South African Leader Declines to Join the Chorus on HIV and AIDS

Jon Cohen

DURBAN, SOUTH AFRICA--When South African President Thabo Mbeki rose to address the opening ceremony for the XIII International AIDS Conference here last Sunday, the thousands of researchers packed into Kingsmead Stadium hoped he would say three simple words: HIV causes AIDS. He didn't. "He waffled while Rome is burning," said Glenda Gray, a pediatrician who co-runs a perinatal HIV clinic at Soweto's enormous Chris Hani Baragwanath Hospital.

HIV has infected one in five adults in this country, which puts South Africa in the unenviable position of having more infected people than any other country in the world. Mbeki recently convened a panel to help his government develop policies to tackle the growing AIDS crisis, but he included so-called "dissidents," who insist that HIV does not cause disease and question whether AIDS is a new disease or old diseases collectively given a new name. Scientists around the world have berated Mbeki for giving new lifeblood to the dissidents, whose arguments had been thoroughly dismissed years ago, and they were hoping that the president would finally distance himself from their views.

Mbeki addressed this criticism head-on in his lengthy speech to the conference, which runs through 14 July. "Some in our common world consider the questions that I and the rest of our government have raised around the HIV/AIDS issue ... as akin to grave criminal and genocidal misconduct," said Mbeki. "What I hear being said repeatedly, stridently, and often angrily is 'Do not ask any questions!' "

When it came to stating his own position about the role of HIV, however, Mbeki was anything but direct. Much of his speech quoted from a 1995 World Health Organization report that fingered "extreme poverty" as "the greatest cause of ill health and suffering across the globe." Mbeki did note, however, that his government would continue to intensify its anti-AIDS campaign by encouraging the use of condoms, supporting research on an AIDS vaccine and anti-HIV drugs, and responding humanely "to people living with AIDS and HIV." But he made no mention of his decision not to supply relatively cheap courses of anti-HIV drugs to infected, pregnant women, which studies have shown can cut by 50% transmission of the virus to their babies.

Mbeki's failure to acknowledge directly that HIV causes AIDS has angered the country's AIDS researchers. "This was a good opportunity for him to put a closure on the whole thing, and he didn't," complained virologist Lynn Morris, who works at the National Institute of Virology in Johannesburg and sat on the panel that Mbeki convened. Many visiting scientists also expressed their dismay. "He could have emerged as a spectacular leader of the whole African continent," said Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases. "He flubbed it."

Still, some top South African researchers saw the speech as a step forward. "Considering all we've gone through over the last few months, it's an excellent speech," said Malegapuru William Makgoba, head of the country's Medical Research Council and another member of Mbeki's panel. "He had the option of just talking about AIDS. But he always talked about HIV/AIDS. So he links HIV to AIDS." What some saw as wordsmithery, Makgoba concluded was a "clever way" for Mbeki to extricate himself from the debate. Those who criticized the speech, Makgoba said, were being "churlish."

The speech itself came after a day of rumors and controversy surrounding the sudden and unexplained cancellation of a press conference to publicize the so-called "Durban Declaration." More than 5000 scientists had signed the document, published in the 6 July issue of Nature, which declares that HIV causes AIDS. The declaration apparently offended Mbeki, whose spokesperson earlier in the week said he would put it in the "dustbin" if it were sent to the president.

Many speculated that the Mbeki administration threatened South African scientists who signed the document that they would lose their government funding if they spoke at the press conference. But Hoosen Coovadia, chair of the meeting, insisted that "they didn't put any pressure on us to cancel this." Chris Hani's Gray said she and others nixed the press conference simply to avoid offending Mbeki on the eve of his much-anticipated speech. They hoped their conciliatory gesture would encourage him to end a sad chapter in a sad saga about a country that seems to have swapped the anguish of apartheid for the anguish of HIV and AIDS.

Volume 289, Number 5477, Issue of 14 Jul 2000, p. 222.
Copyright © 2000 by The American Association for the Advancement of Science.