Politics and AIDS: a bad mix.

Abstract

Last month I spent two weeks in Southern Africa and was astounded at the continual debate on whether or not HIV causes AIDS. “The hypothesis that HIV causes AIDS is an assumption, not a fact,” says Thabo Mbeki, President of the Republic of South Africa. The Health Minister, Manto Tshabalala-Msimang, adds that the government will not be stampeded into precipitate action by pseudoscience and an uncaring drive for profits. Sadly, Nelson Mandela, the most respected elder statesman of the ruling African National Congress (ANC), has lost his battle to change the government's policy. Despite incontrovertible evidence that antiretroviral drugs drastically reduce transmission of the AIDS virus to newborns by their HIV-infected mothers, the government will not provide nevirapine to HIV-positive pregnant women. Government officials maintain that they cannot implement a nationwide program until the results from 18 test sites are available sometime this December. Between now and then this “go slow” approach will lead to more than 50,000 South African babies being born with HIV, half of whom could be spared if a single dose of nevirapine (costing no more than $10) is given to the mother between labor and delivery and to the baby within 72 hours of birth. Interestingly, the courts in Pretoria are ruling in favor of compelling the government to provide nevirapine to pregnant mothers. Nearly 5 million of the 42 million people in South Africa are infected with HIV, and more than half of these infections occur in women; thus, vertical transmission will continue to increase. Why then do people like Peter Mokaba, a member of the Parliament and a senior official in the governing party, say “HIV? It doesn't exist.” I heard him say the following in a television interview: “… anti-retrovirals, they are quite dangerous. They are poison actually. We cannot allow our people to take something so dangerous that it will actually exterminate them. This will lead to genocide.” Fortunately, Mokaba is in a minority: The majority of scientists and health officials are treating AIDS as a sexually transmitted epidemic. In a recent report, the Medical Research Council (MRC) found that by the year 2000, AIDS was the leading cause of death in South Africa. Instead of acting on this information, the Health Minister has launched an inquiry as to who leaked the report and is asking for lie detector tests from highly respected academicians like Malegapuru Makagoba, President of the MRC. One wonders why there is such opposition in the face of overwhelming facts. The few but influential anti-AIDS activists draw their arguments and strength from a group of international scientists who believe—without any reliable data—that AIDS is a lifestyle disease. Some of this certainly originates from the apartheid days when science was abused to oppress the black majority. For example, on Robben Island, where Mandela was imprisoned for over two decades, I saw on the wall of the prisoners’ dormitories the recommended amount of food rations. Blacks were to be given substantially lower amounts of food than colored people because it was “scientifically proven” that they needed less food. Therefore, it is critical now that scientists, health officials, politicians, government officials, and journalists speak in one clear voice that HIV causes AIDS. There is no room for skepticism; action is needed—and now! In neighboring Botswana, 38.5% of women of child-bearing age are HIV-positive. In response, the government launched an anti-retroviral program in April, 1999. This maternal treatment program also involves a massive public awareness campaign to reduce the stigma of AIDS. Clearly, the AIDS scourge in Africa can be combated if there is political will.