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August 04, 2003

The Politics of Denial: AIDS, South Africa, and the Struggle for Survival

part one

In the port city of Durban, the nation of South Africa seeks a way to combat the growing AIDS crisis by holding its first International Conference on AIDS and HIV-related illnesses since the end of Apartheid. While one’s initial reaction to such news would be to congratulate the government on its progressive concerns, understand first and foremost that the government of South Africa is and has been in the grip of denial about the cause-and-effect relationship of AIDS/HIV for many years. South Africa has the highest rate of HIV/AIDS infection in the world. An estimated 600 people die from the disease each day there, while the national government prefers to offer a population already suffering from AIDS infection “prevention methods” - such as eating garlic, olive oil, and potatoes - leaving virtually no hope for those already suffering, already dying from the disease.

It is fact that the Mbeki government of South Africa has officially stressed cost-free nutrition-based AIDS prevention methods, supposedly designed to boost the immune system, while providing no real program of AIDS/HIV education to its citizens. Local “customs” can be rife with superstition; many people in South Africa believe that AIDS drugs are poison to kill you faster or make one into a mindless slave. Other mistaken beliefs that help to spread the virus include the brutally cruel rumor that having sex with a virgin can cleanse a man of AIDS or HIV; the incidence of child-rape – of babies under a year to adolescents, of both sexes - is at an all-time high.

The administration has repeatedly questioned the efficacy of anti-retroviral drugs for treatment, while simultaneously complaining of the expense of the anti-retroviral medications. Public-sector hospitals there are forbidden to administer anti-retrovirals, currently the only treatment for infection with AIDS currently exists. Bizarrely, South Africa has also rejected multiple offers from individual Western drug companies, willing to provide them with the drugs at little to, in some cases, no cost at all.

Repeatedly, cost has been the issue over which the most concern has been expressed by the current South African administration. Yet, as the UN Special Envoy for HIV/AIDS in Africa stated in her speech to the conference, South Africa ranks higher on both the HPI (Human Poverty Index) and the HDI (Human Development Index) than do many other countries in Africa that already offer modern AIDS treatments. South Africans also live on more money per day, stated the Special Envoy, than do the populations of many of the other countries in Africa offering comprehensive treatment.

Yet as lately as this week, the Mbeki government refused to extend approval for public access to the AIDS drug Nevirapine (one dose of which to both mother and child before and after delivery has been shown in clinical trials to reduce the mother-to-child transmission rate by 50%) citing its doubt over the research that proved the drug was effective in the first place.

What drives the South African government to such a depth of denial, such a refusal to look at AIDS as the threat that it absolutely is? To refute data from many, many international sources with regard to the deadliness of AIDS, and the best procedures for its treatment? To ignore the potential economic and humanitarian crisis that AIDS poses to that nation –as few as seven to ten years from now – instead preferring to encourage its citizens to fight a deadly retrovirus with some garlic, like a vampire in a story of old? Why can’t they see that through their inaction, they are complicit in the murder – perhaps the genocide – of their own people?

As the conference opened yesterday, activists jeered South African Minister of Health as she spoke at the conference opening. South Africans are rightfully angry; they are tired of hearing that the government is “soberly considering” the use of AIDS medicines. They are now literally begging for their lives.

At AfricaBlog I know we are seeking answers. When I first read about the crisis in South Africa I thought that the solution was the bounty of drug companies, banding together to help cure the nation. Then I heard that this solution had been rejected. I thought a possible solution could lie in a bit of laissez-faire by the pharmaceutical industry - they could permit cheaper, unpatented "generics" to slip quietly into South Africa, while still charging "rich" nations full price for the name-brand drugs. But it appears that the government doesn't believe the drugs will help treat the ill, anyway.

In short, the only solution that I can see to the looming humanitarian disaster in South Africa is one that involves a new government - one that is committed to using all the rich natural and human resources at its disposal to save the lives of its dying people, to ultimately save its culture from extinction.

Sources:

UN Document: Speech by the UN Special Envoy on HIV/Aids in Africa
ITN Channel 4 News, South Africa addresses AIDS problem
HiPakistan English News: AIDS Meeting Opens In South Africa
BBC NEWS: Is access to Aids drugs in Africa fair?
Radio Australia News: Aids conference opens in South Africa
BBC NEWS: S Africa faces Aids pressure
Voice Of America News: South Africa AIDS Conference Opens
Deutsche Welle: First national AIDS conference opens in South Africa
ABC News Online: Minister jeered at S Africa AIDS meeting
BBC NEWS: SA Aids deaths report leaked
CNN: S. Africa facing child rape crisis
World Net Daily: Child-rape epidemic in South Africa
Human Rights News: South Africa: Stop Court Fight on AIDS Drugs
Pfizer to Provide Diflucan Drug At No Cost to South Africans With AIDS

Posted by at August 4, 2003 04:08 AM
Comments

I find myself hoping that when Bush's 15 billion dollar AIDs package for Africa starts taking shape (and there are a lot of questions about that package that we'll all need to have answered), that the aid is tied to reforms in situations like that.

