So, South Africa has new leadership in its national AIDS programs and in managing the policy of dealing with HIV. The Deputy President of the Country, Phumzile Mlambo-Ngcuka, some one I have high regard for and totally have confidence in as a politican, is leading the new initiative. This new article has an obvious bias against Thabo Mbeki (South Africa’s President) and Health Minister Manto Tshabalala-Msimang. The line that’s been (wrongly) repeated world wide is that Mbeki and Tshabalala-Msimang (aka, Manto) deny that HIV causes AIDS, and some reports are ridiculous enough to suggest that they completely deny that AIDS exists and hence you have had the blind leading the blind on AIDS.
I think that this is a wrong interpretation of the situation. First of all, Thabo Mbeki is probably one of the most intelligent heads of states in ANY country in the world. I’d like to have any one suggest anything else. There is no way he would deny obvious science, but rather, the mistake he made, as a head of state, was to apply some critical thinking. It was to ask clever questions which could lead to some other response. Obviously that’s not something that you can encourage heads of states to do [hence some other countries have really really stupid people leading them. They don’t think, they just do as they are told.] the main thrust of Mbeki’s inquiry was on the overall causes of AIDS and its devastating impact. The article in the Washington post actually does mention this but I believe, glosses over it and actually misinterprets what Mbeki meant/means:
"President Mbeki said, 'It cannot be the virus alone, we must look at other, other issues that predispose people to the immune system being depressed,' and I am of the same view also," Tshabalala-Msimang said on "Nightline."
The main point is that, people are not dying because of the “virus alone.” So Mbeki’s argument was really, only supposed to lead people to look at the wider system that was causing the extreme impacts of HIV and AIDS. In Africa, poverty is probably the worst killer. Poverty is that parent of violent conflict, disease—including HIV/AIDS, malaria and many others, corruption, dictatorships, hunger and malnutrition. So to have a rallying call to pour millions of dollars into repainting one side of a house falling apart is not doing much justice to the situation either.
I am not saying ARVs are not important or urgent, or that treatment must not be a priority. But we must answer the question of why are the conditions that “predispose people to the immune system being depressed.” These are questions of nutrition and health care systems more than anything else. If the South African government spend all of its money on treatment (i.e. paying global pharmaceutical corporations that own the patents to ARV) millions of dollars to provide the wonder-drugs, what is the real impact…? People will continue to live in environments that do not really compliment the effectiveness of the drugs.
So perhaps one of the greatest blunders of Mbeki’s presidency has not being ‘doing nothing’ about HIV and AIDS, but rather, miscommunication the complexity of the issue. We live in a world where the media simplifies every issue to much for its average reader or viewer that we often fail to understand the multiple dimensions to some of the world’s most complex problems. You need to be able to communicate complexity, with simplicity. Not an easy task. So I actually see the whole “beetroot and lemon” show that Manto has been pushing over the years as a tongue in cheek way of getting people to see beyond the complexity of it all. I am not sure it work so well because, hey, government officials dealing with serious issues are not supposed to have a sense of humor.
But let’s look at bit closely at the beetroot message. What Manto and Co are saying are, let us find simple ways, accessible to people for them to mitigate some of the impacts of AIDS through addressing nutritional issues. Getting South African tax payers to boost the stock prices of Merck, GlaxoSmithKline and Pfizer isn’t always the best way to go. Of course just giving people beetroots and lemon juice won’t solve the issue, but how do you make the ‘cocktail’ more than just plastic capsules, but also basic issues that people can do something about. So there was a lot of mismanagement in how to communicate these issues. I don’t think the SA government will reduce their emphasis on the nutritional side of things, but this article is really more about changing tune and direction in engaging different stakeholders, especially on the treatment end of things. It’s not about replacing health and nutrition with treatment. It never has been. It’s been about finding the strategy that best compliments other efforts and the deals with the systemic dimension of the problem, and not just the sound bite friendly aspect of free pills for all.
I hope with this ‘new’ take on the AIDS issues, we’ll see less tension around the issue and more partnership and solidarity to really make a difference on a situation that is causing a lot of death, pain, and suffering.
http://www.washingtonpost.com/wp-dyn/content/article/2006/10/26/AR2006102601874.html?referrer=email
In South Africa, a Dramatic Shift on AIDS
Treatment, Prevention Get New Emphasis as Deputy President Takes Key Role
By Craig Timberg
Washington Post Foreign Service
Friday, October 27, 2006; Page A01
JOHANNESBURG -- The South African government is seeking to shake off years of international denunciation for its handling of the AIDS epidemic -- including a fixation on the supposed protective powers of beets and lemons -- while expanding treatment, testing and prevention programs, officials and activists say.
In public comments and private meetings over the past six weeks, Deputy President Phumzile Mlambo-Ngcuka has emphasized that the government now believes unequivocally that HIV causes AIDS, a connection that President Thabo Mbeki once publicly questioned. She has also said that antiretroviral drugs must be the centerpiece of the government's response while playing down the dietary recommendations long cited by Health Minister Manto Tshabalala-Msimang as key to fighting AIDS.
