Mbeki: What is the Aids test testing?
On 24 March, President Mbeki was interviewed on the private South African TV channel, eTV (?On the Record?) about his Expert Panel report on Aids. Here is the full transcript.
Debra Patta [the interviewer]: President Mbeki, HIV-Aids has dominated the headlines in South Africa for the last two years and bit before that as well, let’s bring this down to the personal level would you take an HIV-Aids test?
Mbeki: Sitting where I sit as the president of South Africa, I think that the challenge I face is to have all outstanding questions with regard to this matter answered, so that we are then able to respond as effectively as possible to the Aids challenge.
So the matter of whether I take an HIV test or not, I think is irrelevant. It might be dramatic, and make newspaper headlines.
Debra (interrupting): But would it not set an example the president takes an Aids test?
Mbeki: No, but it would be setting an example within the context of a particular paradigm.
What I am saying is that on the 5th of February this year, the US government issued new guidelines about the use of anti-retroviral [drugs] radically different from what had been the practice before. And they themselves the US government and all the scientists who did this say we are issuing these new guidelines based on our experience and because there are many unanswered questions. So they change the guidelines which is fine.
But what they are raising fundamentally is that science does not have enough answers to deal with this question.
So what I am saying is that... [changes train of thought]... is why we set up the Aids Panel to bring all of the scientists from across the world, all different points of view scientific points of view to say we are not scientists, can you help us to answer these questions?
That’s the critical matter, so that we are then able to deal more effectively with Aids, which is a reality, which is a very serious problem.
Now I don’t believe that stunts, publicity stunts, help in addressing the health needs of our people.
I would think it would be, well, a criminal dereliction of duty if our government didn’t say: ?how do we cope with issues of the toxicity of these drugs which [has been] raised very sharply by these US government guidelines on the 5th of February. And they [the Americans] say the levels of toxicity of these drugs are such that we’ve got to introduce these drugs later in the incidence of the disease, because you have these toxicities and they even say that there are even other unknown toxicities which we know happen.
So, do I go down the street dispensing these pills knowing from the best science there is, that there are these consequences which science itself says we don’t know enough?
No. So I think no stunts, please no stunts. Let’s stop politicising this question. Lets deal with the science of it.
The Panel said one of the things we’ve got to do is to determine when you do an HIV test, what is the test testing. And those were the scientists: what is it measuring?
So I go and do a test, I’m confirming a particular paradigm. It doesn’t help in addressing this health need. Our focus must be how do we improve the health of our people, and that is what we are focused on.
Patta: Well, what is the next step then?
Mbeki: I am very keen that this Panel should do these scientific experiments that it decided, on its own, [to] do to empower us to respond better to this crisis.
The letter that started it all
President Mbeki’s (3 April 2000) letter to world leaders that heralded the coming of his Aids Advisory Panel.
"I am honoured to convey to you the compliments of our government as well as my own, and to inform you about some work we are doing to respond to the HIV-Aids epidemic.
As you are aware, international organisations such as UNAIDS have been reporting that sub-Saharan Africa accounts for two-thirds of the world incidence of HIV-Aids. These reports indicate that our own country is among the worst affected.
Responding to these reports, in 1998, our government decided radically to step up its own efforts to combat Aids, this fight having, up to this point, been left largely to our Ministry and Department of Health.
Among other things, we set up a Ministerial Task Force against HIV-Aids chaired by the deputy president of the Republic, which position I was privileged to occupy at the time. Our current deputy president, the Hon. Jacob Zuma, now leads this Task Force.
We also established partnerships against AIDS, with many major sectors of our society including the youth, women, business, labour unions and the religious communities.
We have now also established a National Aids Council, again chaired by the deputy president and bringing together the government and civil society. An important part of the campaign that we are conducting seeks to encourage safe sex and the use of condoms.
At the same time, as an essential part of our campaign against HIV-Aids, we are working to ensure that we focus properly and urgently on the elimination of poverty among the millions of our people.
Similarly, we are doing everything we can, within our very limited possibilities, to provide the necessary medicaments and care to deal with what are described as ?opportunistic diseases’ that attach to acquired immune deficiency.
As a government and a people, we are trying to organise ourselves to ensure that we take care of the children affected and orphaned to Aids. We work also to ensure that no section of our society, whether public or private, discriminates against people suffering from HIV-Aids.
In our current budget, we have included a dedicated fund to finance our activities against HIV-Aids. This is in addition to funds that the central government departments as well as the provincial and local administrations will spend on this campaign.
