Mbeki’s AIDS denial – Grace or folly? Part III
Pambazuka News continues to serialize 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 parts four and five in upcoming issues.
What made Mbeki turn to the AIDS dissidents? In July 1999,Anthony Brink, an advocate and the author of the online book Debating AZT, had given him and senior health department officials copies of his book, which argued that the so-called life-giving drug was highly toxic.[33] His interest aroused, Mbeki began doing further research on his own, via the Internet.
While surfing the Net, he stumbled on virusmyth.net, a website favoured by the international dissident community. On 28 October 1999, Mbeki told the National Council of Provinces that he had examined ‘a large volume of scientific literature’, which showed that AZT was dangerous.[34]
The orthodox scientific community has never claimed that AZT is not toxic, but makes the point that all drugs have side effects, and that those known to be caused by AZT were far outweighed by its benefits to AIDS patients.
But Mbeki had been seduced, and before long his meanders along the inform- ation highway led him to question whether HIV caused AIDS and whether the virus was sexually transmitted.The dissidents argued that HIV was a benign ‘passenger virus’, and that AIDS was a lifestyle disease caused by poverty, malnutrition and narcotic abuse by homosexuals. They claimed that, far from helping the infected, ARVs caused even greater damage to their compromised immune systems.[35]
The World Health Organisation and the MCC had classified AZT safe, but Mbeki, newly installed as South Africa’s president, decided that his health minister, Manto Tshabalala-Msimang, would be entrusted with determining the ‘truth’ about the disease and its treatment once and for all. On 2 December 1999 she met with AIDS dissident Charles Geshekter, and came away from their discussions convinced that the president was right to question views that had already gained wide international acceptance.
In his nocturnal online research, Mbeki also found the writings of American biochemist David Rasnick, a leading rebel against the conventional premise that AIDS stems from HIV. Mbeki contacted him by fax and spoke to him at length by phone, and soon the two were in regular e-mail contact. Rasnick enthusiastically agreed to support Mbeki’s quest for the ‘truth’. The president also made contact with another prominent AIDS dissident, Peter Duesberg, a professor of molecular and cell biology at the University of California in Berkeley.
There was a major stir when a South African newspaper published Rasnick’s assertions that ‘condoms don’t prevent AIDS because AIDS isn’t a sexually transmitted disease. In fact it isn’t contagious at all. AIDS in Africa is just a new name for the diseases of poverty caused by malnutrition, poor sanitation, bad water, parasites and so on. Using condoms to prevent the diseases of poverty is the leading obscenity of our time.’[36]
Mbeki was sincere in challenging mainstream science and in his support of AIDS dissidents. He stoically believed that he was a modern-day Copernicus who would ultimately be vindicated, even if posthumously. Needless to say, the dissidents, long banished to the scientific wilderness, latched on to the new legitimacy that the president provided, and it would prove all but impossible for Mbeki to dissociate himself from them later.
His next mission was to persuade unsuspecting world leaders of the dangers of treating AIDS with conventional methods. In a brazen and bizarre letter to Bill Clinton and UN secretary general Kofi Annan dated 3 April 2000, South Africa’s head of state defended an alternative approach to dealing with AIDS. In the five-page document, Mbeki passionately defended Duesberg and the other dissidents, and suggested that factors other than HIV could be the cause of AIDS in Africa. He called for a uniquely ‘African solution’[37] to the problem, as AIDS seemed to affect Africans differently to those who live in the developed world. He also defended his right to consult dissident scientists, and accused unnamed foreign critics of waging a ‘campaign of intellectual intimidation and terrorism’ akin to ‘the racist apartheid tyranny we opposed’. In an earlier period in human history, Mbeki wrote, Duesberg and his followers ‘would be the heretics that would be burnt at the stake. The day may not be far off when we will, once again, see books burnt and their authors immolated by fire by those who believe that they have a duty to conduct a holy crusade against the infidels.’[38]
The letter, copies of which were delivered by hand to Clinton and Annan, concluded: ‘It would constitute a criminal betrayal of our responsibility to our own people to mimic foreign approaches to treating HIV/AIDS.’[39]
The Clinton administration initially thought the letter was a hoax. Upon realising it was genuine, the contents were leaked to the Washington media. Mbeki was suitably embarrassed, and furious, convinced more than ever that Western leaders were conspiring against their African counterparts.
