Andrew Maykuth Online
The Philadelphia Inquirer
May 13, 2002
S. African AIDS activists see new government effort

JOHANNESBURG, South Africa -- President Thabo Mbeki's dramatic reversal on AIDS policy last month appears to be a genuine shift from the government's oft-criticized detachment toward the disease in the past, AIDS activists say.

Since Mbeki's cabinet announced in mid-April that it was tripling its AIDS budget and halting opposition to treating rape victims and newborns for the AIDS virus, activists say they have encountered a new attitude among public health officials.

"Some people think the cabinet's change was a cynical ploy to reduce pressure on the government," said Mark Haywood, head of the AIDS Law Project in Johannesburg and a frequent government critic. "But people we know at public hospitals say the atmosphere has changed in government, that more drugs are being made available and there are fewer obstacles. Things are stirring."

The government's rollout of a program to treat newborns with the antiretroviral Nevirapine, which is shown to reduce transmission from HIV-positive mothers, is still in the planning stages. And the government still has no plans to provide antiretrovirals to adult patients.

But Haywood believes a fundamental change is under way. "Our feeling is that once you publish the change in a cabinet statement, it's hard to reverse course," he said.

The shift in attitude comes none too soon for South Africa, where about one in eight adults - 4.7 million people - is believed to be HIV positive.

The South African government has been widely perceived to be insensitive to the AIDS pandemic. The health ministry balked at authorizing treatment on technical grounds, citing the severe side effects caused by antiretrovirals. And Mbeki's government appeared to be immobilized by fears about the potential cost of AIDS, preferring to treat no one rather than provide inequitable treatment.

Making things even worse was Mbeki's embrace of discredited AIDS dissidents, who deny that HIV causes the disease and who say the AIDS crisis is nothing but a fabrication - a racist Western conspiracy designed to frighten Africa.

The president's mixed messages buttressed impressions among the populace that AIDS was no threat - even rumors that antiretrovirals caused, rather than treated, AIDS.

The government reacted defensively to criticism. When former President Nelson Mandela and Anglican archbishop Desmond Tutu suggested AIDS should be attacked more aggressively, Mbeki reportedly declined to return Mandela's telephone calls for a month.

Despite escalating international pressure, the government's turnaround appears to be a response to an erosion of support among key domestic constituencies, particularly labor unions. While they are close allies of the ANC, the unions increasingly had been supportive of those suing the government to provide AIDS drugs. In addition, some provincial governments found themselves compelled to defy Pretoria by allowing greater access to treatment.

South Africa's courts repeatedly sided with AIDS activists and ordered the government to treat newborns with Nevirapine, most recently last month when a Constitutional Court ruling said the government is constitutionally obliged to try to save children's lives.

That led to one more burst of defiance from Mbeki - then, less than two weeks later, the about-face by his government. Officials reportedly disassociated themselves from the AIDS dissidents, asking them to remove Mbeki's endorsements from their Web sites. ANC supporters of the unorthodox AIDS theories were instructed to keep their opinions private.

"I think we are beginning to turn a corner in our country," Health Minister Manto Tshabalala-Msimang told reporters last week.

The health ministry continues to appeal the court case ordering it to provide treatment - not because it wants to challenge the order but because it wants a higher court to define the limits of the judiciary's power to order the executive in the future.

But not everyone is convinced that the shift is authentic.

"It's not clear yet that the government is going to own up," said Thabani Masuku, a constitutional analyst for the Institute for Democracy in South Africa in Cape Town.

Some private health workers also are skeptical about the government's change of heart.

At the Cotlands Baby Sanctuary in southern Johannesburg, Executive Director Jackie Schoeman is impatient with the government's promise to provide Nevaripine to babies - upon completion of a pilot program at 18 hospitals.

"They say they're worried about the side effects of Nevirapine, but I don't know what side effects could be worse than dying," said Schoeman, whose hospice serves about 60 children at a time.

Each day at the hospice, more HIV-positive babies arrive whose deadly infection might have been prevented had they been given a single dose of Nevirapine at birth.

"We see more and more children who are coming to us to die," said Schoeman. "We need to get something in place soon." home page   
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