Mbeki’s AIDS Denial: Grace or folly? Part IV

http://www.pambazuka.org/images/articles/368/47585aids.jpgPambazuka News continues to serialise William Gumede's chapter on Mbeki and the controversies surrounding his AIDS policies. This is from his book 'Thabo Mbeki and the Battle for the Soul of the ANC'. Be sure to look for the last part in the next issue.

For COSATU, the link between HIV and AIDS was irrefutable. General secretary Zwelinzima Vavi pointed to the success of Brazil, a country with similar income disparities to South Africa, in providing medication to its infected citizens, and called on the government to declare a national emergency in terms of TRIPS so that ARV delivery could start.

Formal criticism from inside the ANC was slow to emerge, with those who differed from Mbeki scared of reprisals if they spoke out. Most criticism was uttered in hushed tones, but Madisha’s and Vavi’s relentless public attacks on Mbeki’s AIDS stance opened the way for other prominent black figures to join the choir.

Some had kept their own counsel for fear of being lumped with white conservatives who had taken up the AIDS cudgel only because they could use it to bash the ‘inept’ black government. Thanks to Madisha, Vavi and prominent scientist William Makgoba, the Mbeki-ites could no longer charge that criticism was confined to white reactionaries bent on undermining the black government.

Once the wall of silence had been breached, the AIDS policy came under fire from within. Some of the harshest critics were members of the ANC’s health committee, one of the party’s constitutional structures, while former health minister Nkosazana Dlamini-Zuma told Mbeki privately that his stance was undermining not only the government’s own policy, but his presidency.

The most serious opposition came from individuals serving on the ANC’s powerful NEC, but only as late as mid-2000. At an NEC meeting in Johannesburg, Dlamini-Zuma and Shepherd Mdladlana cautiously warned that Mbeki’s high-profile international advisory panel on AIDS was adding to confusion over the official AIDS message. They couched their arguments in a way that spared Mbeki from direct criticism, emphasising that the government’s message was not being effectively conveyed. They also warned that AIDS had the potential to undermine the ANC’s efforts in the 2000 local elections, given that opposition parties and civil movements were threatening to make AIDS, as well as slow social delivery to the poor, central campaign issues.

Mbeki loyalists such as Essop Pahad and Manto Tshabalala-Msimang responded dismissively that government was doing enough, within its capacity, to deal with the AIDS crisis. They listed AIDS education programmes and the amounts spent on them, arguing that it would cost too much to accede to calls by NGOs, trades unions and churches for the government to supply ARVs to all AIDS sufferers. Tshabalala-Msimang reiterated that the toxicity of ARVs had not been unequivocally determined, and cited warnings by the American government that some ARVs were believed to be so toxic that their use could prove fatal.

Mbeki was adamant that he would not backtrack on any of his AIDS statements, and continued to believe that his views were correct.

But he did agree, albeit reluctantly and unhappily, to refrain from further public comment on AIDS, at least until after the municipal elections. His chief policy guru, Joel Netshitenzhe, was assigned the unenviable task of extricating Mbeki from the hole he had dug for himself, without repudiating anything the president had previously said on the subject of HIV and AIDS.

Fully aware of the damage that had been done to the government’s reputation, Netshitenzhe fell back on the spin doctor’s hardy annual and attacked the media for colluding with critics of the official AIDS policy. Insisting that the government’s programmes were fully effective but not ‘on message’, he got the go-ahead for a R2-million advertising blitz that would somehow make it clear that neither the president nor anyone else in a position of authority had ever said that there was no link between HIV and AIDS.

‘We want to put the theorising behind us and programmes to fight the pandemic in front of us,’ said one senior NEC member optimistically. Mbeki’s international AIDS advisory panel would continue to meet, but behind the scenes, and the president would avoid all public reference to the pandemic until the local government ballots were cast.

The advertising campaign failed to clear up the confusion, not least because no one could admit what lay behind Mbeki’s withdrawal from the public AIDS debate. And since the dissidents continued to use his name in support of their own agenda, his silence was widely interpreted as confirmation that he did not agree with the messages imparted by official government policy.

In the wake of the NEC meeting, members of the ANC’s parliamentary wing became emboldened enough to make their voices heard on a range of issues, including the economic policy, Mbeki’s ineffective ‘quiet diplomacy ’with Zimbabwe and AIDS.

Nelson Mandela tried to meet with Mbeki to raise his concerns over the AIDS policy, but the president was smarting over what he saw as his predecessor’s constant criticism on the subject, and refused to take Mandela’s calls.

At a special meeting of the ANC’s parliamentary caucus in October 2000, Mbeki raged against senior leaders who criticised him in public, specifically on AIDS and Zimbabwe, and slammed the media for its coverage of the AIDS debate.

In contrast, he spoke approvingly about a conference in Uganda the previous month, where some 60 dissident scientists had argued convincingly that there was no scientific proof that HIV caused AIDS. He quoted from a document stating that the virus had never been isolated, and said reports that Uganda had scored significant successes in the fight against AIDS were untrue.

