The Politics of HIV/AIDS in South Africa

The Virodene Controversy (1997)

In January 1997, three scientists from the University of Pretoria announced that they had found an antiretroviral drug — Virodene — that could cure AIDS, and requested R3.7-million in state funding to continue researching it. Then health minister, Nkosazana Dlamini-Zuma, circumvented accepted practice by allowing the researchers to address Cabinet with their preliminary findings that were neither controlled nor peer-reviewed. (See Pretoria scientists claim Aids breakthrough)

The main ingredient in Virodene is dimethylformamide, a toxic industrial solvent that is used in dry-cleaning, among other applications. The drug has since proved not to have any antiviral effects.

Soon afterwards, the Medicines Control Council was effectively disbanded when its chairman and several other officials were fired, prompting speculation that the move was the result of the MCC's blocking of clinical trials of the drug. (See ANC rebuttal.)

In 2002, the Mail&Guardian revealed that the ANC "secretly arranged millions of rands in funding for Virodene". A memo written by the Virodene researchers, which was later retracted after it was revealed in court, earmarked a 6% shareholding for the ANC.

Miracle AIDS cure hits the South African press

In a February 1997 article, Miracle AIDS cure hits the South African press, published in the British Medical Journal, Pat Sidley reflects on the way the South African media portrayed the announcement of Virodene

The Johannesburg daily newspaper, The Star, used most of its front page, with elaborate colour illustrations of the virus and the new drug Virodene P058, to inform its readers of its discovery. The researchers, led by a laboratory technician, Olga Visser, her husband, Ziggy, and Dr Kallie Landauer, claim that while "playing around" in the laboratory with "strong antivirals, chemical compounds, rats' tissue and human cells" Olga Visser "noticed something funny happening." The compound she was fooling around with was killing the virus, she told a mass circulating Sunday newspaper, the Sunday Times. The news article was totally unquestioning.

"AZT Toxicity" (1999/2000)

Although many respected local scientists advocated the use of antiretroviral AZT in the late 1990s, President Thabo Mbeki didn't necessarily agree that that the drug was a good one for people living with HIV/AIDS to be taking.

On 28 October 1999, speaking to the National Council of Provinces in Cape Town, Mbeki said that there was "a large volume of scientific literature alleging, among other things, the toxicity of this drug is such that it is in fact a danger to health".

"I have therefore asked the Minister of Health ... to go into all these matters so that ... we ourselves, including our country's medical authorities, are certain of where the truth lies.''

He urged the members of the National Council "to access the huge volume of literature on this matter available on the Internet, so that all of us can approach this issue from the same base of information". (read speech)

Presidential media liaison officer Tasneem Carrim confirmed Mbeki's Internet research. "The president [has] got a thick set of documents. He went into many sites, including the World Health Organisation's [WHO] one. The president goes into the Net all the time," Carrim was quoted as saying in a Sunday Independent article.

This was one of the first times Mbeki questioned conventional medical opinion on AIDS treatment, showing sympathy instead with a fringe group of AIDS dissidents who didn't believe in the efficacy of the drug. Mbeki was widely condemned for his stance.

The Sunday Independent editorialised: "For a leader who has shown such statesmanship in the vital task of making Africa a prosperous continent, it is surprising that President Thabo Mbeki has not shown the same dedication to the most injured citizens in our own country.'' (see AP report)

In 2000, Tony Leon, leader of the Democratic Alliance and the official opposition, and Mbeki exchanged letters on the AZT debate. Debates over antiretroviral treatment today are still common.

Presidential Advisory Panel on AIDS (2000)

On 28 February 2000, special advisor to the health ministry Dr Ian Roberts announced plans to convene an international panel in South Africa that would assess, amongst other things, the scientific evidence that HIV caused AIDS.

The panel was split between doctors who held the traditional view that HIV caused AIDS and doctors who questioned this view, including prominent denialists Peter Duesberg and David Rasnick.

In March 2000, presidential spokesperson Parks Mankahlana told the Village Voice that the panel would look into "everything about AIDS", from the merits of various treatments such as AZT to "whether there's this thing called AIDS, what it is, whether HIV leads to AIDS, whether there is something called HIV, for an example. All these questions".

Later that month, Mankahlana seemingly clarified the president's position with a column in the South African Business Day issued from his capacity as "Head of Communications — President Mbeki's Office".

"HIV/AIDS is not going to succumb to the machinations of the profiteering pharmaceuticals and their propagandists," wrote Mankahlana, likening the drug companies to the "marauders of the military industrial complex" that had benefited through the arms race during the Cold War.

"The President has authorised an international panel to be instituted to broaden the search for solutions. The international panel must strive to give us answers to all the unknowns. They must attempt to unravel the ‘mysteries' of HIV/AIDS, including and more especially what the profit-takers cannot tell us."

The panel's final report, published in 2001, showed that it had failed to reach consensus on a number of issues, including the link between HIV and AIDS (see full report), and was widely criticised in the local and international press as a waste of time and money.

"It confirms the fact that this international advisory panel was never going to provide proper advice in the fight against HIV-AIDS in South Africa," said Mark Heywood of the Aids Law Project in a Reuters report. "Its recommendations are limited, confusing and damaging to public health in the further recommendations doubting the efficacy of HIV tests."

Mbeki's Letter to World Leaders (2000)

In April 2000, the Washington Post published a hand-addressed letter sent by President Thabo Mbeki to world leaders defending his approach in dealing with HIV/AIDS. In it, he clearly showed his mistrust of Western solutions to the problem of HIV/AIDS in Africa.

"It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical. Such proceeding would constitute a criminal betrayal of our responsibility to our own people. It was for this reason that I spoke as I did in our parliament, in the manner in which I have indicated.

I am convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of AIDS in the West.

We will not, ourselves, condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV-AIDS ..."

Mbeki also took the opportunity to liken the dissident scientists to "heretics that would be burnt at the stake!", and to conventional scientists as supporters of the apartheid regime:

"Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and in public because the established authority believed that their views were dangerous and discredited.

We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited."

The Washington Post described the response at the White House: "So stunned were some officials by the letter's tone and timing — during final preparations for July's [13th International AIDS] conference in Durban — that at least two of them, according to diplomatic sources, felt obliged to check whether it was genuine."

The Durban Declaration (July 2000)

On 1 July 2000, the Durban Declaration signed by 5000 scientists, was released just before the 13th International AIDS Conference in Durban, clarifying the mainstream scientific view on AIDS science. The declaration stated:

"The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous ...

As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS…

Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs …

There are many ways to communicate the vital information about HIV/AIDS. What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and hopefully a vaccine ..."

Presidential spokesperson Parks Mankahlana denounced the "Durban declaration" and said he hoped the conference would not descend into "Mbeki-bashing".

"If the drafters of the declaration expect to give it to the President, or the government, it will find its comfortable place among the dustbins of the office," he said. "People can't, under the pretext of meeting in Durban to discuss questions of HIV/Aids, circulate a petition all over the world condemning the President."

Cost of Treatment: Political Debate

The cost-benefit analysis of treatment of the HIV/AIDS epidemic was a central concern of the South African government in 2000, according to PAC Health Secretary Costa Gazi. Gazi said the government's reason for not providing anti-retroviral drugs to pregnant women was to reduce the potential orphan burden in the country.

Gazi noted in an interview with the Citizen:

"I have suggested that one rationale for refusing women AZT is that the government does not know what to do with the AIDS orphans. If it refuses anti-retroviral drugs to pregnant women then many of those children will die before they are seven and the country won't have so many orphans.

Tshabalala-Msimang said that these remarks were insulting and defamatory. In fact I think that as Zuma always said cost is the real reason behind the refusal. It does not fit in with the GEAR policy which demands an immediate reduction in social expenditure. The government is frightened that if it starts to provide anti-retroviral drugs to pregnant women it won't be long before women who have been raped will demand them — and then the 4 million or so who are HIV+ but who cannot afford the drugs. There's no way the government's economic policy can accommodate such expenditure."

In July 2000, presidential spokesperson Parks Mankahlana implied that providing antiretroviral treatment to infected pregnant women worried the government because of the number of surviving orphans this would create.

"A country like ours has to deal with that," Mankahlana told Science. "That mother is going to die and that HIV-negative child will be an orphan. That child must be brought up. Who is going to bring the child up? It's the state, the state. That's resources, you see?"

Mankahlana later labeled the quotation in Science magazine as "a complete fabrication". After Science responded saying they had the quote on tape, Mankahlana said: "I have issued a statement denying what I am alleged to have said … That means I repudiate what I am alleged to have said. Whether I have said it or not, it means that statement is considered by me to be wrong or unacceptable. That should then settle the matter."

A Time article asked if Mbeki's appeal for assistance from the West "wouldn't be more persuasive if his government weren't spending some $5 billion on new jet fighters and submarines when it is AIDS, rather than some foreign military, that will kill half of South Africa's current generation of teenagers if its spread is unchecked."

Also see: Treatment: The Cost of Treatment in South Africa

Mbeki at Opening of 13th International AIDS Conference

During his speech on the opening day of the 13th International AIDS Conference held in Durban, 2000, President Thabo Mbeki controversially focused on poverty rather than HIV/AIDS as a leading killer in South Africa.

"As I listened and heard the whole story about our own country, it seemed to me that we could not blame everything on a single virus," Mbeki said (read full speech).

The Durban conference gave scientists the opportunity to present research that conclusively refuted the premise that AIDS drugs were ineffective and dangerously toxic. Executive Director of UNAIDS Peter Pilot concluded: "This conference has made it irreversible — prevention and care are combined."

In an interview with Time magazine in September 2000, Mbeki was asked: "Are you prepared to acknowledge that there is a link between HIV and AIDS?"

Mbeki's response: "No, I am saying that you cannot attribute immune deficiency solely and exclusively to a virus. There may very well be a virus … If the scientists ... say this virus is part of the variety of things from which people acquire immune deficiency, I have no problem with that."

"The problem is that once you say immune deficiency is acquired from that virus your response will be anti-retroviral drugs,'' he added.

After Time published the interview, government-sponsored advertisements were placed in national newspapers to "clarify" the government's position.

The advertisement read:

"The published edited version in Time, on which many critics now depend, conflated his remarks in a way which could give rise to a misunderstanding over his use of the word 'no' after being asked if he was prepared to acknowledge that there was a link between HIV and AIDS. In fact, the president went on to say 'you cannot attribute immune deficiency solely and exclusively to a virus'. The context of the full transcript makes it expressly clear he was prepared to accept that HIV might 'very well' be a causal factor."

Mbeki Fingers CIA in AIDS Conspiracy (September 2000)

In an address to African National Congress MPs at a caucus meeting in Parliament on September 28, 2000, Mbeki was reported as saying that the CIA was working covertly alongside the US pharmaceutical industry to undermine him as he posed a risk to drug company profits. Mbeki denied the story as a "pure invention", in a BBC Hard Talk interview.

According to an article in the Mail&Guardian, Mbeki had also said that South Africa's leadership of the developing world was threatening the world economic order, and the HIV/AIDS case was one example where corporate entities were putting pressure on him to ease his offensive against traditional economic structures.

He allegedly stated that if HIV caused AIDS, then it followed that the condition should be treated with drugs produced by big Western drug companies. He also allegedly accused the TAC of being funded by US drug companies and accused fellow Cabinet members of disloyalty to the presidency.

Shortly after the article was published, Mbeki announced to the ANC's National Executive Committee that he was withdrawing from public debate on the science of HIV/AIDS, according to the Sunday Times.

Ten days later, the AFP reported that Mbeki said his comments "didn't represent a withdrawal" and he would "continue to be interested in various questions in regard to this".

Mbeki Questions HIV Testing (2001)

On April 24, 2001, an interview between investigative journalist Deborah Patta and President Thabo Mbeki was aired on e.TV, a South African independent television channel.

Patta asked the president whether he would take an HIV test. Mbeki replied:

"So the matter of whether I take an HIV test or not I think is irrelevant to the matter. It might be dramatic, and make newspaper headlines …

[Patta (interrupting:] But would it not set an example — the president takes an AIDS test?

Mbeki: No, but it would be setting an example within the context of a particular paradigm … Now I don't believe that stunts — publicity stunts — help in addressing the health needs of our people …"

Mbeki also referred to the experiments that were being conducted by the Presidential Advisory Panel to interrogate the HIV test.

"Let's deal with the science of it. The panel said one of the things we have got to do is to determine when you do an HIV test, what is the test testing. And those were the scientists: what is it measuring? So I go and do a test, I'm confirming a particular paradigm. It doesn't help in addressing this health need."

He also continued his defence for not providing AIDS drugs on grounds of toxicity:

"So, do I go down the street dispensing these pills knowing from the best science there is that there are these consequences which science itself says we don't know enough? No."

Mbeki and AIDS Mortality (2001)

In an interview with Tim Sebastian on BBC World's Hard Talk (6 Aug 2001), Mbeki defended his stance that AIDS was caused by multiple factors. When asked whether he accepted that his position had "actually damaged the fight against AIDS in this country", Mbeki said he didn't.

He said that the "largest single cause of death as we sit here is what in the medical statistics is called external causes and that is violence in the society".

His position was refuted in the media. In September 2001, a letter addressed to Health Minister Manto Tshabalala-Msimang from Mbeki was leaked to the Business Day, a national South African daily. The letter instructed Tshabalala-Msimang to examine 1995 WHO data that showed AIDS to be the cause of just 2.2% deaths in South Africa. Mbeki referred to the WHO website as a source for the material. The fact that he was using old data caused a furore in the media. The low statistics were quickly discredited by a Medical Research Council (MRC) report released in the same month, which estimated approximately 40% of deaths of working age adults were due to AIDS (see more about this below).

Mbeki wrote in his letter:

"I believe that these [1995 WHO] figures present us with the challenge to answer a number of social and medical questions … Of course, I assume that they represent a more or less accurate picture of the causes of death in our country. If this is the case, some of the questions we have to answer are:

* What social policies have we put in place to reduce the incidence of death, bearing in mind the importance of the causes of death by rank?

* Do our health policies and therefore the allocation of resources reflect the incidence of death as reflected by these figures? and,

* Are the programs of the state medical research institutes geared to respond to the profile of the incidence of death as reflected by these statistics?

… Needless to say, these figures will provoke a howl of displeasure and a concerted propaganda campaign among those who have convinced themselves that HIV/AIDS is the single biggest cause of death in our country

Nevertheless, whatever the intensity of the hostile propaganda that might be provoked by the WHO statistics, we cannot allow that government policy and programs should be informed by misperceptions, however widespread and well established they may seem to be …"

The MRC's report on the AIDS impact on mortality statistics released the same month, September 2001, stated that AIDS was the leading cause of death and was responsible for nearly half the deaths (40%) of working-age adults. The report predicted that HIV and AIDS would account for 66 percent of all deaths by 2010 and that the death-toll from the disease would have risen to between five and seven million by that time. (See Statistics Factsheet for the most up-to-date HIV/AIDS statistics.

Mbeki's Cabinet initially tried to block the report, but the Sunday Times obtained a leaked version and published portions of it.

The MRC's president, Malegapuru Makgoba, was hopeful at the time that the report would lift the country out of its "complete denial" (source).

Instead, the ANC asked for more credible statistics. In a report in The Star newspaper, Smuts Ngonyama said the exclusion of "other stakeholders" from the MRC report was causing "problems" for the ANC. "All we need is credible statistics agreed to by all stakeholders," said Ngonyama.

Tshabalala-Msimang meanwhile castigated the MRC for its "regrettable actions".

"It is highly regrettable that employees of the MRC, who themselves are government employees, should have chosen to act in ways which place themselves in a hostile position vis-a-vis the government, and it will be necessary for this serious situation to be attended to," she said in a statement issued by the Government Communication and Information System.

Later, Tshabalala-Msimang wrote to the board of the MRC, asking for a forensic audit to be undertaken in order to establish who had leaked the report to the media.

Mbeki, AIDS and Race (October 2001)

In a lecture at Fort Hare University in late October 2001, Mbeki inferred that traditional explanations of the sexually transmitted diseases were racist.

Reported the Mail&Guardian:

"Mbeki's address, at the inaugural ZK Matthews memorial lecture on October 12, makes no direct reference to the disease.

However, after referring to medical schools where black people were "reminded of their role as germ carriers", he says: 'Thus does it happen that others who consider themselves to be our leaders take to the streets carrying their placards, to demand that because we are germ carriers, and human beings of a lower order that cannot subject its [sic] passions to reason, we must perforce adopt strange opinions, to save a depraved and diseased people from perishing from self-inflicted disease.'

He returns to the theme two paragraphs later: "Convinced that we are but natural-born, promiscuous carriers of germs, unique in the world, they proclaim that our continent is doomed to an inevitable mortal end because of our unconquerable devotion to the sin of lust." (read full speech)

In a parliamentary debate in 2004, Mbeki lashed out at people who saw a link between HIV/AIDS and the sexual behaviour of black Africans. The Mail&Guardian reported him as saying:

"I will not keep quiet while others whose minds have been corrupted by the disease of racism accuse us, the black people of South Africa, Africa and the world, as being, by virtue of our Africanness and skin colour, lazy, liars, foul-smelling, diseased, corrupt, violent, amoral, sexually depraved, animalistic, savage and rapist." (see full speech)

Using language which disconcerted some of his own supporters, Mbeki said certain white people regarded black people as 'rampant sexual beasts, unable to control our urges, unable to keep our legs crossed, unable to keep it in our pants'."

In a 2002 research paper, South African researcher Mandisa Mbali described Mbeki's HIV/AIDS position as a struggle "fuelled by his own mistaken belief that Western biomedical mainstream understandings of the causes and treatments of HIV and AIDS are part of a plot to discredit Africans, their culture and sexuality. In arguing this he is wrestling with the ghosts of colonial medicine and old traditions in Western culture projecting ‘negative' sexual practices and sexual traits onto the Other." (read paper)

The Prevention of Mother-to-Child Transmission Programme

In August 2000, the South African health ministry decided that the use of nevirapine for the prevention of mother-to-child transmission (PMTCT) would first be tested for two years at 18 pilot sites — two for every province — around South Africa , "to determine whether or not the exercise would be feasible". (Health MinMEC Minutes cited by Heywood, 2003).

The progress of the programme was slow and haphazard, resulting in the Treatment Action Campaign instituting legal proceedings in August 2001.

Quotable Quote

"Our government has ignored science, economics, morality, good planning, good governance and the law for more than five years on this issue. We've organised, marched, presented petitions and government has ignored every decent plea for them to do something. That's why we've taken this step," — Zackie Achmat on why the TAC was taking government to court, August 2001.

The TAC, together with Save Our Babies (SOB) and the Children's Rights Centre (CRC) in Durban filed a case against the government:

On 14 December 2001, the Pretoria High Court ordered the government to allow nevirapine to be prescribed to pregnant women in South Africa where "medically indicated" and develop "an effective comprehensive national programme to prevent or reduce MTCT" by March 31, 2002, for further scrutiny by the Court." (see excerpt of judgement).

The government delayed the process with a notice of intention to appeal the matter before the Constitutional Court, effectively freezing the original order. Subsequently, in March 2002, the TAC applied for part of the Pretoria High Court order to be executed. The request was granted.

In an SABC interview, Tshabalala-Msimang was asked whether the government would respect the court order.

"No, I think the courts and the judiciary must also listen to the authorities — regulatory authorities — both from this country and the United States," she said. Asked to clarify if she was saying no, Tshabalala-Msimang said: "Yes and no. I'm saying no."

During this time, some provincial governments took advantage of the High Court's decision by instituting their own PMTCT programmes.

In February 2002, KwaZulu-Natal Premier Lionel Mtshali — a member of the Inkatha Freedom Party, a rival party to the ANC — announced that the provincial Department of Health would roll out a province-wide MTCT programme and said he had accepted the free donation of nevirapine from Boehringer Ingelheim for five years. In his speech, he questioned the government's AIDS policy:

"As a Premier who heads a legitimate government, I must ask myself, as our posterity will undoubtedly do, what went wrong in South Africa for a judge to have to order us to have a plan and re-prioritise in order to save our children. Certainly, history will judge us harshly for the appealing of this ruling and the many unfounded attacks made on it on the grounds that it threatens to interfere in government policy-making. ... I will not have another 20,000 HIV positive children who could have been saved on my conscience in 2002. (read full speech)

He also attacked Mbeki's AIDS denialism. "HIV causes AIDS. In this province this axiom of science is not open to bizarre personal theories with no relation to reality."

Gauteng Premier Mbhazima Shilowa — a member of the ANC — committed his government similarly to a nevirapine PMTCT programme, albeit with a more politically correct statement.

On 5 July 2002, the Constitutional Court upheld the 2001 High Court decision and ordered the government "without delay" to make nevirapine available for the prevention of mother-to-child transmission at public hospitals and clinics.

