS dissidents,” some of whom deny the very existence of the epidemic in Africa.

Mbeki’s speech followed a spirited march of about 2000 people, mostly Africans, demanding access to AIDS medication. The march was led by Nelson Mandela’s former wife Winnie Madikizela-Mandela, as well as religious leaders, labor union officials, doctors, and AIDS activists. Mbeki, however, made no reference to their march—believed to be by far the largest AIDS demonstration ever in Africa—nor did he offer any proposals on how to make the medicines that have slashed AIDS death rates in rich countries available to the 4.2 million South Africans estimated to be infected with HIV. Instead, he spent much of his talk quoting from a five-year-old World Health Organization document calling poverty the greatest cause of ill health and human suffering, and ended with a terse summary of his government’s current AIDS efforts.

“He said nothing,” complained Lucky Mazibuko, an openly HIV-positive columnist for the Sowetan newspaper who participated in the march for medicine. “All he did was to try to justify his reasons for calling the panel of experts to raise the issue of whether HIV causes AIDS. He should have said what the plans are for people with HIV.” Mbeki also made no direct appeal to ordinary South Africans to engage in the fight against AIDS.

“What is he doing in South Africa to make a difference?” asked Florence Ngobeni, who lost her baby to AIDS and now counsels other HIV-positive people. She said she was so angry that she stood up during the president’s speech and tried to interrupt him.

Doctors and scientists were more reserved. Asked what he thought of Mbeki’s
remarks, Dr. Salim Abdool-Karim, scientific co-chair of the International AIDS Conference, replied only, “I’m thinking about it.”

“Yes, poverty is part of the story,” said Peter Piot, director of the Joint United Nations Programme on HIV/AIDS, UNAIDS. “But I won’t comment further.” Privately, others said they were appalled, with several saying that the 11-year-old Nkosi Johnson—who told the audience how his mother died of AIDS and that he is infected—gave a better speech than the South African president.

But at least one scientist, South African Medical Research Council president Malegapuru Makgoba, called Mbeki’s speech “excellent.” Makgoba added, “He talked of an HIV/AIDS epidemic, linking the two without having to say it.”

In his speech—delivered in an outdoor stadium at a lavishly produced ceremony worthy of Disney—Mbeki declared poverty “the biggest killer” and listed many of the illnesses that plague Africa, from tuberculosis to river blindness. Such problems, he said, made him come “to the conclusion that as Africans we are confronted by a health crisis of enormous proportions.

“One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defense against attack by many viruses and bacteria.” He added, “As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus.”

The ambiguity of Mbeki’s statements left him room to continue to insist that he has never denied HIV causes AIDS while at the same time not endorsing any view. He said that he “looked forward” to studies that members his controversial panel would conduct, including one designed to verify the accuracy of HIV antibody tests, which are used to estimate the extent of the epidemic. Mbeki expects the results of that work at the end of the year, by which time, if infection rates remain unchanged, more than a quarter million more South Africans will have acquired the virus.

Yet Mbeki insisted, “There is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV/AIDS.” He said that “we will intensify our own campaign against AIDS,” but only listed, in bullet-point form, six items from the current health program, ranging from promoting safe sex to research on anti-HIV drugs.

That list did not include trying to reduce HIV transmission from mother to child. That has been one of the greatest advances in AIDS medicine, but Mbeki ignited controversy last year when he delayed implementing it, raising questions about whether the drugs are too toxic. Such concerns are in line with those of the AIDS dissidents, who argue that AIDS drugs actually cause diseases attributed to HIV. Recently, the health minister has backed off questioning side effects and focused on cost.

Earlier in the day, Winnie Madikizela-Mandela gave a fiery speech at a rally before the march calling for cheaper drug prices. After rousing the crowd with anti-apartheid chants and songs, Madikizela-Mandela said, “If we could struggle against AIDS with the same commitment as we did against apartheid, we could turn the tide.” She lambasted drug companies for profiteering, and railed against the South African government for acquiescing to “the tyranny of the market” by not breaking pharmaceutical patents. AIDS, she said, “is a social holocaust. We cannot declare this the African Century and continue to ignore this pandemic, as some African leaders have been doing.”

At the end of the march, South African health minister Manto Tshabalala-Msimang vowed to “fight tooth and nail” for better access to medicines. “We can collectively in Africa manufacture these drugs,” she said, adding that her government is considering granting local companies license to produce generic versions of anti-HIV drugs. Drug companies oppose such “compulsory licensing” because it breaks their patents.

Meanwhile, African physicians told horrific tales of trying to treat patients with no money. Christopher Ouma, a doctor who works with the Nobel Prize–winning group Médecins Sans Frontières in Nairobi, said that AIDS has flooded hospitals: “Patients share beds almost all the time, up to three in a bed,” he said. As for the expensive anti-HIV drugs, “We prefer not to tell patients they exist,” he said. “It’s a cruel joke. They cost $10,000 a year, but the patient makes only $300.”

The march, which was punctuated by Zulu dances, brought ordinary people into the streets. Many were carrying pre-printed placards with the bloody handprint ACT UP made famous in America. But many other signs were handpainted, such as one that read simply, “MBEKI PLEASE HELP US.” Monica Ishmael, a shop steward in the South African Clothing and Textile Union, was marching because “our workers get sick and we don’t know where to tell them to get treatment.” She added, “Just this morning one of my workers passed away.” The woman who died was only 23 years old.

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