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AIDS in South Africa

Deadly meddling, Nov 1st 2001 | JOHANNESBURG

From The Economist print edition

Thabo Mbeki shows no sign of giving up his misguided views on AIDS

Pseudo-scientist in chief
NO POLITICIAN is a keener armchair scientist than South Africa's president, Thabo Mbeki. He sits up late searching the Internet for titbits on AIDS, the disease that is devastating Africa. He invites foreign scientists to discuss it. He encourages a South African institute, the Medical Research Council (MRC), to develop vaccines against the disease. But Mr Mbeki is a politician, not a scientist, and his cyberexcursions have led him to take a tragically misguided stance.
He rejects the scientific consensus that AIDS is caused by the human-immunodeficiency virus (HIV), opining that poverty, poor diets and other social ills may be to blame. Mr Mbeki does not care that HIV "has been investigated more thoroughly than almost any other virus in the history of science", as William Makgoba, who heads the MRC, puts it.
The president also doubts statistics from the United Nations, the MRC, the World Health Organisation (WHO) and his own health ministry which show that millions of South Africans now carry the virus. In August he told the health ministry to rethink spending on AIDS, in light of "evidence" (culled from a six-year-old document on the WHO's website) that more South Africans die of violence and accidents than of the illness. This month a report by the largely government-funded MRC showed that AIDS is in fact the largest single killer in the country and could claim between 4m and 7m lives within a decade. The state statistics agency immediately attacked its methodology, but smaller-scale studies match the MRC estimates, suggesting, for example, that a fifth of university students now carry the virus.
Last week, having failed to discredit the MRC's report, Mr Mbeki took a different line, and attacked the use of powerful anti-retroviral drugs to reduce the impact of AIDS. Although these drugs are used by dozens of infected MPs and members of the government, and thousands of other South Africans, the government will not sanction them in state hospitals.
The president argues that the drugs are too toxic, too costly and are not proven to be effective. He told parliament last week that "radically revised guidelines the US government issued at the beginning of this year about treatment with anti-retroviral drugs have said that these drugs are becoming as dangerous to health as the thing they are supposed to treat". Mr Mbeki was referring to information on a website run by America's National Institute of Allergy and Infectious Diseases, which revised its AIDS-treatment guidelines in February. The new guidelines acknowledge "serious toxicities" in long-term use of anti-retrovirals, and specify a modified treatment regimen to minimise harmful side-effects without diminishing benefits to patients.
There is no question that the side-effects can be unpleasant. A study of 1,160 Swiss users of anti-retrovirals published last month in the Lancet found that the drugs can cause vomiting, diarrhoea, sleep disturbance, blood abnormalities and kidney dysfunction. But since the alternative is death, this does not mean that anti-retrovirals should not be used. Mr Mbeki is simply wrong to claim that the side-effects are as dangerous as the disease.
As well as prolonging life, anti-retrovirals also slow the spread of HIV by making sufferers less infectious. Yet the government objects even to the temporary use of the drugs, for example by infected pregnant women, to stop them passing the disease on to their offspring. A number of South African activist groups, including the Treatment Action Campaign, are now suing the government for not allowing one such drug, nevirapine, which is offered free by its makers, in state hospitals.
The government dismisses its critics as stooges for greedy drug companies. But government intransigence, not the cost of drugs, is the real problem. Despite its scepticism about the drugs' efficacy, in April the government forced drug companies to slash prices. GlaxoSmithKline has given a local generic-drug maker, Aspen, a licence to make and sell three AIDS drugs in the country. Neighbouring Botswana, which has the highest rate of HIV infection, says it will give free AIDS drugs to all who need them. Will any of this persuade Mr Mbeki to change his views? He told parliament last week that he sees no reason to do so.
Copyright © 2001 The Economist Newspaper and The Economist Group. All rights reserved.