Also see: Heywood, 2003. Preventing mother-to-child HIV transmission in South Africa: Background, strategies and outcomes of the Treatment Action Campaign case against the Minister of Health)

Peter Mokaba and the Castro Hlongwane Document

In early 2002, an AIDS dissident lobby group within the ANC circulated a paper purportedly authored by high-level ANC officials which denounced the use of antiretroviral drugs. Entitled Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics: HIV/AIDS and the Struggle for the Humanisation of the African, the 114-page document was written off as "ludicrous" by Dr. Saadiq Kariem, the ANC's health secretary and a qualified epidemiologist.

"I can't imagine anything more farfetched than that," he was quoted as saying in an Associated Press article.

The document claimed that presidential spokesperson Parks Mankahlana had died, "vanquished by the anti-retroviral drugs he was wrongly persuaded to consume". It also alleged that South African AIDS icon, Nkosi Johnson, had died of antiretrovirals he "was forced to consume".

The late Peter Mokaba has been cited as the editor of the "collected works", but it has also been alleged that Mbeki had a hand in the document.

Mokaba campaigned for the removal of antiretrovirals, saying they were poisonous and that HIV didn't exist. Mokaba also said he had discussed the document with Mandela before its release. Although AIDS policy was a sensitive issue at the time, Mbeki did not attempt to silence Mokaba.

"How can you have a situation where you must ban ideas?" ANC spokesperson Smuts Ngonyama, told the New York Times. "We are coming from a situation in this country where organizations were banned, newspapers were banned, people were banned. Are we returning to that stage now?"

Mokaba also denied having AIDS himself: "I was ill with something in my lungs and there was no HIV. The reason why that story emerged is that people were fighting with President Mbeki and they wanted to use a person who is regarded to be Mbeki's man to say: 'But his own lieutenants are dying of AIDS'," he told The Star.

Mokaba died in June 2002 of acute pneumonia amid rumours of an AIDS-related death.

Mbeki Distances Himself from AIDS Dissidents (April 2002)

By April 2002, in the wake of vociferous international and local criticism, President Thabo Mbeki had distanced himself from AIDS denialists.

In April 2002, Mbeki instructed the health minister to write letters to dissidents requesting them not to use his name when signing letters or documents, according to a Sunday Times report. Some dissidents had signed "Member of President Mbeki's AIDS Advisory Panel" in dissident literature.

The report said Mokaba was also silenced by the government and that Mbeki "will refrain from expressing his personal views in public and will instead reiterate the official position when questioned on Aids".

However, this was not the last time Mbeki's views on AIDS science were questioned.

In September 2003, The Washington Post reported Mbeki as saying, "Personally, I don't know anybody who has died of AIDS." Asked whether he knew anyone with HIV, he reportedly said, "I really, honestly, don't." At the time, the newspaper reported one in 10 South Africans — nearly 5-million people — was infected with HIV according to government statistics (BBC story).

HIV/AIDS and Nutrition

In March 2003, Tshabalala-Msimang invited Roberto Giraldo, an influential dissident scientist and member of Mbeki's Presidential Advisory Panel, to advise the government on nutrition.

Giraldo had in January that year briefed South African Development Community health ministers, angering Aids activists. Giraldo told the meeting:

"The transmission of Aids from person to person is a myth … The homosexual transmission of the epidemic in Western countries, as well as the heterosexual transmission in Africa , is an assumption made without any scientific validation."

Tshabalala-Msimang said that Giraldo was invited based on his expertise in nutrition, and said "our own strategic plan is based on the premise that HIV causes Aids. I am only looking for expertise in nutrition."

In April 2005, Tshabalala-Msimang defended controversial vitamin proponent Matthias Rath. She said nutrition was the foundation of fighting disease, including HIV/AIDS, and that the Rath Foundation, which advertised "natural" treatments for AIDS, was "not undermining government's position".

"If you eat properly you can delay the onset of AIDS — in some cases indefinitely," she said, according to a Business Day report.

The Dr Rath Health Foundation Africa and the Treatment Information Group advertise "natural health" treatment, including the use of multi-vitamins, to fight AIDS. Their adverts also claim that antiretroviral drugs are highly toxic and dangerous (see advert).

The adverts have been condemned by the South African Medical Association (source), the Southern African HIV Clinicians' Society (source), the World Health Organisation and the United Nations (source). The Advertising Standards Authority of South Africa ordered the withdrawal of some of the newspaper advertisements and fliers published by the group because they contained unsubstantiated claims.

