Mail and Guardian (Johannesburg) - September 15, 2000
Timothy Trengove-Jones

Following the minister's very proper advice, I do my homework and confirm my hypothesis. In March we had an incident very similar to the Robbie case. Then Minister of Health Manto Tshabalala-Msimang addressed the National Conference of People Living with Aids in Durban. There were angry exchanges, dignity was stood on, and a high horse mounted. The minister told angry delegates that their behaviour was "not comradely", and lamented that, given their "attitude", "she should not even have [attended]". Later she complained that her treatment was "insulting and provocative".

Reading much of the fallout from the Robbie interview it is appalling to see how the real issue is being missed. An article in a leading daily is representative: "Robbie was downright rude, and that is unacceptable," we read. The issue has become how one should appropriately address the minster of health. In other words, our national debate - and that seems an inappropriately highbrow term - concerns the niceties of etiquette and decorum.

Let us be very clear about the issue, it is not about decorum or whether Robbie should apologise or be fired.

Rather, what is at issue - and many of us will find this as tedious as the minister does - is whether HIV causes Aids; whether our minister of health is willing to publicly announce her position on this matter; and whether her position coincides with that of the government.

If the minister had acknowledged that the common clinical element in all those who develop Aids is the presence of HIV, she would have clarified the issue in the minds of what is - I am reliably informed by health workers - a largely bewildered population. And she would have reassured foreign investors who, among many other criteria, look to see what chance there is of having a healthy, productive workforce in this country.

Why, at the very moment that the president "urges all our people to break through the barrier of fear and to speak their minds", is Tshabalala-Msimang herself so unwilling to do just that? Why is it that we hear that Professor Jerry Coovadia, chair of the Aids 2000 conference, was leant on by the government? Why are persistent rumours that those advocating the administration of Nevirapine have been told to get into line? Is this polarised climate conducive to people speaking their minds, or is it a constituent of "the barrier of fear"? In his interview with Time magazine, the president refused to provide a simple answer to a direct question. Asked: "Are you prepared to acknowledge there is a link between HIV and Aids?" he replied: "No, I am saying that you cannot attribute immune deficiency solely and exclusively to a virus." He claimed that, "at a certain point, if you have TB [tuberculosis] you will test HIV-positive".

What he claims here is indisputably inaccurate. Dr Des Martin, president of the Southern African HIV Clinicians Society and an acknowledged authority on both TB and HIV, dismisses the president's remarks outright. "False positive tests do occur with antibody testing in patients with TB.

But confirmatory testing rules out this false test," he explains. Additionally, Martin stresses that "TB does cause some - and I'd stress some - immunosuppression.

But to say it 'destroys' the immune system is wrong." The president's remarks are, in his opinion, "clearly nonsense".

I have taken the minister's advice to Robbie and done my homework. In the HIV/Aids/ sexually transmitted diseases strategic plan to which Robbie was referred, the Ministry of Health highlights the need for "an effective and culturally appropriate information, education and communications strategy".

Government leaders should lead. The current morass is a direct consequence of a failure by the minister and the president to provide effective and appropriate information. On Robbie's show Tshabalala- Msimang actually stressed the need for the "media to inform the public about the positions of government". Yet she herself refused to clarify the government's position. At the current juncture nothing could be more "appropriate" and myth- dispelling than a simple, clear answer from an authoritative source.

Martin claims that current government- sponsored misinformation has "put our education campaigns back a few years". He says children react to safer sex messages with derision, people who test HIV-positive assert "the test is meaningless", and education messages generally "are being disbelieved". Much of this is a direct consequence of damaging messages "coming from a highly respected source".

Timothy Trengrove-Jones is a Wits academic and an Aids researcher.
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