DURBAN — On July 9, 5000 people, many wearing "HIV Positive" T-shirts gathered at the Durban city hall to demand equitable access to HIV/AIDS treatment.
The march preceded the opening of the 13th International AIDS Conference, held here on July 14-19. The excited group of nuns, drag queens, traditional healers, doctors, Communists, teenage punks on skate boards, Pan-Africanists, gay activists, unionists, students and nurses had come from all over South Africa and from cities as far away as Mumbai, Paris, Guatemala City and Lagos to join the Global March for Access to HIV/AIDS Treatment. The streets of Durban were full of singing, dancing, laughter, warm solidarity and hope.
While the official protest posters castigated the multinational drug companies for making huge profits from the AIDS crisis, participants' homemade posters said things like, "AIDS is as real as cANCer"; "Mbeki, forget your R3 million jet and buy us medicine" and "One dissident one bullet" [referring to South African President Thabo Mbeki's dalliance with the "AIDS dissidents" who argue that HIV does not cause AIDS].
[There is growing outrage at the African National Congress government's refusal to treat HIV+ pregnant women and rape survivors with anti-retroviral drugs, such as AZT, based on the claim that they are "toxic". This is seen as an excuse to justify not spending money on treatment while cutting government spending and reducing the taxes paid by big business and high-income earners.]
The march was organised by the Treatment Action Campaign (TAC) — a rapidly growing organisation which draws much of its support from the trade union movement. The TAC succeeded in making the demand for equitable access to HIV/AIDS treatment the single biggest issue confronting the 13th International AIDS Conference. Previous conferences had focused on prevention.
Mbeki's credibility compromised
Earlier this year, a letter written by Mbeki to US President Bill Clinton was leaked to the Washington Post. In it Mbeki defended his government's dealings with the "dissidents". Mbeki's position was attacked in the international media. Leading South African intellectual Dr Mamphele Ramphele accused him of "irresponsibility bordering on criminality".
Mbeki's credibility was compromised further when, on the eve of the Durban conference, 5000 leading scientists from around the world, including 12 Nobel Prize winners, and 160 South African scientists, signed the Durban Declaration, which insisted: "The scientific evidence that HIV causes AIDS is unambiguous". South Africa's leading AIDS expert and conference chairperson, Professor Jerry Coovadia, said, "The importance of this document cannot be underestimated".
South Africa's minister of health, Manto Tshabalala-Msimang, dismissed the document as "elitist" and Mbeki's spokesperson, Parks Mankahlana, said, "It belongs in the dustbin".
Things started off badly with a gauche conference opening "extravaganza" which cost just under US$1 million and infuriated activists.
Mbeki was booed as he repeated in his conference speech the dissident view that, "AIDS in Africa has become a catch-all name associated with malaria, tuberculosis ... and other maladies". He questioned the gravity of the AIDS pandemic, saying that he had also "heard stories" about other diseases like malaria, tuberculosis and hepatitis B.
The world's most eminent scientists issued statements of strong condemnation. Coovadia said the speech had evoked "an absolute sense of disappointment". "I was hoping and praying that [Mbeki] would find a way to back out of this madness gracefully", he added.
Phil Wilson of the African-American AIDS Initiative told the Durban Mercury: "The house is on fire and Mr. Mbeki is sitting around trying to decide whether it was started by a match or a lighter". Professor Thomas Croates of the University of California went so far as to call the government's stance "genocidal". Sipho Mthathi, a local AIDS activist, wasn't so extreme, but said, "The message from the government to me is that if I have got HIV, I am on my own and the government doesn't have a place for me".
While Mbeki and his supporters were claiming that the criticism of his AIDS stance were an attack on open debate and the president's right to free speech, Mbeki and the African National Congress were quick to try to stifle debate. At the July 9 march, Winnie Madikizela-Mandela insisted that "HIV causes AIDS" and that "our government has become an obedient servant to the multinational companies that continue to put their profits about our people".
A few days later at an ANC convention, Mbeki delivered a scathing attack on her. Bizarrely, he also dismissed rape survivor Charlene Smith's plea that the state provide AZT to rape survivors as "racist rage".
