PRESIDENT'S QUESTION TIME
In South Africa's National Assembly of Parliament

24 Oct. 2001

BANTU HOLOMISA (Leader of UDM): Will the government consider initiating a special allocation with the social cluster to address the much talked about pandemic of HIV/AIDS and in doing so acknowledge and give weight to the importance of this disease that affects every citizen of South Africa in every aspect of their lives.

THABO MBEKI: The government, as the honourable members knows, the government has got a comprehensive programme to deal with this matter and its response ­ the governments responses to the issue of AIDS are governed by that programme and therefore government will do whatever is required with regard to that programme and there are allocations that have been made, the honourable member will know, that special funds voted in the context of the national budget with regard to this and I do not believe that at this particular moment the government is going to do anything to change the policy positions that it has announced with this regard.

VAN JAARSVELD (New National Party - Afrikaner): More and more South African are starting to wonder whether the president and the ANC are living in the same country as the rest of us while acknowledging the plight of the children of this country and I want to quote from The Star of 18 October 'people are dying of hunger in the rural areas of the Northern Province. Villages are being ravaged by poverty with many adults dying and leaving their families ­ in most cases leaving children to fend for themselves. One has to be reminded that the scenes of famine and disease being played out in these villages are not in Ethiopia or Angola but in South Africa. Apart from living in dire poverty children are orphaned by AIDS, faceless discrimination and abuse at all levels within the communities, at schools and when attempting to access health and social services. Now my question ­ to the president, the honourable President is it is common knowledge that the president refuses to acknowledge the reality of AIDS

(Called to order by Deputy Speaker for time being up and not yet having asked a question. She tells President Mbeki that if he wishes to comment he is free to do so.)

THABO MBEKI: Yes, No, Madame Speaker. I am very, very pleased, very pleased indeed that the honourable member is beginning to learn something about South Africa (applause) and perhaps we need to thank the media for giving him the education (loud laughter and clapping). There are high levels of poverty. There are high levels of poverty in this country. The children of this country indeed suffer. Many sections of our population indeed experience terrible levels of poverty. Terrible ­ a terrible impact of the diseases of poverty. Terrible levels of underdevelopment. So, indeed I am pleased the honourable member has come to know of these, at least in the last fortnight (Laughter) If the member had paid at least some attention to the history of this country and where we come from he would know where this problems derives from (applause). He would also understand that this is a task that I am quite certain faces all of us as South Africans and I would really be very pleased if at some point the honourable member would say I've now recognised the tragedy, this is what I am doing about it. It would be extremely useful. Thank you. (Loud applause).

DUDLEY (Freedom Party): If as it seems to most South Africans, South Africa does not have the resources to meet the requirements of adequate social services delivery, should the priorities of the president and government be focused on these issues: a new Boeing for the president, lavish reception rooms at the airports, extravagant parties regularly run by premiers and mayors, white elephant like Coega proceeding before completion of environmental impact studies, arms deals, repeated scrapping of education programmes etc - unfortunately give the impression that there is a squandering of resources and misplaced opulence amid a sea pf poverty. How will the president address this perception?

THABO MBEKI: I think the ­ what the honourable member needs to do - is to focus on the truth and not perceptions. That might help to deal with this matter, Thanks, Madame speaker, (Loud laughter and applause).

TONY LEON (Leader of the Official Opposition Democratic Party) ­ Sorry don't have question which was something about the president's letter to the health minister asking her if she had taken into account the latest WHO reported AIDS figures (for 1995/96 in South Africa's case) and the MRC report.

THABO MBEKI: In order properly to respond to the needs of South Africans, the government constantly evaluates all of its programmes to ensure they remain relevant to our changing realities. We adopt the same approach in respect of programmes to address the health needs of our population. It was within this context that I asked the Minister of Health to examine the latest known statistics on the numbers and causes of deaths in South Africa and to advise government on whether it is responding correctly to the picture painted by those statistics. The social cluster of ministers is looking into that matter.

Our health expenditure is informed by among others the health profile of the population which includes the burden of disease in the country; by policy choices such as the need to focus on Primary Health Care, by fiscal constraints and by mortality rates. I am informed that the MRC report that the honourable member refers to does not fully address the issues I raised in my letter to the minister since it seems to have addressed only one cause of death namely AIDS. I am also informed that the information set out in that report is being evaluated by an interdepartmental task team led by Statistics South Africa as well as the Presidential Advisory Council on AIDS. The MRC is part of that interdepartmental task team as are indeed are members of the MRC members of that advisory panel. The reports from these processes are still outstanding and therefore we are not considering any reapportionment of funding until that social cluster of ministers and these other process are concluded. We will then decide as to how to proceed on this matter. Thank you.