However, Tshabalala-Msimang has never publicly condemned Rath's activities, prompting the TAC to file court papers against the minister, Rath and some of his associates, the Medicines Control Council (MCC) and the Western Cape MEC for Health in late November 2005 (see TAC newsletter).

Also see: See the Journ-AIDS Treatment Factsheet for more information on Matthias Rath.

TAC and Civil Disobedience

On 21 March 2003, 200 AIDS activists marched to the Sharpeville police station to lay charges of manslaughter against Health Minister Manto Tshabalala-Msimang, for not rolling out antiretroviral treatment, and against Trade and Industry Minister Alec Erwin, who had blocked the production of generic drugs in South Africa.

It was the beginning of a civil disobedience campaign, entitled "Dying for Treatment", that was in many ways reminiscent of the anti-apartheid struggle. On March 25, protestors disrupted a speech by Tshabalala-Msimang in Cape Town. The TAC also picketed outside the new R26-million magistrate's court complex in Khayelitsha, which Mbeki was opening.

Three weeks later, Tshabalala-Msimang accused TAC Chairman Mark Heywood of manipulating black people into civil disobedience. Picketers outside the welcoming ceremony for the Global Fund for HIV/Aids, TB and Malaria, had apparently angered Tshabalala-Msimang.

The Mail&Guardian reported on "The madness of Queen Manto":

"She then launched into a blistering, sarcastic attack that left senior government officials, Feachem and the rest of the high-profile audience cringing. 'They come with two buses and go to the commissions where they wait for the white man to tell them what to do ... Our Africans say: ‘Let's us wait for a white man to deploy us ... to say to us ... you must toyi toyi here.'

Tshabalala-Msimang spoke of Heywood as a white director holding sway over a group of impotent black actors. Without referring to him by name she said that this 'white man' was among the guests. Feachem looked bemused at Tshabalala-Msimang's continuous reference to this 'white man'.

Heywood was clearly furious. 'You are lying, minister,' he retaliated.

There was a deathly silence until Tshabalala-Msimang thanked him for speaking up, saying she was happy she did not have to mention him by name."

The TAC suspended their civil disobedience campaign when then Deputy President Jacob Zuma appealed for political space until May 17 2003, when a full-day meeting between the SA National Aids Council and TAC would be held.

An antiretroviral treatment plan was announced by Cabinet in November 2003, but slow rollout ensured TAC protests continued.

In July 2005, the TAC again marched to Frontier Hospital, Queenstown, to hand a memorandum to management condemning the inadequate ARV roll out in the Chris Hani Municipality, the hospital's ARV task team's relationship with the TAC, and allegations of mismanagement in the hospital. The police used tear gas and rubber bullets to disperse the crowd. At least one person was taken to hospital. (see TAC statement).

Antiretroviral Treatment

Also see: Treatment

South Africa 's controversial AIDS treatment history over the past decade has resulted in considerable media focus and attention.

After years of withholding general antiretroviral treatment in the public health sector, arguing that the drugs were unaffordable and inappropriate, the SA Cabinet announced its approval of the SA National Department of Health's Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (1.9MB) in November 2003. The five-year plan provided for ARVs to be made available in the public health sector for the first time on a large scale.

The Cabinet announcement cited "favourable conditions", including falling drug prices and growing experience in fighting HIV/AIDS as reasons for the implementation of the plan at this stage.

Planned number of patients on antiretroviral treatment vs no. of new AIDS patients per year

Years

ARVs

Total Cases on ARVs (planned)

Projected total new AIDS cases 1

2003/2004

53,000

53,000

388,701

2004/2005

138,315

188,665

462,841

2005/2006

215,689

381,177

530,658

2006/2007

299,516

645,740

586,181

2007/2008

411,889

1,001,534

624,720

1. Data from Table 16.1. Represents new AIDS cases per year and not a culmative total.

Source: SA National Department of Health, 2003. Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (1.9MB)


However, the government was not able to meet its own projections as set out in the table above. By March 2005 about 104,600 people (44,600 public sector; 60,000 private sector) were being treated with ARVs in South Africa, out of a WHO-estimated 837, 000 who needed the treatment (Dec 2004).

Also see : WHO "3 by 5" country profile on treatment scale up in South Africa (June 2005).