Newsday - July 10, 2000
Laurie Garrett and Tina Susman, Staff Correspondents

Throughout the day, scientists, clinicians and AIDS activists fretted over what, exactly, the controversial president would say.

"I can't remember conferences that were as steeped in controversy as this one," Dr. Hoosen Coorvadia, chairman of the conference, said during the afternoon. "For us this is a watershed. There is high expectation that something definitive will emerge from the president's speech-that he will announce some new effort to tackle the epidemic."

Clearly, as Mbeki spoke, there was disappointment among the 12,000 people jammed into the cricket stadium in downtown Durban. In a long, dry speech delivered without interruption for applause or other response, Mbeki identified poverty as the culprit for his nation's epidemic. To date, HIV has infected 4 million South Africans.

"Extreme poverty is the world's biggest killer and the greatest cause of ill health and suffering across the globe," he said.

Mbeki read for five minutes directly from a 1995 World Health Organization report on poverty and disease, repeatedly blaming "extreme poverty" for the "deeply disturbing phenomenon of the collapse of immune systems among millions of our people."

"As I listened and heard the whole story told [in the WHO report] about our own country," he said, "it seemed to me that we could not blame everything on a single virus."

And he defended his ongoing inquiry into whether HIV causes AIDS. It began in May when Mbeki convened a panel, including dissident scientists who insist HIV is harmless, to discuss the efficacy of accepted AIDS treatments and whether HIV causes AIDS.

Drawing from a page written by the dissidents, Mbeki demanded "accurate statistics and not estimates" about illness and disease in Africa. The dissident scientists have said statistics are grossly exaggerated and not the result of a new epidemic.

Mbeki offered no strategies to combat HIV: no concrete proposals, government plans or commitments to provide drugs for HIV treatment to his people-not even acknowledgment of drug company offers of medicine, free or at significant discount.

Dr. Tom Coates, a top AIDS researcher from the University of California in San Francisco, was flabbergasted. "This is such a missed opportunity," he cried. "He could have been the world's spokesperson. I'm so disappointed."

A United Nations official who spoke on condition he not be identified acknowledged sadness over Mbeki's failure to definitively separate himself from dissident views on HIV's role in causing AIDS, to address the stigmatization most HIV-positive people on this continent experience or to support drugs to prevent mother-to-child transmission of the virus.

Before Mbeki's speech, AIDS activists blasted western drug companies for not making AIDS drugs more available to poor countries and accused the South African government of failing to do anything about the disease until it was too late.

"We must take the responsibility for that failure," Winnie Madikizela-Mandela, the head of the African National Congress' Women's League, told about 2,000 people who roared in approval at her fiery speech, which was extremely critical of Mbeki.

"We knew this was a plague and that it was moving south...yet we did nothing," she said. In a clear reference to Mbeki's acceptance of the dissident scientists, Madikizela-Mandela, the ex-wife of former President Nelson Mandela and one of the ANC's most popular leaders, opened her address by declaring: "AIDS exists. HIV causes AIDS."

Later, she headed an enthusiastic but peaceful march through central Durban to the stadium.

"It's wrong, immoral, unethical and unconstitutional not to provide those drugs," Zachie Achmat of South Africa's Treatment Action Campaign told a news conference before the march, accusing drug companies that have not offered such drugs as AZT for free or at deep discount of waging a "holocaust against the poor."

Achmat and Eric Goemaere of Mdcins Sans Frontires (Doctors Without Borders) dismissed the drug companies'-and the government's - arguments that even if such drugs were available free of charge, South Africa lacks the expertise to properly administer them and to ensure patients adhere to their regimens. If anything, said Goemaere, patients receiving AZT in clinics in poor parts of South Africa often have proved better at complying with the dosages than patients in Europe. "That's because here they know they have only one chance. They know that's their only chance of survival," Goemaere said.

Major Rubanga Rubamamira of the Uganda defense forces was another who eagerly awaited Mbeki's speech, saying, "This is the strongest country in Africa-to have a bad policy speech here is disastrous for us all." In the end, the Ugandan military leader concluded, disaster had struck.

Some scientists felt Mbeki's wrath earlier in the day, when South African scientists who recently signed a document opposing Mbeki's stance on HIV's connection to AIDS were threatened with loss of their jobs. The Durban Declaration, signed by 500 of the world's most famous AIDS scientists and published in the July 6 issue of the journal Nature, insists that "the evidence that AIDS is caused by HIV- I or HIV-2 is clear-cut, exhaustive and unambiguous, meeting the highest standards of science."

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