He told the gathered MPs that if one agreed that HIV causes AIDS, it followed that the treatment lay with drugs manufactured by Western corporations. The pharmaceutical companies therefore needed people to believe that HIV and AIDS were linked, in order to peddle their products. One drug company, which he did not name, had confessed, he said, that it had spent vast amounts of money on the search for an AIDS vaccine, but had abandoned the effort after failing to isolate the virus. This fact remained hidden from the public, Mbeki claimed, because the company’s share price would plummet if the truth were told.

He accused the CIA of being involved in a covert plot to spread the belief of an HIV/AIDS link, and cited statistics showing that 10 per cent of Africans died of AIDS. It made no sense, Mbeki argued, to focus the bulk of a state’s resources on this 10 per cent, to the detriment of the remaining 90 per cent. Drug companies continually urged governments to pay attention to a growing number of AIDS orphans, but how, asked the president, were the authorities to distinguish between the needs of AIDS orphans and orphans of any other kind?

He claimed he had the support of the editor of South Africa’s conservative daily newspaper, the Citizen, but said it was less clear that members of his own cabinet stood with him on this issue. They should declare their positions, he said, and the ANC’s MPs should join him in fighting off attempts by international forces to undermine him and the government’s agenda.

Those within the ANC who criticised him were playing into the hands of the local and foreign media – some of whom had dared to describe his views on AIDS as deranged – and unwittingly supporting the campaigns of the powerful drug companies and their allies, Western governments opposed to Mbeki’s vision of success for developing countries.

Before launching his tirade, Mbeki had made it clear to caucus chair Thabang Makwetla that he would take no questions. Deeply shocked by the virulence of his attack, none of the ANC MPs challenged anything he said. According to one, ‘there was a stunned silence in the room’.

Throughout his presidency, Mbeki’s Achilles heel has been his uncompromising ‘you are either with us, or against us’ attitude. He sees all criticism of government policy as a personal attack, and those who dare express views that contradict his own are categorised as secretly hating him, or, worse, wanting to topple him.

His censure of the AIDS critics choked any further criticism of the government’s policy. Not even the bravest ANC leaders would risk being labelled allies of a hostile ‘white’ media, greedy drug manufacturers or covert Western intelligence conspiracies.

In October 2001, during question time in parliament, it emerged that a number of ANC parliamentarians were taking ARVs, paid for by their state medical aid. The inescapable conclusion among activists was that the government could afford to pay for medicine for its own officials and representatives, but such help was too costly for the masses. Former opposition Pan Africanist Congress firebrand Patricia de Lille openly denounced the government’s ‘absolute hypocrisy’, but Mbeki’s response was merely to warn the ANC MPs that the drugs could be toxic. Having successfully drawn a curtain of silence over AIDS critics within the ANC, the president broadened his attacks to include black intellectuals, activists and individuals of all political persuasions who agitated against the government’s policies. A particularly vicious campaign was launched against outspoken physicist and political analyst Sipho Seepe, while Essop Pahad slammed local medical experts as ‘pseudo-scientists’.

Mbeki accused William Makgoba of deliberately leaking a long-awaited MRC report on the devastation wrought by AIDS in South Africa to the media before it was handed to him or the cabinet. Tshabalala-Msimang ordered a forensic audit to sniff out the source of the leak.

Achmat and TAC activists, many of them ANC cadres, were next to face Mbeki’s ire. He refused to meet any TAC representatives, telling confidants: ‘I will not give them the credibility of my presence.’ The vilification of Achmat as a pawn in the hands of Western interest groups intensified, and he was publicly accused of defying ANC discipline.

Achmat had infuriated Mbeki by travelling to Thailand in late 2000, buying 5000 fluconazole pills for 28 cents each, and bringing them back to South Africa in a well-publicised stunt. The government had him arrested for smuggling, and the attacks on the TAC only let up after Mandela visited a very sick Achmat at home in 2002 to plead with him to take ARVs.

Mandela lauded Achmat’s commitment to the ANC and praised him as a role model and loyal member, pledging to ensure that his protests were heard in the right government circles. ‘We were really under siege', Achmat later reflected, ‘and Nelson has given us protection. It was not for us that he did it. He’s not interested in opposing the government. He’s interested in doing what is right.’ Mandela had visited a clinic where the international humanitarian agency, Médicins Sans Frontières, was treating 400 patients with ARV and achieving a compliance rate that exceeded that of most AIDS clinics in America. After his emotional meeting with Achmat, the former president broke his own rule of non-interference with his successor’s governance and increasingly began criticising both Mbeki and the official AIDS policy in public. Mandela was greatly concerned about a growing perception that ‘the ANC does not care about the death of millions’.

He tried again to arrange a meeting with Mbeki, hoping to advise him that he and the First Lady, Zanele, should lead the anti-AIDS campaign. But every time Mandela called, Mbeki’s aides would say he was not available.