Bolstered by the counsel of the AIDS dissidents, Mbeki and Tshabalala-Msimang reiterated that the government would not provide ARVs through the public health system, adding the inability of existing infrastructure to implement the drug protocols to their earlier claims of toxicity and cost. Tshabalala-Msimang now argued that anti-AIDS drugs alone would have scant effect, and that the state simply did not have the money to simultaneously offer recipients clean water, sanitation, nutritional food and adequate housing.
Mbeki would charge his AIDS critics, especially those who were ANC members or belonged to the TAC, of being willing ‘to sacrifice all intellectual integrity to act as salespersons of the product of one pharmaceutical company.’[40] Later, he would use this accusation again, to attack ANC MPs critical of his policies,[41] and when he opened the international conferences on AIDS in Durban in July 2000, he lambasted activists in the same manner. He blocked every effort by civil society and private organisations to set up AIDS treatment projects involving ARVs, prompting Desmond Tutu to comment: ‘In South Africa we have to introduce a vibrant and lively education for the people. Churches and religious communities are already playing a role but are hamstrung by the constant worry about what government will say, when they ought to be on the same side.’[42]
Mbeki has consistently placed poverty at the heart of all South Africa’s health problems, and few disagree with him, in general. But he found no broad support for his insistence that AIDS should be treated as just another disease, like malaria or TB.The scariest realisation for many people was that Mbeki genuinely believed that a number of factors, including poverty, caused rather than exacerbated AIDS, and that HIV was not to blame.
Tshabalala-Msimang drew hoots of derision when she famously announced that people with AIDS should preserve their health not with drugs, but with a diet of garlic, lemon, olive oil and the African potato.[43] In March 2003,her credibility took another dive when she appointed Roberto Giraldo,a leading AIDS dissident and one of the most vocal naysayers regarding the link between HIV and AIDS, as a consultant on nutrition.
Amid mounting evidence of AZT’s effectivity and growing criticism of the government’s opposition to ARV distribution, he Mbeki-ites began searching for compliant scientists who would support them.
In October 1999, Tshabalala-Msimang had rejected a report favouring the use of AZT by South Africa’s MCC on the grounds that it had not been subject to a satisfactory review process. A month later, she commissioned the Cochrane Centre, an international health-care NGO that reviews clinical trials on new drugs and has branches all over the world, to research the risks of ARVs, especially AZT. Their preliminary study found strong evidence that both an intensive or shorter course of AZT was effective in decreasing the risk of mother-to-child transmission of HIV, even in breastfed babies. The most serious adverse effect the researchers identified was anaemia, but this condition tended to disappear once the full course of drugs had been concluded. Nevirapine, less expensive than AZT, was found to be both safe and effective.
These findings were given to the health minister in December. She filed the report and allowed it to gather dust while she turned to the National AIDS Council for an outcome more in line with dissident opinion, as well as her own. Tshabalala-Msimang appointed new members, renamed the former AIDS Advisory Council the Presidential AIDS Advisory Council, and extended the council’s influence to sectors not previously involved in AIDS programmes.
Activists saw through the ploy and criticised the council as just another attempt by Mbeki and his health minister to muzzle and marginalise those with a different viewpoint. In due course, the council would issue a report that did nothing but reiterate both the orthodox and dissident views on AIDS, without attaching particular weight to one or the other.
In a new affront to activists, government revealed that in the 1999/2000 financial year,40 per cent ofthe AIDS budget had gone unspent. Worse, it announced that funding of AIDS service organisations was to be cut by 43 per cent the follow- ing year. In March 2000, dismayed by government’s persistent obfuscation and continuous flirting with AIDS dissidents, Judge Edwin Cameron, Archbishop Njongonkulu Ndungane (head of the Anglican Church in Southern Africa),Bishop Mvume Dandala (head of the Methodist Church in South Africa), Professor Jerry Coovadia,(chairman of the 2000 International AIDS Conference) and Merci Makhalamele (a prominent AIDS activist) wrote a personal letter to Mbeki, expressing anxiety over the government’s head-in-the-sand policies. They also asked him to reconsider the decision not to provide life-saving drugs to pregnant, HIV-positive women.[44] The Sunday Independent was given a copy of the letter. Mbeki responded by fax, again questioning available evidence that AZT was safe and effective. He warned the signatories that a similar consensus had existed over the use of thalidomide, with deadly consequences. He urged them not to fall into the same trap.