"The beetroot and all that lemon stuff is out the window," an adviser involved in recasting the government's policy said on condition of anonymity because he was not authorized to speak publicly about it. "These guys are now serious about getting it right."
Driving the recent change is a growing realization of the severity of AIDS in South Africa -- an estimated 5.4 million of 47 million citizens have HIV, among the highest totals in the world -- and concern that the controversy surrounding the disease was damaging the country's international reputation.
The Treatment Action Campaign, the country's leading AIDS activist group, said that after years of hostility and legal battles, government officials were working cooperatively with members to realize some of their long-standing demands, such as setting targets for dramatically expanding the availability of antiretroviral drugs through the public health system. Mlambo-Ngcuka, who has taken control of the national AIDS commission, has met privately with the group.
"There's clearly a shift taking place," said Zackie Achmat, the head of the Treatment Action Campaign.
Officials say that Tshabalala-Msimang, often ridiculed as "Dr. Beetroot," will maintain some role in AIDS policy, but activists say they are confident she has been effectively marginalized by the appointment of Mlambo-Ngcuka to oversee the government's response to the disease. Government officials privately acknowledge that Tshabalala-Msimang had become an embarrassment, and activists say the tenor of conversations with the government has changed dramatically since the deputy president took over.
"I'm still skeptical, and I'm still waiting for the proof," said Francois Venter, head of the Southern African HIV Clinicians Society. "But there's been a switch, the most hopeful switch in years, over the past four or five weeks."
Mbeki's comments questioning the relationship between HIV and AIDS stirred international outrage in 2000, and the government lagged even some less developed African nations in introducing subsidized antiretroviral drugs, which can prolong the lives of those with the disease by many years, perhaps decades. The first government program distributing the drugs began here in April 2004. South Africa's far smaller northern neighbor, Botswana, began two years earlier.
The South African program has grown steadily in the past 2 1/2 years and now reaches about 200,000 people with AIDS -- roughly one-quarter of those estimated to need the medicine immediately. But the demand for the drugs has grown faster than the program could handle despite major new government spending, including $400 million for AIDS programs this year alone.
"There were weaknesses on the implementation side of things," a government spokesman, Themba Maseko, said from Pretoria.
A turning point came in August, at the International AIDS Conference in Toronto, where Tshabalala-Msimang sponsored a display featuring lemons, beets and garlic but no antiretroviral drugs. An interview that Tshabalala-Msimang had with ABC's "Nightline" that same week renewed fears that she and Mbeki did not accept the two-decade-old scientific consensus that HIV causes AIDS.
"President Mbeki said, 'It cannot be the virus alone, we must look at other, other issues that predispose people to the immune system being depressed,' and I am of the same view also," Tshabalala-Msimang said on "Nightline."
The following day, Stephen Lewis, the U.N. special envoy for HIV/AIDS in Africa, denounced the South African government's view as "wrong, immoral and indefensible." Two weeks after that, 81 AIDS scientists from South Africa and around the world signed a letter calling on Mbeki to fire Tshabalala-Msimang.
The president refused. But those events, combined with a government report blaming AIDS for a massive surge of deaths among South Africans in their 20s, 30s and 40s, prompted Mbeki to appoint Mlambo-Ngcuka to lead an urgent review of AIDS programs, pushing Tshabalala-Msimang out of the spotlight, officials say.
In a speech to labor leaders on Sept. 19, Mlambo-Ngcuka said, without qualification, that HIV causes AIDS. She acknowledged "shortcomings" in the government's response to the disease so far. She mentioned the value of a sensible diet but made clear its limits.
"It should be stressed that a healthy lifestyle and good nutrition are not alternatives to treatment," she said, according to a transcript.
Mlambo-Ngcuka also called for peace between the government and its many critics on AIDS. "Our collective response has for too long been undermined by finger-pointing and despair. I appeal to you that we change that," she said.
AIDS activists said they initially reacted warily, but after meeting privately with Mlambo-Ngcuka, including a session Tuesday in Cape Town that lasted nearly two hours, they have grown more confident of the government's desire to improve its handling of the disease.
The activists say they are pushing for several concessions, including a target of treating 1 million South Africans with antiretroviral drugs. They also want targets for expanding HIV testing and for cutting the rate of new infections. Prevention efforts have largely failed in South Africa, experts say, even as Zimbabwe and several East African countries are showing success in curbing new infections.
Maseko, the government spokesman, said that after years of resisting calls from activists, officials have decided to set firm targets for expanding prevention programs and the availability of antiretroviral drugs in the five-year government plan due for release Dec. 1, celebrated around the globe as World AIDS Day.
"We will be accelerating implementation to make sure those who need treatment are getting it," he said.
As discussions continue, activists say the shift in the government's intentions is tangible and hope officials are capable of carrying through on their new promises.
"They have lost at least five years," said Mark Heywood, head of the AIDS Law Project at Witwatersrand University in Johannesburg. "They're behind on prevention. They're behind on treatment. They're behind on planning for the social impact of HIV. But it's not too late to prevent a whole other generation of people from getting HIV."