In November 2001, Mandela, frustrated at his inability to see Mbeki, used a speech at an ANC rally in the Cape Town settlement of Khayelitsha to extend the challenge to Mbeki and his wife to be the visible faces of government’s attempts to combat AIDS. ‘We have wasted time,’ he said, ‘but the more vigorous and focused we are in what we do, the greater the chance we have of moving forward.’ Mbeki was outraged. Yet again, he took the criticism personally, and privately accused Mandela of overstepping the line. He instructed aides to telephone Madiba and demand an explanation. Mandela denied that he had been attacking the president, and Mbeki finally agreed that they should meet, along with the ANC’s national working committee, to discuss the subject.

At the appointed time and place, however, Mbeki was conspicuously absent. Mandela joked that Mbeki was ‘too busy’, and told the committee that the government’s AIDS policy was creating the impression that it did not care if millions of South Africans died. He urged the immediate introduction of ARVs for pregnant women, as a start.

Jacob Zuma, standing in for the president, assured Mandela that the government was serious about the pandemic, but was not ready to roll out the ARV programme because the effectiveness of the drugs was still being tested in a pilot project. The only problem the government would admit to was one of communication, in keeping with Netshitenzhe’s earlier strategy.

Mandela agreed to reserve his doubts and questions for the next NEC meeting, which Mbeki would hopefully attend, but urged Zuma to play a leading role in the fight against AIDS, because Mbeki’s busy schedule frequently took him abroad.

Archbishop Tutu, just as exasperated as Mandela over the government’s vacillation on AIDS, went public with what was undeniably a rebuke of Mbeki:

'It would be tremendous if our president said this is the common enemy. The stance adopted by the president has harmed his image. He has done wonderfully well – the world thinks the world of him, I want to see him succeed. I think it is silly to hold on to positions that are untenable. At the present time, everybody recognises that the president’s position is undermining his stature in the world. When the New York Times is constantly bashing us over this issue, it is not good for us or for him. He has so much going for him.'

Tutu threw his full support behind efforts to prevent mother-to-child transmission of the virus. ‘Yes, this means the use of Nevirapine if that is what is available. It is irresponsible of us not to save lives we could save. It makes us appear hard-hearted where we are not. We are seen to be lacking in compassion and [seem] uncaring. Women who are raped should be put on a course to ensure that they are not infected.’

He also made the point that, whereas AIDS was considered a chronic condition in the United States, it was tantamount to a death sentence in South Africa. At a January 2001 cabinet meeting, Mbeki finally acknowledged that negative perceptions of South Africa’s AIDS policies were based not on bad communication, but on a lack of consensus over what the government’s message should be. A year later, he and his cabinet accepted, for the first time, that confusion over the policy was no longer a medical or scientific matter, but a major issue that was undermining the country’s interests.

The opposition Inkatha Freedom Party leader, Mangosuthu Buthelezi, decried the lack of leadership on the AIDS front and proposed more stringent monitoring of the activities of Mbeki’s international AIDS advisory council. In his State of the Nation address at the opening of parliament, Mbeki hinted at finally putting the issue to rest when he spoke of government’s intention to ‘intensify its comprehensive programme against AIDS’.

Ahead of the NEC meeting in March 2002, Nelson Mandela was attacked by a number of Mbeki-ites, including one of the president’s loudest cheerleaders, Dumisani Makhaye, a KwaZulu-Natal ANC leader. Thami Mazwai, the black entrepreneur in charge of a publishing house, also launched a broadside against Mandela in the mass-circulation Sunday newspaper City Press, accusing him of unprecedented interference in government affairs.

The NEC spent a whole day discussing the government’s AIDS policy. All the provincial health MECs had been invited to the meeting, but members of the ANC’s health committee, who had been critical of the failure to make ARVs freely available, were barred. When Mandela voiced his concerns, he was heckled and jeered by Mbeki supporters.

The loyalists urged Mbeki to bulldoze ahead with the controversial AIDS policies rather than reverse or revise them, lest this be seen as caving in under pressure from Mandela and others. After hearing impassioned arguments from the likes of Peter Mokaba, the NEC resolved that rape victims, health workers and pregnant women should not be provided with ARVs, because the effectiveness of the drugs remained unproven. The hardliners also pushed through a bizarre decision that the government would appeal against the recent judgment by Judge Chris Botha in the Pretoria High Court ordering that Nevirapine be given to pregnant women.

This was one of several truly extraordinary reactions by the government to a high court ruling. Immediately after it was handed down, then justice minister Penuell Maduna, a trained lawyer, said the judgment could be enforced only in the province where the case was heard. He later retracted his statement, but Tshabalala-Msimang said on national television that the government would not obey the court order. For Mandela, the NEC’s decision to appeal against the ruling was the final proof that people were justified in seeing the ANC as a party that did not care about those who were dying of AIDS.

*William Gumede is the author of Thabo Mbeki and the Battle for the Soul of the ANC - Published by Zed Books (http://zedbooks.co.uk). His latest book, 'The Democracy Gap - Africa's Wasted Years', will be published later this year.

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