AIDS BATTLE IN S. AFRICA Mbeki's stance on disease becoming an embarrassment

By Tina Susman

Newsday (New York) 22 May 2000

Johannesburg, South AfricaAs is his custom when making important speeches, President Thabo Mbeki began one of his most eagerly awaited addresses recently with poetry.

"In attempting impossible things, deeming them alone worth the toil, was it folly or grace?" Mbeki recited from Patrick Henry Pearse's poem "The Fool" on May 6 as he opened the first meeting of his Presidential AIDS Review Panel, 33 scientists invited from around the world to discuss the disease ravaging South Africa.

Mbeki's message was clear: No matter how foolhardy critics say he is for loading the panel with rebel scientists who question accepted thinking about AIDS, and no matter how much he is slammed for giving credence to their widely lampooned theories, he is holding onto his unorthodox views.

"We are faced with a catastrophe, and you can't respond merely by saying 'I will do what is routine,'" Mbeki said as he defended his embracing of socalled AIDS dissidents who argue, among other things, that HIV does not cause AIDS and that wellknown AIDS drugs such as AZT are toxic and do more harm than good.

Mbeki's stance on AIDS is likely to be an issue during a visit this week to the United States. President Bill Clinton, with whom he was to meet this morning, was one of the recipients of the nowinfamous letter Mbeki sent to Western leaders April 3 arguing against what he called Western solutions to African problems and appealing for support for his defense of AIDS dissidents. They contend AIDS is a melange of diseases triggered not by HIV but by lifestyle: drug use, promiscuous homosexuality and malnutrition.

The refusal to be cowed by criticism is a wellknown facet of Mbeki's personality and one that even his critics, during last year's election campaign, said could be a positive change after five years of Nelson Mandela's warm, fuzzy style. Less than a year into his presidential term, however, Mbeki's dogged attitude, particularly toward the biggest health, social and economic calamity facing his country, is widely seen as a severe flaw rather than a strong will.

"People who reject reasonable criticism are often unreasonable people. People who accept it are good leaders," said political scientist and historian Tom Lodge, former director of the Africa Program at the Social Science Research Council in New York, now a professor at Johannesburg's University of the Witwatersrand.

What is striking about the criticism being leveled here against Mbeki on the AIDS issue is its breadth. It is not just a fight between the whitedominated scientific community and the blackdominated government; Mbeki is getting it from all sides, including from within his ruling African National Congress.

"The current controversy is causing far more harm than good. It's undermining the efforts of all AIDS agencies," the party's secretary for health in the Western Cape province, Dr. Saadiq Kariem, said of Mbeki's public questioning of the link between HIV and AIDS.

South Africa has one of the world's fastestgrowing HIVinfection rates, a situation made all the more intolerable, medical experts say, by Mbeki's support of AIDS dissidents like Drs. Peter Duesberg and David Rasnick, and his opposition to AZT and other AIDS drugs widely used outside South Africa.

With South Africa hosting the XIII International AIDS Conference in July, Mbeki's behaviorparticularly the convening of the panel to discuss issues that mainstream science laid to rest years agois also humiliating, they say.

"I think we are just creating an image of ourselves as an embarrassment to the world," said Dr. Malegapuru Makgoba, head of the Medical Research Council, South Africa's equivalent of the Food and Drug Administration.

The May 6 scientists' meeting, which cost 2 million rand (about $ 285,000) , apparently did not bridge the gap between AIDS dissidents and other scientists. For the next few weeks, participants will exchange views via email and present a report to Mbeki on their conclusions.

Various estimates from the government and independent researchers say 10 percent of South Africa's 40 million people are HIVpositive, and in some regions the rate among pregnant women exceeds 30 percent. A quartermillion South Africans will die from AIDS this year, and 700,000 will die in 2005, according to a study released May 16 by the Institute of Race Relations, an independent think tank.

Mbeki's questioning of the HIV AIDS link can only make things worse, doctors say.

"It is irresponsibility that borders on criminality," said Dr. Mamphela Ramphele, a medical doctor and former University of Cape Town vice chancellor. "If the government gives credence to this voodoo science, there's a real danger that people might say 'I don't have to worry about condoms.'"

That scenario already is being played out in the public health clinics where Kariem sees patients each day.

"People ask, 'If the president is questioning whether HIV causes AIDS, then I also question this....Therefore, there is no need for me to wear a condom, is there?' What do I say to this?" said Kariem, who resigned as head of his province's AIDS program in December. His resignation followed ideological clashes with senior ANC leaders over Kariem's support for projects that provide AZT to HIVinfected pregnant womensomething the government opposes on grounds AZT is too expensive.

Like most scientists, Kariem disputes that view, saying it is far cheaper to give the drug to pregnant women than to care for the HIVinfected babies they produce without the drug.

Nobody questions Mbeki's intelligence, which is why his backing of discredited AIDS theories, apparently collected during latenight surfing on the Internet, is all the more baffling.

His harshest critics, both within and outside the ANC, speculate that the main reason for Mbeki's stance is the weak economy. Faced with unemployment estimated at 40 percent, rising prices and the falling value of the national currency, Mbeki is eager to keep spending down, said Dr. Costa Gazi, a publichealth specialist and member of the opposition Pan Africanist Congress.

"Once you make these AIDS drugs available in the public sector, you are paving the way for further availability of the drugs, and they are expensive," said Gazi, who in January was fined 1,000 rand (about $ 166) by the Department of Health for saying the health minister should be charged with manslaughter for refusing to give AZT to pregnant, HIVpositive women.

"That's what they fear: If they start making it available for pregnant women, pressure will grow to make it available to other categories of people," Gazi said.

More likely, Lodge says, Mbeki's actions are the result of a lack of clear vision, advisers who are either too weak or timid to give him advice he does not like, and inability to admit mistakes.

The problem is clear in his handling of the AIDS problem, and in his conspicuous refusal to condemn political violence in neighboring Zimbabwe despite overwhelming documentation of a campaign of intimidation by President Robert Mugabe's ruling party, Lodge said.

"What we're seeing are all the symptoms of a weak presidency," said Lodge, who last year gave optimistic predictions of the Mbeki presidency. "I think that the projection of Mbeki as a strong, decisive president who would provide leadership on key issues was a misrepresentation."