S. African's Speech on AIDS Protested

By David Brown and Jon Jeter

Washington Post 10 July 2000

Durban Hundreds of delegates to an international AIDS conference walked out on a speech by South African President Thabo Mbeki tonight when he failed to renounce his skepticism about what causes the disease and how it is treated.

In a lengthy and eagerly anticipated address, televised live on national television, Mbeki spoke of poverty, malnutrition and inequity as the driving forces behind the great burden of disease shouldered by Africans. He mentioned many diseases, including AIDS.

Mbeki's blunt questioning of lifesaving medicines commonly used in the West and his insistence on an African solution to the AIDS epidemic have been at the center of the 13th International AIDS Conference--the first in Africa--which began here today.

Medical experts and activists say that by courting opinions from dissident scientists who contend that HIV does not cause AIDS, Mbeki has reopened a debate that most in the medical community considered closed years ago. And in doing so, they say, he is wasting time that this country--which has more people inflected with HIV than any other in the world--cannot afford. Twenty percent of adults in this country of 41 million people are infected with HIV, and it has one of the fastest growing rates of infection.

Mbeki told about 10,000 people gathered in a cricket stadium here that "there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV-AIDS." He called specifically for a "sustained public awareness campaign" on safe sex practices, a "concerted fight against opportunistic diseases" and for research on the accuracy of the standard HIV test in African populations.

The conference is being attended by scientists presenting the latest medical research and by AIDS activists who are trying to improve health care services for HIV sufferers. Organizers expect as many as 15,000 people from around the world to attend.

"I'm just fed up with it," said one delegate, Lindsey McKenna, an HIV counselor in Britain, as he walked out while Mbeki was delivering his opening address. "We've heard it all before, and it's just distracting attention away from the real issue, which is stopping HIV."

"He blames AIDS on capitalism and imperialism, and people continue to die," said Alexandra Calmy, a doctor who treats AIDS patients in Geneva, who also walked out on the speech. "The whole poverty thing is worth examining, but you've got to do something until you can work it all out."

Jennifer Ann Geel, a South African physician who treats AIDS patients in Cape Town, said Mbeki's public scrutiny of AIDS drugs has fueled a dangerous skepticism among her patients. "People come into the clinic where I work and say: 'The president says that HIV doesn't cause AIDS. So why are you telling me to wear a condom?' We can't afford his contemplation."

As with Mbeki's other statements on AIDS in recent months, tonight's remarks were enigmatic and subtly defiant. He did not express explicit doubt that HIV causes AIDS, but his language encouraged skeptics to doubt the link between the two. He portrayed himself at one point as only an "insufficiently educated" observer seeking answers.

"What I hear being said repeatedly, stridently and often angrily, is: Do not ask any questions!" he said.

To many AIDS experts, however, his words bear the imprint of a long-discredited view that AIDS is the product of numerous deficiencies, toxins and other causes--but not HIV.

"One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of the immune systems among millions of our people, such that their bodies have no natural defense against attack by many viruses and bacteria," Mbeki said. "As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus," he said.

He did not mention another issue that many delegates consider important--a call for greater access by developing nations to antiviral drugs.

"What he says is that there are some issues that are up to debate, and that is not true," said Charles van der Horst, an American AIDS researcher. "He is a well-meaning man who obviously cares deeply for his people, but on this issue he is wrong, wrong, wrong." Van der Horst was one of the organizers of a statement, signed by 5,000 scientists and released last week, that asserts that HIV indisputably causes AIDS.

Mbeki was followed to the rostrum by an 11-year-old boy with AIDS, Nkosi Johnson, who in occasionally halting tones told of how he entered a foster home when his mother could no longer care for him, of her death and his subsequent first meeting with his father at the funeral, and of the prejudice in his school that news of his disease created. He ended with a plea to the government to provide the antiviral drug AZT to pregnant women.

"It is amazing to me that an 11-year-old boy can hit all the nails on the head, but his president couldn't," van der Horst said.

Others, however, offered more charitable assessments. "Mbeki's speech, I think, is very truthful, linking poverty to so many of these diseases," said Abraham Alabi, a 40-year-old Nigerian microbiologist working in Gambia. He said that he, too, believes all pregnant women should be offered antiviral medicines to lower the risk of transmitting infection to their newborns--a policy the South African Health Ministry currently opposes.

This afternoon, before the conference opened, about 5,000 people gathered outside the Durban city hall to hear more than a dozen speakers call for free medicines for poor countries. Not a single person questioned the connection between HIV and AIDS, and unlike occasional hecklers during the opening ceremony, none uttered harsh words for the South African president.

"Viva Thabo Mbeki!" said Winnie Madikizela-Mandela, former wife of Nelson Mandela, South Africa's first post-apartheid president. "Let me start by asserting what appears to have become less obvious in Africa in recent months. AIDS exists. HIV causes AIDS."

The crowd eventually marched to the cricket ground. One of the people who stopped to watch it pass was Thembaka Ngubane, 32, an unemployed teacher who was with her small son and niece. Until a few months ago, "AIDS was something that was far away from me," she said. "Now there are ads on TV; now we realize it's really existing."

Still, her most personal contact with the disease was cloaked in the denial and euphemism that marks much discussion here. Her 28-year-old cousin spent three weeks in a hospital in Durban last month. He was treated for tuberculosis, but relatives who visited whispered he had AIDS. Ngubane does not know if he was told he has AIDS, or if, in fact, he does. "TB and AIDS--they are different, but they are similar," she said.

At a visit to the same hospital this morning, Sandra Thurman, director of the White House Office of National AIDS Policy, was told by Umesh G. Lalloo, a professor of medicine, that most of the adults now admitted have AIDS.