I've heard it said that tying political reforms or behaviors to our aid packages is unreasonable--I say it's one of the best ways to leverage our unique position to help move countries toward better treatment of their citizens. I'm loath to say that I hope there is a huge change in the government in South Africa--I would hope, instead, that the government continues on its path toward liberalization, even if that means we have to give them occasional nudges in the right direction.

Posted by: zombyboy at August 4, 2003 04:52 AM

A really well written piece, Kelley. Those numbers are appalling. 600 people a day is staggering. And yet the rates of new infections continue to rise.

They say we don't care about human rights.

D

Posted by: David Strain at August 4, 2003 03:03 PM

zombyboy - my first inclination was of course to hope that westerners could help to apply media pressures, etc. to force the current administration in SA see the 'error of their ways', urging them to do the right thing by their people. And on the timeline of geopolitik, that solution would be a fine one.

Unfortunately, we are dealing with the timeline of AIDS rather than that of political forces. I fear that by the time our external pressures could help the Mbeki crew open up to new treatments (or hell, even to OLD treatments), that a disaster of literally Biblical proportions will *already have happened* in South Africa.

A clarification: I am not advocating a violent regime change in SA! Gaah! Noooo! I should have been more specific in my language. I hope for a new ADMINISTRATION in South Africa, one with eyes to see that the sufferings of its people is paramount, and trumps ideas like "national pride".

With regard to the pairing of mandatory policy reform and aid money, I think that it is silly to do otherwise than consider each state/recipient on a case-by-case basis. In South Africa, our aid SHOULD be tied to reforms of this nature. MHO, of course!

Posted by: kelley at August 4, 2003 05:34 PM

Oh, absolutely. I was reading the wrong thing into that. I most whole heartedly agree.

Posted by: zombyboy at August 4, 2003 05:36 PM

uhhh, there's actually a serious case to be made that HIV may not be the cause of AIDS. Peter Duesberg is no slouch, and neither is Nobel Prize winner Cary Mullis. Even Luc Montaigner has stated that he now believes that HIV has cofactors that cause AIDS, that it can't do it all by itself. Furthermore, I think Mbeke is fundamentally right in asserting that poverty collapses more immune systems by known methods that HIV does.

I could go on. I just think that the HIV causes AIDS theory (which BTW, has never been proven) is looking more and more like a pre-copernican system of describing what's happening. It keeps getting more and more complicated because the predictions, especially the macroscopic ones, never seem to come true and require more complexity to explain away what didn't happen.

I just think that there's a lot of industry, government money, egos and an unwillingness to admit to bad medical practices that were engaged in in the early days of AIDS. Mbeke, for his part, is trying to think for himself.

Posted by: sama at August 4, 2003 07:35 PM

We do know that the drugs cut HIV transmission from mother to child by 50%, though. While searching for other causes, this is still an effective prevantative medicine in the one consistent, known factor. That may not be a silver bullet for the problem, but it has the potential to be a very effective weapon in preventing infection in newborns.

I don't think anyone is saying that this is the only answer, just part of the answer.

And, yes, poverty must be addressed as well--but needing to spend effort on one problem does not exclude the expenditure of energy on another problem.

Posted by: zombyboy at August 4, 2003 08:55 PM

All true points.

Posted by: sama at August 4, 2003 09:14 PM

The money that Bush promised for HIV/AIDS in Africa will go the Global Fund for AIDS, Malaria and TB. It won't go directly to each country, thus we can't put conditions on it like we might if we sent it directly.

I've done a few posts on this. Also, kaisernetwork.org has a daily HIV/AIDS report that keeps up with this issue, its a great source.

The World Bank predicts economic collapse within several generations if the spread of the disease is not controlled in countries (like SA) with an epidemic.

Posted by: hope at August 5, 2003 03:38 AM

Correction - now I'm hearing Bush doesn't want to go through the Global Fund and that the plan is to develop some new US-only mechanism for delivering the aid.

Posted by: hope at August 7, 2003 07:25 PM

That is good news. More control in this instance can only be a good thing.

Posted by: zombyboy at August 7, 2003 08:47 PM

Hello

Posted by: politics at February 19, 2004 01:10 AM
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