TONY LEON: Will the Honourable President not acknowledge that the total expenditure in our national and provincial budgets on AIDS amounts to only 0,6% of the total health budget and in view of the pandemic sweeping South Africa does he regard that - regardless of the statistical base which he is using or model - as being remotely adequate to the emergency of the situation ­ of its urgency? Secondly, could I ask the president the following: in his letter to the Minister of Health which is the subject of this question he said that these were the latest available statistics on causes of death for the particular web page on which they appear. Although the honourable president did qualify that assumption, but would he also accept on the same WHO web page there is a more recent report published by WHO in conjunction with UNAIDS which estimates that 250,000 South Africans died of AIDS in 1999, making AIDS by far the leading cause of death in our country. Would the honourable president then not refer the health minister to those more recent statistics on those WHO/UNAIDS websites and infact.

(Called to ORDER for exceeding allotted time.)

THABO MBEKI: I would be quite happy, Madame speaker, to refer these particular statistics to which the honourable member refers to the minister of health. I would infact hope that the minister has seen them herself as such. I have absolutely no problem with referring those statistics to her and it might help if the minister of health hasn't seen them which I haven't, that the honourable member does the same.

I think we need to look at all of these statistics whoever is issuing them. I haven't seen this particular set that the minister (sic) the honourable member refers to but I will certainly have a look - indeed will refer them to the Minister of Health.

The particular statistics that appeared there that were used there were for all countries of the world. They were not just for South Africa. They were for all countries ­ all members of the WHO. It's a particular set of statistics which for some countries went up to 1998, some countries 95, some 96. The particular set of statistics which the WHO says that at that time were the latest available national statistics available to them. But certainly I think that if there is any further information on this matter that needs to be looked at by the Minister of Health, by Stats South Africa by everybody else. I think those statistics should be made available so that we do indeed get as accurate a picture of what is happening as possible. I have no problem with that. The matter of, as I indicated ­ the ­ we want to have a proper profile of the incidence of disease in this country. The government is not an NGO the government is not an NGO focused on one particular disease - we're not a TB NGO or an AIDS NGO. We are (applause) we are concerned about the health of our people

(LEON: Yes, but the question is are you a GO?)

We are concerned about the health of our people. I am concerned about the incidence of disease and the incidence of mortality comprehensively. We need to have a look at that so that we can see whether our programmes are correct. Those programmes do not consist only of response with drugs and medicines, they must include improving the general health condition of our people, which includes nutrition, which includes clean water, which includes addressing all these things which includes the question of the violence in the society. We have to look at all of those questions and make sure that indeed our spending not only in health but generally throughout government responds to that particular health profile. Thank you.

RUTH RABINOWITZ (HIV/AIDS Spokesperson Inkhata Freedom Party): In spite of the government's comprehensive AIDS action plan and overall spending of about R8bn to promote AIDS prevention, our policies are not finding their target with sufficient accuracy and even those who question the report will not argue with the evidence that AIDS deaths are escalating. Most of the R320 million to be spent on AIDS this year goes to prevention and education and government claims it lacks the budget to support treatment of people with AIDS or pregnant women but we have not accepted offers of free medication or put out tenders for supplies to government or established partnerships with private companies or foreign governments to offer treatment under certain circumstances. Nor have we made concerted efforts to do more widespread testing and inform people of their results. Will this report change the government's approach to include some of these measures?

THABO MBEKI: Well, I'm not quite sure what report the honourable member refers to. I've said there's a task team of government, led by Statistics South Africa to look at the totality of the health profile of this country focusing particularly on the mortality statistics to get as clear a picture as is possible of an answer to the question what is it that is killing our people? What are these things that are killing our people? How many people are dying from what? So that the government can then respond as accurately as possible to that actuality of the South African situation and no doubt once the matter is established ­ the processes in which the social cluster of ministers, the processes in which that cluster is involved will no doubt be informed by what comes out of that particular process.

I have said that the AIDS panel ­ the scientific AIDS panel on this matter is continuing its work and indeed in the last few days the scientists met from both sides of the divide further to work on the experiments that they decided should be carried out. They will continue with that work and that work will also inform what government does.

