Sunday Times, South Africa - June 4, 2000
Carol Paton

The disease in the developed world was under control and was fast losing its stigma as celebrities "came out" about their status.

The campaign to make drugs more affordable in the developing world, kicked off by the former Health Minister Nkosazana Zuma, had given the US AIDS movement a new lease on life. Affordable drugs for AIDS became its main campaign issue.

So when Mbeki renounced the use of anti-retroviral therapy in South Africa, just as the US activists stood poised to win their battle for cheaper AIDS drugs, they were gobsmacked.

They, and the US's public health officials, were equally stunned when he then made contact with US scientists described as dissidents or AIDS denialists, holding views ranging from the belief that HIV does not exist to the idea that there is no AIDS in Africa and that AZT causes the disease.

When Mbeki wrote to US President Bill Clinton to defend these steps in the most passionate of terms, it seems that AIDS activists, of which there are a few in the White House, were sufficiently horrified to provide a copy of the letter to the newspaper the Washington Post.

A torrent of criticism burst forth.

By the time Mbeki arrived in the US last week, the perception had been created that he doubted that HIV caused AIDS, that he "had done nothing" about the epidemic and that "he refused" to give AIDS drugs to South Africans.

In most of this he had been grossly misunderstood.

Casting aside the emotional defence in his letter, which equated criticism of the dissidents with the burning of heretics at the stake, Mbeki opted for a businesslike response to the criticism.

For the first time since the storm erupted, he offered a rational response. AIDS was a serious problem, he said, which required a determined response. South Africa was running as large an awareness campaign as possible and had taken steps to involve civil society in a partnership to fight the disease.

But the provision of antiretroviral therapy to all those infected with HIV, even with the promise that prices would be slashed by 85%, would consume the entire health budget.

Besides, as drug companies themselves admitted, patients on anti-retroviral therapy required constant monitoring and a far better health infrastructure would be needed.

In addition to these practical problems there was an unsolved scientific riddle. While the disease in the developed world had spread mainly among homosexuals, in Africa it was clear it was a heterosexual disease. It was also a mystery as to why scientists had decided in 1985 that AIDS was not an epidemic in SA but the disease was out of control a mere five years later.

It was these unanswered questions which had prompted him to contact scientists across the board and convene a panel to promote their interaction, Mbeki said.

The experts, some of whom are on Mbeki's panel, agree that these are valid and useful lines of discussion.

The underlying assumption, hinted at by Mbeki, may be a bit more controversial: that scientific work should be done to investigate whether there are biological differences between blacks and whites.

Leaving this aside, there is little doubt that Mbeki's rational approach worked, along with some deft spindoctoring by US and SA officials. By the middle of his US tour, sentiment in the media showed signs of becoming more even.

But although Mbeki clarified most misconceptions about his ideas on AIDS, he failed in one glaring and vitally important instance.

The Washington Post, the paper which had criticised Mbeki most vehemently, was quick to point it out.

Mbeki had briefed the editors of the Washington Post at length while in town and, afterwards, the paper ran an article carefully recounting his views. But it condemned his steadfast refusal to use anti-retroviral drugs for the prevention of transmission of HIV from mothers to babies.

The Post, seemingly annoyed at what it saw as obfuscation, pointed out that not only was this a mistake but that Mbeki had erroneously downplayed research which has pointed to the efficacy of anti-retroviral drugs in these circumstances.

After his impressively rational response on the broader questions of AIDS, Mbeki's answers on mother-to-child transmission were disappointingly fuzzy.

Instead of the facts and figures that one might have hoped for, answers were lost in generalities about subSaharan Africa.

Many of the assertions about the costs of blood tests, drugs and even health infrastructure were unconvincing without the accompanying facts and figures.

This is particularly so in the light of studies by private health economists which have shown that, rather than being unaffordable, attempts to prevent the transmission of HIV from mothers to babies is cost-effective.

With facts hazy, all that was offered was the old emotional response.

Said Zuma, for instance: "All that people care about is this AZT - nobody asks me what we are doing to make sure the babies survive [thereafter]. It is fuelled by the argument that we need more to buy more drugs, rather than saving children's lives."

But Mbeki's US trip has shown that great strides can be made in a context of rational debate and explanation.

This, and some credible research to examine the viability of a mother-to-child programme in SA, would be very helpful in preventing the discussion sinking even deeper into dogma.

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