Durban Debate

Post-colonial power plays are threatening the first global AIDS conference in Africa. Since January, the rumor mill has been spinning with talk that some U.S. scientists may boycott the Durban 2000 World AIDS Conference in South Africa -- one of the most pivotal AIDS conferences to date. Africa is the world's most AIDS-devastated continent, where 1500 new HIV infections occur daily in South Africa alone. For years, advocates have demanded that world scientists meet in Africa.

The controversy started when the South African Minister of Health, Nkosazana Zuma, dismissed a pilot program to provide a short regimen of AZT to HIV-positive pregnant women designed to reduce mother-to-child HIV transmission by over 50 percent, according to recent studies. Many activists, people living with AIDS and researchers were furious over Zuma's decision, and some provinces like Capetown are going forward with the program, footing the bill themselves.

Reaction to the boycott proposal has been mixed, taking place in heated on-line discussions on the Internet: Phill Wilson, director of AIDS Policy Archive at the University of Southern California, suggests that maybe "people with AIDS in South Africa would view [the boycott] as an act of solidarity." But Clarence Mini, a South African doctor says, "The people we are discussing here are black South African women who are very capable of raising their voices on important and life threatening issues." He is wary of "people who think and decide for us without consulting us," adding, "a boycott of the conference will destroy the fundamental reason for the conference to be held in sub-Saharan Africa: to bring the attention of the whole world to focus in this area."

The bigger picture is complex. According to Nature writer Michael Cherry, Zuma's decision to cut the program was not based on immediate cost (funding had been offered to pay for it), but because "it could lead all HIV-positive pregnant women to believe they have the right to the drug."

"There is not much point in running a pilot study unless you can implement its findings," says Zuma's special adviser Ian Roberts. Although Roberts hinted at negotiations with AZT's U.S. manufacturer, Glaxo Wellcome, he inferred that the government couldn't afford the program yet. While critics argue that the South African government just voted to spend 30 billion rand (U.S. $ five billion) on defense, others say the issue involves more than finding funds for the pilot study. Although it would be cheaper than treating children with HIV, the short-course AZT program excludes breast-feeding, the cost of infant formula and access to clean water from the equation, according to Glenda Gray, a researcher at a major South African hospital. Others also disagree with providing AZT only during pregnancy, leaving mothers to die and orphaning children.

-S K