AIDS in South Africa
Deadly meddling, Nov 1st 2001 |
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
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
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