AEGiS-WSJ: Health: Mbeki's Doubts About Drugs Thwart Efforts to Fight AIDS in South Africa

JOHANNESBURG, South Africa -- With a key legal settlement last week, the opportunity to employ AIDS drugs in the country worst afflicted by the disease has never been greater.

But AIDS activists and many health organizations say South Africa's response to the epidemic is being hamstrung from the highest levels: President Thabo Mbeki, whose erratic comments have already helped thwart efforts to distribute the drugs, these groups say.

Despite winning a legal battle that ended drug companies' opposition to imports of cheap, generic drugs, the government still has no immediate plan to distribute the drugs widely.

Activists and rights groups acknowledge that is partly due to concerns that South Africa's AIDS problem could actually get worse if the drugs are improperly administered. Some drugs, for example, could help create drug-resistant strains of the disease if patients stop taking them too early.

But perhaps the biggest obstacle to creating a coherent attack on the disease appears to be doubts and confusion sowed by comments from Mr. Mbeki.

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Last year, Mr. Mbeki shocked activists and many health officials by appearing to question the link between the human immune-deficiency virus and AIDS. He has raised doubts about retroviral drugs, which are widely used to treat the disease elsewhere, and he has rejected calls for the government to distribute them. As recently as Tuesday, he questioned whether HIV tests are effective and whether they should be widely used.

"He continues to have influence over senior politicians, who may be reluctant to move against what they believe are his wishes," said Mark Heywood, the head of the AIDS Law Project, a human-rights group fighting discrimination against people infected with the virus that causes the disease.

The stakes are particularly high in South Africa, where about 11% of its 45 million people are infected with the virus that causes AIDS. With the legal settlement, AIDS activists and many health officials hope the country could become a model for treating the disease in poor countries.

In a separate development, African ministers agreed Wednesday on a draft declaration calling on their countries to import and produce their own generic AIDS drugs and to boost spending dramatically on AIDS programs to fight the disease.

Activists say Mr. Mbeki's pronouncements are having an impact beyond the capital. They point to Mpumalanga province, three hours drive from Johannesburg. Local government health authorities ordered a private, rape-victim support group, the Greater Nelspruit Rape Intervention Project, to stop purchasing AIDS drugs for victims of sexual assaults, one way in which the disease is spread in the country.

Richard Spoor, a lawyer for the group, accuses local officials of taking their cues from Johannesburg. "Provincial authorities jumped on the 'No AIDS drugs' bandwagon because they wanted to get into step with what they thought their president wanted," he said.

The provincial government describes the drugs, which are legal and were prescribed by doctors, as toxic and says the group's activities undermine the national government. Local officials also brought disciplinary charges against doctors who prescribed the drugs to rape victims, although the charges were later dropped.

A spokesmen for the national government and the South African health ministry said the dispute doesn't reflect national policy. But one health-ministry official, who asked not to be identified, said that without strong presidential support, the health ministry would probably fail to gain cabinet approval for more money to develop a broad program to distribute retroviral drugs.

Activists and many private health officials agree that winning the national government over is essential. "We have to help the government see that in the long term, using these drugs to treat people with AIDS makes the most economic sense," said Zackie Achmat, the head of the Treatment Action Campaign that is leading the charge for better access to retroviral drugs.

Some worry that the government of Mr. Mbeki, who is increasingly embattled on other political fronts, is becoming even less tolerant of any criticism. Mr. Mbeki's top security official Wednesday accused three former anti-apartheid activists of plotting to overthrow Mr. Mbeki's administration.

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