Sunday Times (Johannesburg) - November 11, 2008
Claire Keeton

NOW that South Africa knows the bloody price of HIV-Aids denialism, the critical issue is how to avoid further loss of life.

HIV denialism by the former president Thabo Mbeki and former health minister Manto Tshabalala- Msimang resulted in at least 330000 preventable deaths and 35000 babies born with HIV.

A recent Harvard School of Public Health study shows that between 2000 and 2005, Mbeki's government stalled on delivering a national antiretroviral programme as well as making sure babies were born safe from HIV.

Dr Francois Venter, the president of the HIV Clinicians Society of Southern Africa, said that the former health minister, former president and by default his cabinet, should be accountable for the deaths "directly attributed to the slowness of the rollout".

Here's an example, not in the report, of how political obstruction blocked access to life-saving drugs.

Dr Kgosi Letlape, chairman of the South African Medical Association and executive director of the Tshepang Trust, said that initially only the Western Cape allowed the trust (which made ARVs available to people in public hospitals before the government) to go ahead with an urban and rural treatment project. The trust had planned to conduct two pilot projects in nine provinces.

That was the bad old days. But, in fact, denialism and bad science have not yet been stamped out of government.

Take, for example, MEC for health in KwaZulu-Natal, Peggy Nkonyeni. She encourages charlatans touting HIV potions while attacking dedicated HIV doctors.

As Mark Heywood, head of the Aids Law Project, said: "She has openly promoted the views of charlatans and needs to make it clear she stands by accepted science."

Why is she still in power in the province with the worst HIV infection rates?

South Africa has moved beyond denialism with a clear National Strategic Plan for HIV-Aids and the biggest treatment programme in the world (575000 people on antiretroviral drugs).

Heywood said the country has an unparalleled opportunity now to unite to make sure no more lives are lost.

"There is no question where accountability lies - with the executive of that time and the president of that time in particular," Heywood said.

"The Treatment Action Campaign (TAC) twice wrote to former president Mbeki asking why he was keeping Tshabalala-Msimang on and citing this issue [preventable deaths].

"We do not want to overlook what has been done, and what cannot be undone, but most of all we need to unite behind the National Strategic Plan and new health minister.

"We are behind on every target and that is where our focus should be."

Dr Olive Shisana, director of the Human Sciences Research Council and its HIV head, said that with such heavy investment in science and technology, South Africa should have been at the forefront of implementing evidence on ARV antiretroviral therapy. Ignoring the advice of scientists on the value of treatment interventions should be treated as very serious.

The new health minister, Barbara Hogan - whose appointment has been widely supported - has identified HIV-Aids and TB as top priorities.

But she will need unqualified support from the top down and in the provinces to achieve this.

Her director-general, Thami Mseleku, does not have a strong track record on this score (or, indeed, in any other).

Venter said: "His hands are stained with blood and he is not up to the task. The entire administration needs a priority and an attitude change."

Hogan must form a strong team to overcome the paralysing bureaucracy that has exacerbated the government's slow delivery on HIV-Aids.

Venter said: "The poorest people are dying. The Western Cape and Gauteng got going early on. People in provinces such as Mpumalanga, Limpopo and KwaZulu-Natal are the ones suffering. "And these are only the quantifiable deaths. The Harvard report does not include the number of people dying from TB or poor hospital services. That would triple the number."

Letlape said HIV shows that the crisis in the public healthcare system is much broader than HIV.

"Unless we fix the healthcare system we will lose people unneccessarily."

When it comes to stopping HIV-Aids casualties Dr Ian Sanne, managing director of the Right to Care (which has 48000 patients on treatment) and Letlape, also highlighted the need for effective prevention.

Meanwhile, the question remains: who will take the rap for the 330000 lives lost, children orphaned, babies born HIV positive, the suffering and the lost productivity?

TAC leader, Zackie Achmat, has suggested Mbeki and Tshabalala-Msimang be summoned to a judicial commission of inquiry.

081111
ST081102

Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2008. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .