SOUTH AFRICAN PRESIDENT
ESCALATES AIDS FEUD

By Barton Gellman

Washington Post 19 April 2000

South African President Thabo Mbeki has stepped up an emotional controversy over his country's response to AIDS, saying Africans should chart their own course on the disease with help from, among others, scientists who dispute the prevailing views in the West on the causes and treatment of the disease.

At loggerheads for months with his own medical establishment over the pandemic that is killing millions of South Africans, Mbeki has now raised the dispute to the international arena with a passionate defense of his approach to the crisis in a letter dispatched this month by diplomatic pouch to President Clinton and other heads of state.

Avowing skepticism about the relevance of Western medical models to the "uniquely African catastrophe" of AIDS, Mbeki wrote in the hand-addressed letters that it "would constitute a criminal betrayal of our responsibility to our own people" to mimic foreign approaches to treating the disease. He insisted on South Africa's right to consult dissident scientists who deny that the human immunodeficiency virus, or HIV, causes AIDS. And he accused unnamed foreign critics of launching a "campaign of intellectual intimidation and terrorism" akin to medieval book-burnings and "the racist apartheid tyranny we opposed."

The African continent, where AIDS continues to spread exponentially, faces an unprecedented demographic upheaval caused by the disease. Recent estimates project that several sub-Saharan nations, including South Africa, will lose a quarter of their populations to AIDS by 2010. An estimated 4.2 million South Africans are infected with HIV, with 1,700 people newly infected every day.

Several Clinton administration officials and foreign diplomats expressed dismay at Mbeki's decision to intensify what they see as a diversionary dispute and to bring it to a potentially volatile international forum. One official made a copy of the letter available to The Washington Post, and South Africa's U.N. ambassador, Dumisani Kumalo, confirmed its authenticity. Kumalo said it had been sent to Clinton and U.N. Secretary General Kofi Annan, among others.

Mbeki's words resonate widely because his nation's new democracy and advanced industry make it a natural leader on the continent, a status acknowledged in its selection as host of this year's international conference on AIDS. So stunned were some officials by the letter's tone and timing--during final preparations for July's conference in Durban--that at least two of them, according to diplomatic sources, felt obliged to check whether it was genuine.

"There has never been a significant international political controversy over AIDS," said one top-level multinational official. "This could be the seed of one."

Fearing just that, the Clinton administration restricted distribution of the five-page letter, dated April 3, in an effort to prevent it from becoming public. Asked for official comment, senior managers of U.S. policy toward Africa concentrated their remarks on areas of agreement with Mbeki.

"It was clearly impassioned in parts, but I thought much of its substance was quite logical and quite compelling," said Assistant Secretary of State Susan Rice, reached by phone in London. "I mean, he clearly acknowledges the severity of the HIV-AIDS problem in Africa and in South Africa in particular, and he goes through a persuasive description of the efforts that have been undertaken by his administration. . . . I don't read Mbeki's intent as trying to pit south versus north on the issue. He's making a pretty simple point, which is, 'This is a hell of a serious problem for Africa, and we don't want to be constrained in the universe of solutions that are available to us.' "

Behind the scenes, the administration--along with allies in foreign capitals and at the World Health Organization and U.N. AIDS program in Geneva--is trying to tamp down the rhetoric and ensure that Mbeki does not perceive fresh insults from abroad, officials said.

Sandra Thurman, director of the White House office of national AIDS policy, met Friday in Atlanta with South African Health Minister Manto Tshabalala-Msimang and Ambassador Makate Sisulu. Thurman would not comment on "any specific correspondence between the president and any other president," but she made clear that the substance of Mbeki's letter had been their focus.

"We did talk about how important it is to make sure we're spending most of our time and energy focused on doing the things we know how to do to stop this epidemic," she said. "We need to make sure the conversations we're having move us forward rather than polarizing us."

Mbeki's letter to foreign leaders begins with much the same point. He describes former president Nelson Mandela's decision in 1998 to mobilize national efforts against AIDS, creating a ministerial task force and a national education campaign on the use of condoms and practice of safer sex. "Similarly," he said, "we are doing everything we can, within our very limited possibilities, to provide the necessary medicaments and care."

Medicine is at the heart of the problem for South Africa, as for all developing nations. In the wealthy nations of the West, "cocktails" of anti-retroviral drugs have made it possible--at a cost per patient exceeding $10,000 a year--to live indefinitely with HIV. "In the rural parts of South Africa, where they can't even afford dinner, they're not going to buy cocktail drugs," Kumalo said.

Nor is the government planning to buy the expensive drugs. But activists at home are putting growing pressure on Mbeki to provide AZT or Nevirapine, two drugs that have been effective in preventing mother-to-child transmission, to rape victims and pregnant women without charge. More than one in five pregnant South Africans has HIV, and there is at present no effort to block infection of their children.

Perhaps because the Western treatments are budget-breakers, Mbeki is said by officials who know him well to have spent a great deal of time browsing the Internet for information on AIDS. Late last year he came across Web sites that popularize the theories of Berkeley biochemist Peter Duesberg, the best-known proponent of the view that HIV does not cause AIDS and that treatment with drugs such as AZT does more harm than good. Last month, Mbeki placed a call to Duesberg's ally, David Rasnick. Among virtually all public health professionals, Duesberg's and Rasnick's views are seen as discredited.

Even so, their work formed part of the basis for a speech Mbeki made to Parliament late last year and for more recent statements by his health minister blaming Nevirapine--against the judgment of most South African scientists--for a series of recent deaths in clinical trials. Those remarks came under harsh public attack from South African doctors and clergymen, and some foreign AIDS experts have begun to talk of boycotting the Durban conference.

Mbeki's letter, turning to this controversy, shifted abruptly in tone. "In an earlier period in human history," he wrote, speaking of the dissident scientists, "these 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."

A trained economist who sprinkles speeches with poetry, Mbeki is widely seen by South Africans--black and white--as an intellectual with a mastery of policy detail. Unlike his predecessor, however, Mbeki is wary of all but his closest advisors, and some foreign officials say that frame of mind is central to the present dispute.

"It may be that these comments are extravagant," Mbeki writes near the close of the letter. "If they are, it is because in the very recent past, we had to fix our own eyes on the very face of tyranny."

Correspondent Jon Jeter in Johannesburg contributed to this report.