Mail and Guardian (Johannesburg) - October 4, 2000
Khadija Magardie

In the past few months there have been mixed signals from government, particularly on the causes of Aids. This, say experts, will have damning consequences for a society battling the disease that, according to estimates, will all but decimate the population of sub-Saharan Africa within the next few years.

Recently Minister of Education Kader Asmal refused to clearly acknowledge what is said to be an "irrefutable" link between the human immunodeficiency virus (HIV) and Aids, a fatal disease. Instead, he cryptically acknowledged that "HIV may cause Aids", but added that he was more concerned with the consequences of the virus than what causes it.

By contrast, the South African Democratic Teachers Union (Sadtu) has taken a tough and clear stance on the issue. Speaking at the recently held Congress of South African Trade Unions (Cosatu) congress, Sadtu president Willy Madisha was harshly critical of the government's speculation about the causes of Aids.

"The current public debate on the causal link between HIV and Aids is confusing. For Cosatu, the link between HIV and Aids is irrefutable and any other approach is unscientific and unfortunately likely to confuse people," said Madisha.

The government has recently come under fire from all sides for its failure to acknowledge a widely held but not entirely irrefutable scientific theory that HIV is solely responsible for Aids and the countless deaths resulting from it. But the government says that before devoting resources to fighting the scourge, all possible causes of Aids need to be further investigated.

Earlier this year, just prior to the 13th International Aids Conference held in Durban, a group of prominent local and international scientists issued a position paper spelling out what they believe is "clear evidence" that HIV causes Aids. In what has become known as "The Durban Declaration", the united scientific view slammed attempts to reopen what they regard as a watertight theory that has been proven "over and over again". The scientific community has also expressed alarm at President Thabo Mbeki's decision to appoint a group of controversial scientists who hold "dissident" views on what exactly causes Aids to an advisory panel.

According to the dissident view, which has apparently found fertile ground in the government, including the Department of Health, immunodeficiency cannot be attributed to a single virus, but is the result of a variety of socio-economic circumstances, coupled with so-called "opportunistic infections" such as tuberculosis and malaria.

Using recent World Health Organisation statistics to support their view that the main cause of Aids is "poverty" and not any single virus, the dissident camp hold that the key to combating deaths in the region is eradicating various prevalent and equally fatal infections as well as improving infrastructure, such as access to clean water and proper sanitation. All this, they say, will improve the general health of the population.

Responding to questions in Parliament relating to his alleged favouring of the dissident view, Mbeki said that Aids could not possibly be caused by a virus, because a virus causes a disease, not a syndrome like Aids.

The government has neither officially confirmed that HIV causes Aids, nor has it denied it. The position held by government is that HIV is just one of a host of other but equally serious and attention-deserving causes.

But the government's campaigns appear to work from the premise that HIV causes Aids, pouring money and effort into education campaigns to teach the population about the dangers of contracting HIV, principally through unprotected sexual contact.

Opposition parties and several non-governmental organisations say the government's non-committal stance on HIV/Aids is being used to mask its failure to provide anti-Aids medication to infected citizens, particularly survivors of rape, and HIV-positive pregnant women. The African National Congress's alliance partner, Cosatu, has constantly urged the government to find ways to provide cheap medicines to improve the condition of people with Aids.

The various initiatives by the government to combat the virus will no doubt influence the debate. But Aids educationists and health care workers say too much time is being spent intellectualising while people are dying.

They say that the debate has had an overall negative impact on society, with people in high-risk categories, as well as those already infected with the virus, being thrown into confusion as a result of the mixed signals of the government, particularly among people less educated or in remote rural areas. These people are difficult to reach and education campaigns generally have to be more aggressive in such circumstances.

"If they see the minister [of health] or the president saying on TV that it's not HIV, but poverty [that causes Aids], many will become confused, and maybe think we, the health care workers, do not know what we are talking about," said one health worker, based at Chris Hani Baragwanath Hospital, in Gauteng.

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