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Africa's AIDS crisis finds leaders squabbling

South African president Thabo Mbeki, hosting the 13th International AIDS Conference, is fiddling while his country dies, say a growing number of AIDS scientists and activists. During the five days of the conference alone, 9,000 South Africans will be infected with HIV; 2,600 will see their HIV infection progress to full-blown AIDS; and a further 1,800 South Africans will die of the disease.


Yet, in his keynote speech to the conference on Sunday, Mbeki again refused, to the consternation of the vast majority of the AIDS-treatment community, to unambiguously stress HIV infection as the cause of AIDS. He insisted, instead, that poverty is the prime cause of death and disease in Africa. Mbeki isn't denying an AIDS crisis. Far from it; he's committing his government to redouble its efforts. But what's at issue in his clash with AIDS scientists is the cause, and therefore the solution, to the epidemic.

Of course, this is nothing new for the South African president, who set alarm bells ringing in the scientific community and the White House this spring by publicly questioning the HIV-AIDS link, and inviting two discredited U.S. scientists who argue that HIV is not the cause of the disease to serve on a government advisory panel. But while Mbeki insists he is merely exercising his right to hear all opinions, critics -- including most of the medical community in his own country -- charge that this is dangerous dabbling that deflects from the primary objective of stopping the spread of HIV.

Mbeki is certainly on solid ground in stressing that economic factors determine who will survive and who will die of AIDS. Drug treatments that have successfully slowed the onset of AIDS in HIV-positive people in the West would, even at discounted prices, cost at least $1,000 per patient every year, on a continent where average annual incomes are well below $400 and 25 million people are believed to be infected. Indeed, pharmaceutical corporations will take even more heat than Mbeki has from the activists and scientists involved in the conference, many of whom urge dispensing with profit motives and intellectual property rights when 25 million human lives are at stake.

With U.N. experts projecting that at least $3 billion a year is needed to simply contain the spread of HIV in the continent without even beginning to treat it, assistance from the West also becomes a matter of life and death -- Africa currently spends some $15 billion each year simply on servicing its debts to the industrialized world. Of course, while Mbeki champions this point of view, domestic critics question whether it 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.

Many of the scientists involved in the conference had hoped to foreclose what they see as a debate that was resolved a decade ago by signing onto to the a manifesto published in Nature magazine underlining the urgency of curbing the spread of HIV as the priority in the fight against AIDS. The declaration concurs that economic factors such as malnutrition make those infected more prone to the rapid onset of AIDS following HIV infection, and also that poverty puts lifesaving treatments beyond the means of the overwhelming majority of those infected. But it stresses that "none of these factors weakens the scientific evidence that HIV is the sole cause of the AIDS epidemic."

That declaration infuriated Mbeki's government, which saw it as a political attack and reportedly put pressure on South African participants to cancel a press conference scheduled for Monday to discuss its contents. And in Sunday's , Mbeki dashed expectations that he'd back away from his earlier pronouncements. Referring to the AIDS phenomenon, Mbeki said "it seemed to me that we could not blame everything on a single virus." That left conference-goers disappointed and alarmed, as it was left to maverick populist Winnie Madikizela-Mandela to speak the simple truths about South Africa's AIDS crisis during a rally outside the conference that berated Mbeki's government for failing to act with the requisite urgency: HIV causes AIDS, she told protesters, and people infected need treatment drugs. After all, the salient reality remains that another person dies of AIDS every four minutes in South Africa, and five more people are infected with HIV.

Copyright © 2000 Time Inc.


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