Throughout all the polemic, Mbeki was telling senior ANC leaders that the magnitude of the AIDS crisis in South Africa had been exaggerated to serve the interests of the drug giants and NGOs. Unfortunately, South African AIDS statistics have been the subject of dispute for several years, but it remains the only country in Africa that has even remotely reliable figures, even though, as author Rian Malan45 points out, they are computer projections based on surveys on antenatal clinics.
The situation has not been helped by international studies of dubious credi- bility. As recently as 2003, the World Bank warned in a report that South Africa faced imminent economic collapse as a result of HIV/AIDS, and, even though respected local experts such as Standard Bank chief economist Iraj Abedian and the South African Business Coalition dismissed the report as inaccurate and unreliable, Mbeki grasped at hyperbole to defend his claims that the figures were inflated.
But the first extensive and broadly credible surveys on the incidence of HIV/ AIDS, conducted independently by the South African Medical Research Council and Statistics SA in 2000 and 2001, painted a bleak picture. They estimated that 5.3million South Africans would be infected with the virus by the end of 2002, and that it would be killing 600 people a day.[46]A government report leaked in late March 2004 said 100 000 public servants were HIV-positive, presenting a very real threat to normal government administration.
In August 2001, the government was back in court as the TAC and various NGOs claimed it was acting unconstitutionally by refusing to make ARVs available at state hospitals. In its March 2002 judgment, the Constitutional Court agreed, ordering that pregnant women should start receiving the drugs immediately. Still the government prevaricated, claiming that state hospitals did not have the infrastructure necessary to administer ARVs. It was not until seven months later that Nevirapine became available at some urban hospitals as part of a pilot scheme, and not until the eve of the 2004 election that distribution was extended.
Costs have unquestionably played a role in the government’s response to the AIDS crisis. GEAR, the economic policy adopted in June 1996,calls for economic austerity and financial prudence, and structural adjustment programmes have seen jobs frozen and public service cuts. In 2000,finance minister Trevor Manuel and Manto Tshabalala-Msimang sketched a gloomy picture for Mbeki of the costs involved in the proposed ARV roll-out, and the government concluded that it was not financially feasible to make the drugs available to all HIV-positive patients at state cost.
Thenjiwe Mtintso, assistant secretary general of the ANC at the time, pointed out: ‘Making antiretroviral drugs available is only one side of the story; the state will have to take responsibility for all the costs ofAIDS-infected individuals. The state doesn’t have that kind of capacity or resources.’[47][ Manuel was more blunt: ‘The rhetoric about the effectiveness of ARVs is a lot of voodoo and buying them would be a waste of limited resources.’[48]
Underlying the decision was an unspoken belief among Mbeki’s inner circle that spending money on ARVs would be futile, since the real problem lay with the reasons for South Africa’s masses being particularly vulnerable to AIDS. At its most cynical, the view suggests that the exchequer was to be spared the cost of subsidising treatment for the poor and unemployed, who were a drain on resources rather than contributors to the state coffers. It suggests that in the long term, resources would be better utilised by creating jobs, educating people, and fighting poverty and malnutrition.
Manuel said as much at a closed hearing of the committee that investigated the feasibility of a basic income grant: ‘It does not make financial sense to spend money on people dying anyway, who are not even productive in the first place.’[49] He apologised when he realised that the commissioners were shocked by his comments, but, far from being an isolated aberration, such sentiments were the driving spirit behind the economic mandarins’ response to the pandemic. The tendency to focus on the healthy has been the overriding objective of govern- ment’s financial managers.
In June 2003, Mbeki’s media spokesman, Parks Mankahlana, asked in an interview with Science magazine: ‘Who is going to look after the orphans of AIDS mothers, the state?’[50] The clear implication was that prevention of mother- to-child transmission of HIV would be counterproductive, since the children saved would end up as welfare cases in any event.