We have also contributed to our Medical Research Council such funds as we can, for the development of an Aids vaccine.
Demands are being made within the country for the public health system to provide anti-retroviral drugs for various indications, including mother-to-child transmission. We are discussing this matter, among others, with our statutory licensing authority for medicines and drugs, the Medicines Control Council (MCC).
Toward the end of last year, speaking in our national parliament, I said that I had asked our minister of health to look into various controversies taking place among scientists on HIV-Aids and the toxicity of a particular anti-retroviral drug.
In response to this, among other things, the minister is working to put together an international panel of scientists to discuss all these issues in as transparent a setting as possible.
As you know, Aids in the United States and other developed Western countries has remained largely confined to a section of the male homosexual population.
For example, the cumulative heterosexual contact, US percentage for AIDS cases among adults/adolescents, through June 1999 is given as 10% (HIV-Aids Surveillance Report: Midyear edition. Vol 11, No 1, 1999. US Department of Health and Human Services). The cumulative absolute total for this age group is reported as being 702,748. US Aids deaths for the period January 1996 to June 1997 were stated by the US CDC as amounting to 32,750 (Trends in the HIV and Aids Epidemic: 1998, CDC).
On 13 May 1999, a SAFA-AFP report datelined Paris stated that 1998 UNAIDS and WHO reports had said that Aids was responsible for one death in five in Africa, or about two million people. It quoted a Dr Awa Coll Seck of UNAIDS as saying that there are 23 million carriers in Africa of HIV.
This SAFA-AFP report quotes Dr. Coll Seck as saying: ?In Southern Africa, the prevalence of the [HIV] infection has increased so much in five years that this region could, if the epidemic continues to spread at this rate, see its life expectancy decline to 47 by 2005.’
(Interestingly, the five years to which Dr. Coll Seck refers coincide closely with the period since our liberation from apartheid, white minority rule in 1994).
The report went on to say that almost 1,500 people are infected in South Africa every day and that, at that point, the equivalent of 3.8 million people in our country carried the virus.
Again as you are aware, whereas in the West HIV-Aids is said to be largely homosexually transmitted, it is reported that in Africa, including our country, it is transmitted heterosexually.
Accordingly, as Africans, we have to deal with this uniquely African catastrophe that:
It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-Aids, a simple superimposition of Western experience on African reality would be absurd and illogical. Such proceeding would constitute a criminal betrayal of our responsibility to our own people. It was for this reason that I spoke as I did in our parliament, in the manner in which I have indicated.
- Contrary to the West, HIV-Aids in Africa is heterosexually transmitted
- Contrary to the West, where relatively few people have died from Aids, itself a matter of serious concern, millions are said to have died in Africa; and
- Contrary to the West, where Aids deaths are declining, even greater numbers of Africans are destined to die.
I am convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of Aids in the West.
We will not, ourselves, condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV-Aids.
I make these comments because our search for these specific and targeted responses is being stridently condemned by some in our country and the rest of the world as constituting a criminal abandonment of the fight against HIV-Aids.
Some elements of this orchestrated campaign of condemnation worry me very deeply.
It is suggested, for instance, that there are some scientists who are ?dangerous and discredited? with whom nobody, including ourselves, should communicate or interact. In an earlier period in human history, these would be heretics that would be burnt at the stake!
Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and in public because the established authority believed that their views were dangerous and discredited. We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited.
The scientists we are supposed to put into scientific quarantine include Nobel prize winners, members of Academies of Science and emeritus professors of various disciplines of medicine!
Scientists, in the name of science, are demanding that we should cooperate with them to freeze scientific discourse on HIV-Aids at the specific point this discourse had reached in the West in 1984.
People who otherwise would fight very hard to defend the critically important rights of freedom of thought and speech occupy, with regard to the HIV-Aids issue, the frontline in the campaign of intellectual intimidation and terrorism which argues that the only freedom we have is to agree with what they decree to be established scientific truths.
Some agitate for these extraordinary propositions with a religious fervour born by a degree of fanaticism, which is truly frightening.
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.
It is most strange that all of us seem ready to serve the cause of the fanatics by deciding to stand and wait.
It may be that these comments are extravagant. If they are, it is because in the very recent past, we had to fix our own eyes on the very face of tyranny.
I am greatly encouraged that all of us, as Africans, can count on your unwavering support in the common fight to save our continent and its peoples from death from Aids.
Please accept, Your Excellency, the assurance of my response."
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