U.N. Envoy Sharply Criticizes South Africa's AIDS Program
---------------------------------------------------------
Taken from: ahila-net List <AHILA-NET@WHO.INT>
New York Times article - October 25, 2005
By SHARON LaFRANIERE
JOHANNESBURG, Oct. 24 - A new book by the United Nations' spe-
cial envoy to Africa on AIDS brings to light an extraordinary
breach between the organization and South Africa over the cri-
sis, under which the government has effectively banned the envoy
from carrying out his duties here for the past year.
The book, written by Stephen Lewis, singles out South Africa's
government and its president, Thabo Mbeki, for what it calls be-
wildering policies and a lackadaisical approach to treatment of
the nation's millions of H.I.V.-positive citizens.
Virtually every other nation in eastern and southern Africa "is
working harder at treatment than is South Africa with relatively
fewer resources, and in most cases nowhere near the infrastruc-
ture or human capacity of South Africa," Mr. Lewis says in the
book, "Race Against Time" (House of Anansi Press).
[see: http://www.anansi.ca/titles.cfm?pub_subid=281]
Mr. Lewis, a Canadian who has served since 2001 as the special
envoy to Africa on AIDS for the United Nations secretary gen-
eral, Kofi Annan, wrote that "every senior U.N. official, en-
gaged directly or indirectly in the struggle against AIDS, to
whom I have spoken about South Africa, is completely bewildered
by the policies of President Mbeki."
He contended that his colleagues are "incredulous" at how Health
Minister Manto Tshabalala-Msimang has exaggerated the possible
side effects of antiretroviral drugs and wrongly suggested that
a diet of sweet potatoes and garlic can be as important as an-
tiretrovirals in treating AIDS.
Such public criticism is highly unusual for an official of Mr.
Lewis's rank. His criticism largely mirrors that of civic groups
and advocates for AIDS patients here. Those groups have long
lambasted Mr. Mbeki and his health minister for what they call
the government's halfhearted efforts to tackle the crisis head
on.
In response, a spokesman for South Africa's Health Ministry
called Mr. Lewis a biased and uninformed judge of South Africa's
response to the epidemic. "No other country has increased treat-
ment at the pace at which we are implementing our program," the
spokesman, Sibani Mngadi, said in a telephone interview. "Soon
we are going to have the highest number of people on treatment
of anywhere" in the world.
Mr. Lewis's rift with the South African government dates from a
July 2004 international AIDS conference during which Ms. Tsha-
balala-Msimang publicly questioned the safety of a widely ac-
cepted drug treatment used to lower the risk of transmission of
H.I.V., the virus that causes AIDS, during pregnancy. Several
international officials objected to her comments, including Mr.
Lewis, who lamented South Africa's lack of progress in offering
antiretroviral therapy to hundreds of thousands in need of
treatment.
Ms. Tshabalala-Msimang then publicly invited Mr. Lewis to visit
South Africa "and realize how little he knows about the South
African health system." But when he tried to take her up on the
offer, Mr. Lewis said in a written response to questions, the
minister fired back a missive "bristling with (untenable) accu-
sations, and said I could not come to South Africa until I had
apologized to many individuals and groups, the president and
herself included."
After consulting with his superiors at the United Nations, he
said, he wrote back to the minister, telling her he had nothing
to apologize for.
Mr. Mngadi, the minister's spokesman, acknowledged in a tele-
phone interview that Ms. Tshabalala-Msimang had demanded an
apology. "The whole approach of Stephen Lewis was to question
whether we as a government had a right to take particular ap-
proaches, and in that situation it really requires an apology,"
he said. South African officials have worked constructively with
other United Nations representatives on AIDS, he said, "and
never experienced the kind of fallout that we have with Mr.
Lewis."
Mr. Lewis's book is a compilation of lectures he delivered as a
private citizen during the past year. In his last chapter, he
commends South Africa for devoting an ample share of its budget
to AIDS problems and for its efforts to prevent new infections.
"But on treatment, it is lagging unconscionably," Mr. Lewis
wrote. "What troubles me, and troubles me deeply, is that the
United Nations knows that something is terribly wrong, and yet
we feel we cannot say anything about it."
About 6.3 million of South Africa's 47 million citizens are in-
fected with the AIDS virus, up from an estimated 5.3 million in
2003. The World Health Organization estimated that about 837,000
South Africans urgently needed antiretroviral drugs by the end
of 2004. Only about 78,000 of them now receive drugs through the
government's programs, which began last year after a fusillade
of criticism over delays. Health analysts say that perhaps
60,000 more South Africans are treated through private programs.
That leaves South Africa far behind countries like Botswana and
Uganda , which by the end of last year were already reaching at
least half of those in need. The World Health Organization's
goal is to have 375,000 South Africans in treatment by the end
of this year.
President Mbeki's decision in late 2003 to triple the AIDS
budget and his government's efforts over two years to roll out
free antiretroviral drugs has somewhat lowered the level of
frustration. But many groups condemn his continuing silence on
the epidemic and say Ms. Tshabalala-Msimang continues to sow
confusion about the safety and effectiveness of antiretroviral
therapy, the only proven defense against AIDS.
"There are continually mixed messages, and there is almost in-
creasing confusion in the mind of the average Joe," said Rob
Stewart, a health researcher helping the Health Ministry monitor
treatment programs.
The latest controversy erupted Wednesday with disclosures that
two self-proclaimed specialists were invited to argue to the Na-
tional Health Council that antiretroviral drugs are toxic and
ineffective.
Mark Sonderup, a spokesman for the South African Medical Asso-
ciation, said that his organization was "flabbergasted" by the
presentation, and that government officials were trying "to tor-
pedo their own programs." His organization represents three-
fourths of the nation's doctors.
The ministry spokesman, Mr. Mngadi, insisted that the ministry
was fully behind antiretroviral treatment. "If we were denial-
ists," he asked, "why would we invest so much money in treat-
ment?"