Mbeki backs down: he shuns dissidents and expands drug treatment programme

11 June 2002. Related: Treatment access.

Graham McKerrow, HIV i-Base

President Thabo Mbeki of South Africa has distanced his government from the controversial advice of AIDS dissidents that included denying a link between HIV and AIDS, and dismissing antiretroviral drugs as toxic.

The cabinet has decided to make nevirapine universally available to HIV-positive pregnant women and their children in order to reduce mother to child transmission of the virus. Zidovudine will also be provided at state hospitals as post-exposure prophylaxis for rape survivors and people infected through needlestick injuries.

The South African government is also planning a series of other measures including a massive awareness campaign, negotiations with pharmaceutical companies to obtain cheaper drugs, a campaign against discrimination against positive people, the appointment of a deputy minister of health to focus solely on AIDS, and the expansion of the South African National AIDS Council with more funding and more expertise.

Officials say the government has decided that it must project an image of sensitivity towards people living with AIDS.

And they add that the president now accepts that the pandemic and his government’s response to it have had a negative impact on South African society and the country’s image overseas, and that he will now refrain from voicing his personal views in public and will instead promote the official policy on AIDS.

Mr Mbeki has distanced himself from AIDS dissidents by instructing the health ministry to write to them telling them to stop using the president’s name when signing correspondence. Dissidents, including the Americans Peter Duesberg and David Rasnick, have been in the habit of signing themselves as advisers on “President Thabo Mbeki’s Advisory Panel on AIDS”.

Government spokesman Joel Netshitenzhe said: “We are telling them that there are other members of the panel who hold the orthodox view so they cannot sign themselves as if they represent the view of the entire panel.”

Officials said Mr Mbeki would cut all informal contact with the dissidents and only communicate with them at meetings of the advisory panel.

Furthermore, Peter Mokaba MP, who has become the dissidents’ champion within the ANC, has been instructed to stop speaking out on the subject.

These dramatic shifts in policy follow pressure on the president from many sources including his predecessor, Nelson Mandela, and other leading figures within his own party, the trade union movement and the Department of Health where senior staff have reportedly threatened to resign over the issue.

Officials said there were growing fears in cabinet and ANC circles of “mass mobilisation and hysteria” against the government, which was increasingly regarded in the country as uncaring. There was a growing gulf between the government and sectors of society, they said, and many community organisations were beginning to see the government as an “enemy” on the issue.

The country’s diplomats also reported difficulties explaining South Africa’s policy abroad and said this hampered efforts to raise foreign money for projects in Africa. Pressure has also come at cabinet level from the ANC’s coalition partners, the Inkatha Freedom Party, led by Mangosotho Buthelezi, and from the widely respected former presidential contender, Cyril Ramaphosa, who is now a leading businessman.

The first concrete sign of a change in official policy came in February when the finance minister, Trevor Manuel, trebled the AIDS budget to pay for measures that would include “a progressive roll-out of a programme to prevent mother to child transmission.” (See HIV Treatment Bulletin Vol 3 No 3, page 2).

In an interview with The Star newspaper at the end of April, President Mbeki said the government had had problems “communicating” its policies: “It is critically important that I communicate correct messages.”

He said he was concerned that a message of hopelessness had been conveyed to people infected and affected by the virus, and said a lot could be done by treating curable diseases such as tuberculosis regardless of the person’s HIV status.

Mr Mbeki said: “I think that if people are told the truth, they can get through this. And it is necessary to tell the truth repeatedly.” And he added: “You need to inculcate into the minds of people that they, too, have a responsibility for their health. You can’t be going around having hugely promiscuous sex all over the place and hope that you won’t be affected by something or the other.”

Nelson Mandela said he was “delighted” by the change in policy and believed South Africans would now realise what a brilliant president Mr Mbeki was.

Nono Simela, the head of the Department of Health’s AIDS Directorate, said the end of the argument over antiretrovirals would enable officials to deal with practical issues in fighting the virus.

Blade Nzimande, secretary of the South African Communist Party, said he was glad the cabinet was now “ignoring the political idiosyncrasies of the likes of Mokaba”.

Bantu Holomisa, leader of the United Democratic Movement, welcomed the changes but said the president must demonstrate leadership by “immediately and unreservedly apologising to the people of South Africa, especially the women who have until now been denied treatment for HIV/AIDS in cases of rape”. He said the president should also apologise to the mothers who did not receive treatment that could have protected their newborn children.

Critics of the government pointed out that South Africa has not asked for donor funds to expand its pilot study of antiretrovirals. In May it asked the Global Fund to Fight AIDS, TB and Malaria for 500 million rand (£32.7 million) to fund TB drug research and psychological services for people living with HIV/AIDS, but nothing for the antiretrovirals study.

The latest government statistics show that 4.7 million of South Africa’s 43 million people are living with HIV.

Comment

Those concerned with fighting HIV and AIDS can only welcome the South African government’s change of heart and their new policy announcements. Following the budget statement in February they amount to a commitment to accept the link between HIV and AIDS and the usefulness of antiretroviral drugs. They show a new determination on the part of the South African authorities in the battle against the virus.

Above all, they mean that the South African government is now the enemy of HIV and AIDS, rather than being seen as the enemy of organisations and people in the frontline of the battle against the virus.

The relationship between the government and the AIDS community is transformed and criticism of government policy can be offered in this new atmosphere, as part of a constructive engagement between people working towards the same ends.

However, underlying this U-turn is the strange statement of officials that Mr Mbeki will keep his personal views to himself in future, which suggests that he does not yet believe the accepted, orthodox views on HIV, AIDS and antiretroviral drugs. The government, the health service and AIDS organisations may be able to operate efficiently without the full faith of the state president, and his acquiescence is better than his opposition. But the clear impression remains that they do not have their president’s full, unambiguous support, which is what they deserve.

If they are left to get on with their jobs regardless of the president’s personal – and now to be private – views then all well and good. But unless Mr Mbeki assures his country of a genuine change of heart then there will always be the suspicion that his known but unspoken views still influence policy. What other reason can he provide as to why South Africa has not asked for funding to expand the pilot study into antiretroviral treatment?

We learn from Mr Mbeki’s officials that the government has decided it must “project an image of sensitivity towards people living with AIDS”. How on earth does one explain to a man who now has secret views on the subject that people living with AIDS need rather more than an “image of sensitivity”?

People with AIDS and many others with HIV require access to antiretroviral drugs. The South African government is right to prioritise negotiations with pharmaceutical companies for cut-price drugs. It should also explore the possibilities of domestic production of generic versions of the drugs.

Then can a government that has just cut taxes by R15 billion (£1 billion) foot the bill for these cut-price drugs?

A recent study showed that providing home-based care would cost the country about R1.8 billion (£118 million) a year. Such a policy requires the political will to make it happen. If Mr Mbeki will not provide that will, then his government has a duty to take his words at face value, accept his silence on his true opinions, and give people the care they need.

On prevention, someone who has the president’s ear should to talk to him about sex. In his interview with the Star Mr Mbeki says people “can’t be going around having hugely promiscuous sex all over the place and hope that you won’t be affected by something or the other”.

If those last four words are the president’s way of referring to HIV, then he needs to learn about safer sex. Someone send him a leaflet!

Finally, Mr Mbeki should remember Dr Thys von Mollendorff, the hospital superintendent at Rob Ferreira Hospital in Nelspruit, who was sacked for allowing zidovudine to be given to women who had been raped. He should be reinstated immediately.