It was reported that the press conference to launch the Durban Declaration had been called off due to intense government pressure on the 120 South African signatories. According to a widely spreading rumour, the sudden interruption of the radio and television broadcast of Mbeki's speech was not a technical error but an apartheid-style intervention to prevent people hearing Mbeki being booed.
Government priorities
While theories abound about why Mbeki has taken the stand he has, the most popular view is that government is simply not prepared to carry the cost of fighting the plague. The South African Department of Health estimates that it would cost US$6 billion a year at current prices to provide anti-retroviral therapy to all people living with HIV. That would be less than 20% of the $32 billion which the government recently announced it would spend on arms and less than a sixth of what is spent each year paying off the apartheid debt.
Coovadia insisted, "It is too expensive not to intervene"; experts estimate that the cost of non-intervention will be a 17% decline in South Africa's GDP by 2010.
When the respected magazine Science asked Parks Mankahlana why the South Africa government is refusing to provide drugs that can prevent mother-to-child transmission, he revealed the ANC government's real concern: "That mother is going to die and that HIV-negative child will be an orphan. That child must be brought up. Who is going to bring the child up? It's the state, the state. That's resources you see."
There was a danger that Mbeki, rather than the AIDS pandemic, would be the big news story of the conference. But the extent of the crisis was made apparent.
No one had to tell South Africans that they were spending many of their weekends at funerals, but they did learn that: there will be 44 million African orphans by 2010; South Africa has the highest number of HIV infections in the world; 5000 HIV+ babies are born in South Africa each month; 4.2 million South Africans are living with HIV/AIDS; and, by 2010, life expectancy in South Africa will drop to 36 years.
For some time the South African government had been claiming that AIDS drugs are "ineffective" and "toxic". Just days before the conference, Mbeki repeated these claims in a letter published in Sunday Times. But the scientists had the last word and South Africans learned that the drugs do work and that people who can afford them can live longer and healthier lives.
Rigorous research presented at the conference showed that women who were given AZT and 3TC after being raped by HIV+ men were not infected with HIV. As well, although the South African government has repeatedly claimed that Nevirapine is ineffective and toxic, South African research shows that Nevirapine does prevent mother-to-child transmission, the worst side effect being a mild rash on the day after treatment. Coovadia didn't mince his words. "The position", he insisted, "is now absolutely clear".
Treatment necessary
Yet, according to Time magazine, only 20,000 of the millions of Africans living with AIDS are receiving some form of treatment. The rest will probably be dead within two to three years.
HIV+ South African High Court Judge Edwin Cameron made the point with headline grabbing eloquence: "My presence here embodies the injustices of AIDS in Africa. Amidst the poverty of Africa, I stand before you because I am able to purchase health and vigour. I am here because I can afford to pay for life itself."
The executive director of UNAids, Peter Pilot, declared that AIDS prevention strategies and treatment must both be implemented: "If there is no decent care at the end of testing, why would people go for testing? If there is no prevention of mother-to-child transmission, why would women go for testing? There would be no hope and hope has always been the driving force in all social movements."
But South Africans are still drinking bleach in a desperate attempt to self-medicate and wandering from hospital to hospital in a fruitless search for help. Nevirapine could prevent 5000 babies a month from being infected with HIV yet there is no treatment for the 25% of 15-24-year-old South African women who are HIV+. At the current South African price (US$4 a dose), 125,000 pregnant women could be treated with Nevirapine for the price of the luxury jet that Mbeki is planning to buy.
While Nevirapine has been approved for use in Uganda and Senegal, South Africa's Medicines Control Council has still not approved its use. Health department director general Ayanda Ntasaluba shocked activists by saying that further "studies" were needed before the government could approve the provision of Nevirapine.
The charismatic chairperson of the TAC, Zachie Achmat, who is HIV+, has taken a principled decision not to take any anti-retroviral drugs until the government makes the medication available to all with HIV. Achmat has confirmed that if the government fails to provide Nevirapine to pregnant women, the TAC will launch an urgent High Court application to demand the constitutional right to treatment. TAC is also committed to a defiance campaign. It will import anti-AIDS drugs and distribute them illegally if necessary.
BY RICHARD PITHOUSE
[The author teaches at the University of Durban-Westville, KwaZulu-Natal, South Africa.]