PRESIDENT MBEKI EXPLAINS

24 May 2000

On May 24, 2000, South African President Thabo Mbeki attended a ceremony honoring him at the Fairmont Hotel in San Fransico. The meeting was sponsored by The Commonwealth Club of California and The World Affairs Council of Northern California. Mbeki answered questions, below the one on AIDS.

QUESTION: There are many, many questions related to AIDS. I suppose the broadest way of putting this question is: Could you clarify your position on the cause of AIDS and explain how you hope to address this growing problem?

PRESIDENT MBEKI: I'm not sure. I have sometimes, wrongly, a rather high opinion of myself -- quite wrongly. But one of them I have never had is that I am a scientist.

The matter of cause is something that science has been dealing with for a long time and scientists continue to be engaged with this particular question. But this I can say: There is a serious problem of AIDS, a serious problem of AIDS in South Africa, a serious problem of AIDS in sub-Saharan Africa generally which requires a very strong and a very determined response.

In South Africa we're taught, like the rest of the world, nothing new. You need to conduct and wage a strong campaign of public awareness focusing on matters of safe sex, use of condoms, those kinds of questions. As a consequence of that, there is really quite a lot of work that has been done as part of that process. We thought it would be necessary not just to have government only address this matter, but that we build a whole series of partnerships. Partnerships against AIDS, which exist. Partnerships with business, with the labor unions, with religious communities, with youth, with women, and so on, to make sure that everybody actually takes up this campaign wherever they are.

We decided also this year that we needed to set aside some dedicated funds in the national budget to address this particular question. That would be in addition to whatever the government departments -- national, provincial and other government structures -- would be spending, but to set aside these dedicated funds. We also contributed funds to work that must go on with regard to the development of a vaccine, government has also made that kind of contribution. The Medical Research Council in South Africa is working with other organizations, including U.S. organizations, on this particular question. I am saying there is a whole range of matters that have been done with regard to this.

But because of the scale of the problem, many, many of us in government tried, without being scientists or anything like this, to understand this challenge as closely as possible. What, indeed, has happened is that some of us have had to be reading lots and lots of material on this question with a view to ensuring that we understand as well as we should so that we should respond with the necessary vigor given the scale and size of the problem.

Now there are some issues that arise which require some answers. We need those answers so that we can make sure that we wage a more effective campaign, to make sure that we respond in focused way to the incidence of AIDS. Let me give you an example of one of these problems.

In 1985, the New England Journal of Medicine published what I think is the first report on the incidence of HIV in South Africa and southern Africa. That same report was published later in the South African Medical Journal. That report said that HIV was not endemic in southern Africa -- that's 1985. It went on to say that the incidence of HIV they found, these medical people and scientists, was among male gay people. Now that was middle of 1985. Five years later, six years later maybe, this had changed radically where it was now said, whereas in 1985 HIV was not endemic in this region, five years later the report was that it was. Secondly, whereas in 85 it was said that this would be homosexually transmitted, five years later it was heterosexually transmitted.

So the question we then asked was: Why this change? The profile in the United States in 1985 was the same profile as in South Africa in 1985, yet the profile in the United States has remained substantially the same. There is a growing incidence in the United States, looking at the CDC figures, of heterosexual transmission. The last report I saw from the CDC, which was up to December 1999, was that there was a 10% incidence of heterosexual transmission in the United States, 90% was homosexual. So we asked the question: What happened between 1985 and 1990? The question, we believe, is important because it would help us to address the focus of our response. Some of the answers I've had is that there is a different strain of HIV in our region of the world which is why you had this change from 85 to 90.

Let us say: Fine. If this is the reason, if this is what science says, this is OK. It's good information because then it enables us to respond to the specific manifestation of this condition in our situation.

Another scientist has said to me -- I must say it is only one scientist, a European scientist -- he thinks the reason is that there are biological factors which affect Africans and don't affect people in North America or Western Europe. Biological factors. He said this was a hypothesis he was following. Now, it would be very important for us to find out what this is because, indeed, if there is a different biological set of circumstances affecting Africans then it would be necessary for us in the intensification of the campaign against AIDS that we take into account those differences.

Fortunately, scientists managed to meet in South Africa at the beginning of this month, around the sixth of May, representing different opinions with regard to this debate that has been going on about these issues for fifteen years or more. Dissidents and orthodox people, as they are described in the literature, discussed some of these questions. One of the decisions they reached was that indeed there were unresolved questions which impact the kind of work that needs to be done to get on top of the problem. The consequence of which they agreed that they would then meet -- both orthodox and dissident -- under the auspices of the Centers for Disease Control as well as the South African Medical Research Council. They would bring all of these scientists together to address these outstanding questions. We look forward to that because we want to make sure that our response is effective, is specific, is focused, and produces results.

So I am saying I hope that process which the CDC will coordinate will help us get to these sorts of points. The other matters that have been raised, of course, about this include the matters of the antiretroviral drugs. In South Africa, the estimate for the HIV positive is something, like, four million. Our minister of health has had discussions last week with UNAIDS and WHO in the aftermath of the announcement by the UNAIDS that they had reached agreement with five pharmaceutical companies to reduce drug prices. The consequence of that reduction in cost terms would be that we would then have to spend the entirety of the public health drug budget on antiretrovirals only. What do we do?

These are the real, actual, practical questions that confront us. We have to intensify the campaign against AIDS. We've got to get results. We've got to make sure that we understand all of the specifics that pertain to this so that we do, indeed, achieve the sort of progress that is needed. Unfortunately, it seems that as a French professor said to me, my professor of medicine and science, part of the problem here is that there is a lot of dogma that attaches to this particular area and it is difficult to deal with it. Even scientists have said to me that to debate the real questions becomes difficult. I think some movement is taking place and I was very happy that the CDC in this country said that instead of all the scientists standing at different ends, let's interact so that, indeed, we can focus on these outstanding issues.