Fri, Nov 28, 2008 page6

• Mbeki’s AIDS policy killed 330,000 people, report says

  ‘A MAJOR OBSTACLE’ A Harvard School of Public Health study concluded that the former South African president’s stance on HIV/AIDS led to foot dragging

  • THE GUARDIAN
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  The AIDS policies of the former president of South Africa Thabo Mbeki’s government were directly responsible for the avoidable deaths of a third of a million people in South Africa, research from Harvard University showed.

  South Africa has one of the most severe HIV/AIDS epidemics in the world. About 5.5 million people, or 18.8 percent of the adult population, have HIV, the UN said. In 2005 there were 900 deaths a day.

  But from the late 90s Mbeki turned his back on the scientific consensus that AIDS was caused by a viral infection which could be combated, though not cured, by sophisticated and expensive drugs. He came under the influence of maverick scientists known as AIDS-denialists, most prominent among whom was Peter Duesberg from Berkeley, California.

  CONTROVERSY

  In 2000 Mbeki called a round-table of experts, including Duesberg and his supporters but also their opponents, to discuss the cause of AIDS. Later that year, at the international AIDS conference in Durban, he publicly rejected the accepted wisdom. AIDS, he said, was indeed brought about by the collapse of the immune system — but not because of a virus.

  The cause, he said, was poverty, bad nourishment and general ill-health. The solution was not expensive western medicine but the alleviation of poverty in Africa.

  In a new paper Harvard researchers have quantified the death toll resulting from Mbeki’s stance, which caused him to reject offers of free drugs and grants and led to foot-dragging over a treatment program, even after Mbeki had taken a vow of silence on the issue.

  “We contend that the South African government acted as a major obstacle in the provision of medication to patients with AIDS,” wrote Pride Chigwedere and colleagues from the Harvard School of Public Health, Boston, in the Journal of Acquired Immune Deficiency Syndrome.

  They have made their calculations by comparing the scale-up of treatment programs in Botswana and Namibia with the limited availability of drugs in South Africa from 2000 to 2005.

  Expensive antiretrovirals (ARV) came down in price dramatically as a result of activists’ campaigning and public pressure. In July 2000 the pharmaceutical company Boehringer Ingelheim offered to donate its drug nevirapine, which could prevent the transmission of HIV from mother to child during labor.

  But South Africa restricted the availability of nevirapine to two pilot sites a province until December 2002.

  Eventually, under international pressure, South Africa did launch a national program for the prevention of mother to child transmission in August 2003 and a national adult treatment program in 2004. But by 2005, the paper’s authors estimate, there was still only 23 percent drug coverage and less than 30 percent prevention of mother to child transmission.

  SUCCESS

  By comparison, Botswana had achieved 85 percent treatment coverage and Namibia 71 percent by 2005, and both had 70 percent mother to child transmission programs coverage.

  The authors estimate that more than 330,000 people died unnecessarily in South Africa over the period and that 35,000 HIV-infected babies were born who could have been protected from the virus but would now probably have a limited life.

  Their calculations will withstand scrutiny, they said.

  “The analysis is robust,” Chigwedere said. “We used a transparent and accessible calculation, publicly available data and, where we made assumptions, we explained their basis. We purposely chose very conservative assumptions and performed sensitivity analyses to test whether the results would qualitatively change if a different assumption were used.”

  “Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available ARVs to prevent and treat HIV/AIDS in a timely manner,” the authors said.
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