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History of HIV in South Africa – Mbeki, denialism

The Start of the HIV & AIDS epidemic in South Africa

The history of AIDS in South Africa starts in the early 1980s with HIV being identified in gay men. This started the widespread belief that AIDS was a disease of gay men which led to a sense of complacency in the general population and an excuse for the apartheid government not to act promptly.

By the late 1980s doctors had begun to warn of a significant HIV & AIDS epidemic. The first Black South African heterosexual AIDS cases, two women who had never left the rural Transval, were diagnosed in late 1987.

By April 1990 it was being said that:

“The campaign waged by the state has been grossly inadequate. Communities have not been consulted. Too little funds have been allocated to HIV prevention and the care of people with HIV disease. The media and education campaigns have promoted fear, stigmatization and discrimination.”

The need for a community based HIV and AIDS program was first publicly acknowledged in 1990 by the Maputo statement on HIV and AIDS in southern Africa, issued jointly by the banned and exiled ANC and a range of anti apartheid organisations.

Then in July 1994, three months after the national elections, the National AIDS Convention of South Africa (NACOSA) issued a National AIDS Plan for South Africa. It spoke in urgent terms about the need to introduce:

“effective measures to ensure that this epidemic is contained and the people and communities that are infected and affected have care and support …The plan proposes a set of interventions which constitute the minimum level of such an effective response. This plan is feasible and affordable and implementation can be initiated immediately.”

The role of Mandela in the history of AIDS

As president Nelson Mandela was very quiet on the subject of AIDS. During his term of office he effectively ignored AIDS, on the basis that in his culture an elder did not publicly discuss sexual issues. Afterwards he said that he “had not had time to concentrate on the issue” during his presidency. It was only after he left office that he publicly acknowledged his son’s death from AIDS.

Dr Manto Tshabalala-Msimang questioned whether HIV caused AIDS

Dr Manto Tshabalala-Msimang questioned whether HIV caused AIDS

1994 Elections

When the African National Congress won the country’s first multiracial elections in 1994, it endorsed an aggressive AIDS policy and designated it a “presidential lead project”. During the Mandela administration the government’s AIDS policy response was led by Thabo Mbeki and the 1994 AIDS program was part drafted by Dr Manto Tshabalala-Msimang. It was certainly not realised at the time the effect that these two people were to have on the South African HIV and AIDS program.

The 1996 Vancouver Conference

In 1996 at the Vancouver AIDS Conference, the world learnt for the first time that for those that could afford the costly drugs, AIDS could become a chronic manageable disease. The first antiretrovirals started to reach South Africa just a few months after the conference. For those with both HIV and money, it was “the triple cocktail, the miracle”.

For those in the public sector in South Africa little changed until 1998. This was when the medical aid schemes, the medical insurance plans began to cover antiretroviral treatment. The plans covered many employed individuals in the private and public sector, but only 18% of the South African population. This was an improvement, and many people believed that it was the best that South Africa could afford.1Oppenheimer, G, “Shattered dreams?”, Oxford University Press, 2007

However, other people believed that although the glaring differences between what was available in the richest countries and South Africa could not be eliminated, it was possible to think of reducing the inequalities within South Africa. This required the government to pay for antiretrovirals. But few people realised that it was going to be the attitude of the government, and not just the cost of the drugs, that was going to become a major barrier to the provision of antiretrovirals for all who needed them.

The history of AIDS – AIDS denialism

President Thabo Mbkei who denied that HIV was the cause of AIDS

President Thabo Mbkei who denied that HIV was the cause of AIDS

In 1999 Thabo Mbeki was elected president, Dr Manto Tshabalala-Msimang became his health minister, and many South Africans hoped that AIDS would receive the attention it needed. However, the government’s AIDS policies quickly became extremely controversial. It was not just that the government did not wish to provide antiretrovirals for the treatment of AIDS. The government also did not wish antiretrovirals to be used for the prevention of mother to child transmission. They would not even allow AZT to be provided to women who had been raped.

The Presidential AIDS Advisory Panel & AIDS denialism

Both President Mbeki and Minister Tshabalala-Msimang publicly questioned the effectiveness of antiretrovirals, and indeed questioned the fact that HIV was the cause of AIDS. When Mbeki convened a panel of experts, the Presidential AIDS Advisory Panel, to answer questions about AIDS he included a number of so called “AIDS dissidents” who were speaking out loudly about the fact that in their view HIV did not cause AIDS. “AIDS denialism” was the term given to the view that HIV was not the cause of AIDS.

The panel comprised “pretty well everyone .. who believes that HIV is not the cause of AIDS, and about 0.0001% of those who oppose this view”
John Moore, Virologist

The final report of the panel provided two sets of recommendations, one assuming that HIV was the cause of AIDS and one assuming that HIV was not the cause of AIDS. There was as a result widespread and international condemnation of Mbeki.

TAC (The Treatment Action Campaign)

tac-logoBetween 1994 and 1998, researchers had shown that a short course of AZT could significantly reduce the likelihood of HIV being passed from an HIV positive pregnant woman to her baby. The South African government however, had little interest in providing HIV positive pregnant women with protection for their babies. President Mbeki and Dr Manto Tshabalala-Msimang argued that among other things AZT was too toxic and too expensive.

So when TAC was started in December 1998, with the aim of ensuring that people living with HIV got access to antiretrovirals, its first demonstrations called for a national prevention of mother to child transmission program. The government did not respond to TAC’s pressure. So in 2001 TAC took the minister of health Dr Manto Tshabalala-Msimang to court to force her to allow facilities in the public health system to provide nevaripine or other suitable antiretrovirals to  pregnant women with HIV. TAC won the case. TAC also worked to breakdown the stigma and secrecy surrounding HIV.

In 2000 MSF partnered with TAC in Khayelitsha, a township outside Cape Town, to provide antiretroviral treatment to people suffering from AIDS who were in need of immediate medication to survive. The clinics showed that with access to correct information antiretrovirals could be successfully taken. There was not only community stigma and government denialism. People were afraid to come forward and get tested. Those that did get tested and tested positive were afraid to take antiretrovirals.

Presidency Changes

In 2007 Mbeki was defeated in the election for the presidency of the ANC, and he was replaced by President Zuma. Finally AIDS denialism came to an end, with the position of the ANC changing to one where they supported the use of antiretrovirals.

 

References

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1. Oppenheimer, G, “Shattered dreams?”, Oxford University Press, 2007