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Public (health) enemy No. 1?

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

May 22, 2000
Web posted at: 4:29 p.m. EDT (2029 GMT)

In what many public health experts consider to be a turning point in the fight against AIDS and HIV, President Bill Clinton has declared the world AIDS epidemic a threat to U.S. national security. But if the American government's perspective represents two steps forward, recent statements by South Africa's President Thabo Mbeki can only be viewed as taking one step back.

Mr. Mbeki recently said that AZT was "too dangerous" to give to pregnant women infected with HIV, even though the practice is viewed by medical experts, public health officials, and AIDS activists as an effective and promising method to prevent the transmission of HIV from mother to newborn. More disconcerting is the group Mr. Mbeki has assembled to advise him on AIDS issues, which includes a number of so-called AIDS "denialists" who hold that HIV is not the causative agent of AIDS.

Center for Bioethics

What's your opinion?

Mr. Mbeki may use the information from the advisory group to help make public health policy decisions for his country -- including whether to spend money on drug programs for HIV-infected citizens, or for public health campaigns to discourage practices that increase risk of contracting AIDS. What will be the impact on the AIDS epidemic for Africa and the world, and what should be the response of the world's public health community to Mr. Mbeki's views?

Individual suffering, global impact

Public health professionals and HIV/AIDS experts have long been concerned that the devastation caused by the disease in the developing world is not only tragic for individuals and their countries, but will have serious implications for the developed world as well.

Estimates are that 1 in 10 people in South Africa are infected with HIV, with much higher rates in other African countries. The virus can be passed by sexual contact, and for some reason passes from women to men at higher rates of efficiency than has been observed so far in the West. Spouses can easily infect each other, and mothers can pass the infection on to their children.

As adults become sick and die, they consume scarce medical resources and leave behind orphaned children. This cycle devastates individuals and families, and in the process, undermines already shaky economies. The effects ripple out; as the epidemic claims a higher proportion of lives in successive generations, more and more resources are depleted.

When leaders speak, citizens listen

These are all real concerns for the leaders in the developing world, who must chart a course for their countries. They must decide how much of their limited health care funds to spend on treatment or prevention of infectious diseases, prenatal care, vaccinations, and many other needs. If policies are made based on claims that AIDS isn't infectious or caused by HIV -- rather than the standard view of the disease -- there could be very different implications for a country's public health outlook.

Holding minority views is the right of all individuals, but positions of leadership carry special responsibilities. If Mr. Mbeki promotes the view that AIDS is not caused by an infectious virus, then citizens in his country and throughout Africa may ignore public health warnings about safe sex and other risky behavior. Given his stature as the president of one of the most influential countries in Africa, Mr. Mbeki's endorsement of the denialist position will only discourage safe behaviors, and perhaps even encourage conspiracy theories promoting AIDS as a weapon of the West against the developing world.

History teaches that good public health requires good information, and ignoring the facts about an epidemic can only deepen and extend its devastating effects. World leaders enjoy the freedom to speak their minds, but must temper their views in light of their positions and responsibilities. Otherwise they risk betraying the public trust and jeopardizing public health.

President Clinton has declared the world AIDS epidemic a threat to U.S. national security. But at the same time South African President Thabo Mbeki has disputed the use of AZT as a treatment for HIV, and his expert advisory group includes a number of people who hold that HIV is not the cause of AIDS. How will these views affect the spread of AIDS in Africa and the rest of the world? What are the responsibilities of world leaders when it comes to public health? And what should be the response of the world's public health community to Mr. Mbeki's views?

Post your opinion here.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.


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