Chicago Tribune - April 1, 2002
Laurie Goering, Tribune foreign correspondent

President Thabo Mbeki has long been criticized for refusing to acknowledge that HIV causes AIDS and for his government's insistence that anti-viral drugs may be harmful.

The debate is more heated than ever as the government and activists square off over nevirapine, a drug that helps limit the transmission of HIV from mother to child. In this nation where 5 million people--1 in 9--are infected with the deadly virus, the battle against AIDS has become a political fight as much as a medical one.

Last year, a coalition of health activist organizations won a landmark court order requiring Mbeki's government to provide nevirapine to all HIV-positive mothers and their newborns. The government swiftly appealed, insisting its own modest program of providing the drug at a few test sites was sufficient.

When a Pretoria high court again demanded last week that the government make the drug available to infected pregnant women at state hospitals until the appeal was settled, the country's Health Ministry initially suggested the government would balk.

"My own view is the judiciary cannot prescribe from the bench," said Health Minister Manto Tshabalala-Msimang.

The government has since backed down, insisting the minister meant only to say she intended to appeal the decision to South Africa's Supreme Court. Mbeki's hesitation to launch a full-scale war on AIDS has some painful political reasoning as well as questionable science behind it.

A recent government-funded study by the Medical Research Council suggests that 5 million to 7 million South Africans will die of AIDS by 2010 unless the government takes quick action to combat the epidemic. Even if the government does take action, the death toll could be reduced by only about 20 percent, the council noted.

Painful tradeoffs

Similarly, even though manufacturers have slashed the prices of AIDS drugs, the costs are substantial at a minimum of 67 cents per infected person per day. For a country that already spends 14 percent of its budget on health programs--one of the highest rates in the developing world--adding more funding for AIDS would take cash away from other vital programs such as education, land reform and public security.

"The government just can't tax people much more than it already is," said Tom Lodge, a political analyst at the University of Witwatersrand in Johannesburg. "You can see the attraction of being a denialist" about AIDS.

Perhaps the most important reason Mbeki and other officials of the ruling African National Congress have been hesitant to admit the seriousness of the AIDS crisis, experts say, is that it threatens to dwarf most of the post-apartheid government's hard-won gains in education and other fields.

"The ghastly prospect of 5 million people dying stands to overshadow every last thing the ANC has done over the past seven years," Lodge said. "This was meant to be the time they were collecting prizes. And now they find a threat to South African humanity itself, a crisis more severe even than apartheid."

Slowly, however, the ANC's refusal to recognize the magnitude of South Africa's AIDS crisis--the nation has more HIV-infected people than any other--is showing some signs of wavering. Nelson Mandela last month labeled AIDS "the greatest threat facing South Africa and the continent" and called for anti-AIDS drugs to be made available at public hospitals to all HIV-infected South Africans who want them.

Neither Mbeki nor Tshabalala-Msimang attended Mandela's news conference, but the former president was flanked by South Africa's vice president and the general secretary of the ANC.

Progress in provinces

Just as important, many provincial leaders and health officials, and a few private foundations, are pushing ahead to provide anti-AIDS drugs, including nevirapine, to HIV-positive pregnant mothers and to rape victims who fear they might have contracted the virus.

Officials in KwaZulu-Natal province, where HIV infection rates are the highest in the country and up to 36 percent of new mothers are infected, have said they will begin providing nevirapine free to pregnant women regardless of federal government policy.

The drug, administered to women in labor and newborns, is estimated to stop transmission of HIV from mother to child in about half of the cases. Currently, only about 10 percent of HIV-positive pregnant women have access to the drug through the national government's test program, and an estimated 100,000 or more HIV-positive babies are born each year.

South Africa's poorer neighbors already are using anti-AIDS drugs such as nevirapine at much higher rates, one indication that South Africa probably could find the money for them if it could find the political will to make AIDS a top priority, experts say.

So far, South Africa's annual death toll from AIDS-related illnesses is about 250,000 a year, experts estimate, but that is expected to double to half a million deaths a year in four or five years. Life expectancy is 47 years in Africa's most developed nation.

"We're not at the holocaust stage yet, but we'll get there fairly quickly," Lodge warned. "Then the denialist position will look a lot less plausible."
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