We are not engaging in these particular matters as an academic exercise. We're engaging in them in order to ensure that indeed as government we respond in a targeted and effective way to these matters that cause ill health among our people, that cause death among our people. So yes, indeed, honourable member, whatever comes out of those processes will indeed form government policy. Thank you.

NKOMO (ANC: Chairperson of Parliamentary Health Portfolio Committee): I'm glad to hear from the president that the government's approach to HIV and AIDS is an approach about people and not merely about statistics that whilst statistics are good, are important for evaluation and monitoring and so on it is essentially about people and that it is this policy which has induced Steven Lewis the UN's envoy who reported positively on the high levels of awareness about HIV and AIDS in South Africa and that same policy which has places South Africa at the epicentre of the HIV and AIDS approach in SADC, at the African Union and also internationally and that therefore it not being about numbers that the president assures us that this comprehensive policy will not be reduced by reductionist views, but will continue to deal with all the comprehensive issues which are about saving lives. I would like to hear the president's response (applause)

THABO MBEKI: Honourable members, the numbers are important, the numbers are important. We need to have as clear a picture as is possible of what illnesses our people suffer from. It is important because our responses have got to be governed by that reality. The matter of the health of our people: I do not believe should become a matter of political ideological campaigns. It is a matter that requires indeed a very, very serious response and a very focused response to produce better results and indeed as the honourable member says in our interactions with international organisations, they are very appreciative of the work our country and government are doing to deal with this in fact very difficult health situation.

In many respects not very different from the situation that is experienced by the majority of Africans throughout our continent. But we must respond to this from the point of view of an informed position. I do not believe we should treat any health condition as a matter of superstition of religious belief. The science is important with regard to this and understanding of the actuality so that we respond positively.

Reference was made to treatment with regard to AIDS ­ very contentious question. I said to the minister of health have we looked at the radically revised guidelines of the US government issued at the beginning of this year about treatment with antiretroviral drugs? When they have said these drugs are becoming as dangerous to health as the thing they are supposed to treat? We have to look at all these matters I am saying not as a matter of religious belief as matters about which you campaign in the street, but as matters which you focus on properly, accurately in order to save our people from ill health and in order to save them from unnecessary disease and I think that is important (Applause).

DE LILLE (Pan African Congress Spokesperson): Honourable President, arising out of your response, I want to agree that treatment for HIV and AIDS is not only antiretroviral drugs. It includes immune boosting supplements, Mother-to-child-transmission and opportunistic - and all those, but I've got one question, Mr President, and that is one of the reasons used any government for not providing antiretroviral drugs is that it is too toxic. Now why is it toxic only for poor people of the country who cannot afford it, but is not toxic for many members of parliament who are using the same antiretroviral drugs. Why are we not taking it off (interjections) why are we not taking it off the shelf of the pharmacies and doctors if it is so toxic so nobody must have access to antiretroviral drugs? Thank you.

THABO MBEKI: Undoubtedly, Madame Deputy Speaker, if these drugs are toxic they are toxic for everybody including members of parliament. I do not know how any conclusion can be reached that they are not for member of parliament, I don't think they have a particular biology the members of parliament.

(Interjection Tony Leon they have particular psychology)

Maybe they have a particular psychology, but I don't think that will save them from particular toxicities. The matter Honourable De Lille, I really do hope you will study this issue ­ the US government at the beginning of this year ­ I have just mentioned this ­ the US government at the beginning of this year radically revised the guidelines for the use of antiretroviral drugs and they said part of the reasons they did this was because experience had shown them that these drugs had toxicities which had not foreseen. They radically ­ I mean radically ­ revised the use of these drugs. They further issued other guidelines as to what needs to happen before you dispense any such drugs. A very, very detailed brief as to what the doctors should do before they dispense this because of this particular concerns, I can tell the honourable member where to get those guidelines in the website of the Centres for Disease Control in the US. He would see that when these matters are dealt with by people who are serious and approach these things from the point of view of health ­ the health of the people ­ not propaganda, no religious faith - that there are very many complex questions which we have to deal with regard to this and that includes the means and ways and the measures and everything that needs to be done before any doctor can responsibly dispense these particular drugs. And I would hope that if any members of parliament are taking those drugs they need to have a look at that so as to advise their own medical practitioners as to how to proceed. Otherwise they are going to suffer negative consequences and that is real and that is actual. It is not a matter of propaganda. Thank you.