Of course, no one in government could say this publicly – it would simply be too cold-hearted. But Tshabalala-Msimang apparently had no qualms about allegedly telling London’s Guardianin 2002 that South Africa could not afford AIDS drugs because it needed submarines to deter US aggression, though she later denied saying anything of the kind. However, many authoritative studies show that public provision of ARVs with an uptake of around 50 per cent reduces the impact of HIV and AIDS on economic growth and greatly justifies the cost involved. One study calculated that a roll-out of ARVs could reduce the number of HIV/AIDS deaths by around 100000 a year between 2008 and 2010.[51]
Mbeki’s attitude to the AIDS problem was almost certainly strongly influenced by his great personal distaste for the stereotypical Western portrayal of black sexuality, which he condemns as racist and neo-colonial. In his mind, this viewpoint extended to scientific postulations that AIDS originated in the African jungle and was primarily spread through sexual transmission. Many share these views. In a lecture at Fort Hare University in 2001,Mbeki said: ‘And thus it happens that others who consider themselves to be our leaders take to the streets carrying their placards...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 oflust.’[52] The argument found support among many ANC leaders and intellectuals outside the party. Tshabalala-Msimang is a great believer in this precept, to which Achmat responds: ‘The president doesn’t want to believe that people in Africa have a lot ofsex.’[53]
In autumn 2002,Mbeki sent an e-mail to members of his cabinet, expanding on this thesis. A 114-page document, chiefly authored by former ANCYL head Peter Mokaba, virulently attacked pharmaceutical companies, ARVs and mainstream opinions on HIV. The sarcastic monologue lashed out at the bigotry that equates blacks with promiscuity and portrays Africans as diseased and poor, and always running to the West for aid:
Yes, we are sex crazy! Yes, we are diseased! Yes, we spread the deadly HIV through uncontrolled heterosexual sex! In this regard, yes, we are different from the US and Western Europe! Yes, we, the men, abuse women and the girl-child with gay abandon! Yes, among us rape is endemic because of our culture! Yes, we do believe that sleeping with young virgins will cure us of AIDS! Yes, as a result of all this, we are threatened with destruction by the HIV/AIDS pandemic! Yes, what we need, and cannot afford because we are poor,are condoms and antiretroviral drugs! Help![54]
Within weeks of writing the paper, Mokaba, like Parks Mankahlana, died from what is widely believed to be an AIDS-related disease, though their families persistently denied this.It was around this time that Mbeki announced that he would launch an international advisory council to investigate the high incidence of heterosexual infection in southern Africa and assess drug-based responses. Renowned medical scientist Jerry Coovadia urged him to leave science to the scientists.
Mbeki’s stubborn AIDS denial epitomised the ANC’s battle to keep its traditions of internal democracy alive as it underwent transformation from a liberation movement to a governing political party. The debate split the tripartite alliance down the middle, with COSATU and the SACP siding with the TAC, as did two ofthe great post-apartheid moralists, Nelson Mandela and Desmond Tutu. COSATU president Willie Madisha accused Mbeki of wasting his time on scientific speculation and hindering the fight against the disease. ‘The current public debate on the causal link between HIV and AIDS is confusing,’[55] Madisha worried publicly.
Privately, government officials warned that Mbeki’s intellectual approach was preventing the government from getting across the message that people should use condoms. Indeed, AIDS educationists frequently encountered resistance based on the argument that if the president did not believe there was a link between HIV and AIDS, unprotected sex posed no danger of infection.
A disturbingly high number of ordinary South Africans saw Mbeki’s views as an endorsement that, since AIDS was not sexually transferable, they had no reason to alter or modify their sexual behaviour.
The health department was as divided on the issue as the general public, with individuals having to battle their own consciences and decide whether they should administer ARVs and risk being fired, or follow orders. Many senior health officials at national and provincial level supported ARV distribution, and though he refused to talk publicly about the reasons for his departure, Tshabalala-Msimang’s director-general, Dr Ayanda Ntsaluba, quit and went to work for foreign affairs, allegedly because of his inability to reconcile his own beliefs with those of the minister and president.
Health professionals at state hospitals were also confused. Should they admin- ister life-saving ARVs or not? If they did, would they be punished? At grassroots level, health-care workers were dealing almost daily with the fatal consequences of confusion over government’s policy, which led the uninformed to believe that the disease was not transmitted sexually.
The greatest tragedy was that Mbeki failed to see that his refusal to acknowledge the effectivity of ARV treatment was undermining the entire AIDS education programme. It had been designed around the premise that HIV causes AIDS, and condom use was a mainstay of the government campaign that was being waged through awareness projects, educational television, radio, posters and in classrooms throughout the country.
*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.
**Please send comments to or comment online at www.pambazuka.org