11 February 2004
President Mbeki Misrepresents Facts and Once Again Causes Confusion on HIV/AIDS
The TAC has strongly welcomed the government's operational treatment plan for HIV/AIDS of November 2003. We also welcome the efforts being made by some provincial governments, including Kwazulu-Natal, Gauteng and Western Cape, to implement this plan. Overall, we recognize that there has been tangible progress by government in improving policies, budgets and plans to prevent and treat HIV infection.
However we are alarmed that this progress and the efforts of national and provincial government health departments and officials are being undermined by inaccurate comments by President Mbeki and Minister of Health, Manto Tshabalala-Msimang.
On the evening of 8 February 2004 an interview with President Mbeki was broadcast live on SABC television and radio. Regrettably, his comments on HIV/AIDS contained serious factual misrepresentations. This and his single mention of ÒAIDSÓ, in passing, in his State of the Nation address to Parliament on February 6th 2004 suggest that he still he refuses to accept the seriousness of the epidemic. We are concerned that this is causing confusion in the public and despair among people with HIV/AIDS and health professionals. The publication of the Operational Plan increases the need for leadership Ð rather than reduces it.
The President stated that no studies have been done using death data to determine AIDS deaths and that the only reliable death statistics we have are for road accident deaths.
This is untrue.There have been two studies examining death registration data to determine mortality due to AIDS. Both were conducted by state institutions, Statistics South Africa and the Medical Research Council(see footnote 1). The Statistics South Africa report was commissioned by Cabinet. Both studies demonstrate the increased and massive mortality due to HIV. Their findings are included in a recent publication of the Health Department titled ÔHealth StatisticsÕ.
Another government endorsed study, the Impact of HIV/AIDS on the Health Sector(see footnote 2), found high AIDS mortality among health-care workers and estimated that 13% of health workers deaths from 1997 to 2001 were HIV-related. The study found that the HIV Òepidemic has an impact on the health system through loss of staff due to illness, absenteeism, low staff morale, and also through the increased burden of patient load.Ó
In response to a question on his silence on AIDS, President Mbeki stated that his doctors informed him that diabetes is also an epidemic. He then questioned why no-one talks about diabetes, suggesting that AIDS unfairly dominates debate on health-care to the detriment of other diseases.
This too is misleading: the PresidentÕs choice of diabetes as an example of a disease neglected in debate is unfortunate. Drugs for treating diabetes are heavily overpriced; there should be a campaign for their reduction. But unlike HIV (until November 2003), diabetes is treated in the public health sector. However, the President should be aware that according to an initial investigation into the burden of disease estimates in South Africa released in 2003 by the MRC, AIDS was responsible for 39% of lost life-years in 2000 -- more than the next 10 worst diseases. Diabetes is the 12th worst disease and is responsible for slightly more than 1% of lost life-years. The two diseases are incomparable in scale.
President Mbeki stated that few countries Ôcan hold a candle to South Africa's HIV/AIDS programmeÕ.
A number of developing countries do much better than South Africa when it comes to HIV prevention and treatment, often with far fewer resources. And certainly, the political leaders of many much poorer developing countries do better than South Africa in their public messaging. With its relative wealth and more sophisticated public health care infrastructure, South Africa should be leading the response in Africa to HIV/AIDS, but it is not.
Currently, South Africa treats approximately 1,500 people in its public sector, who are not on drug trials, paying for their own medicines or being sponsored. Throughout South Africa, fewer than 40,000 people are on treatment. South Africa now has a competent implementation plan on paper, but its roll-out is being delayed.
By contrast:* Brazil's government treats over 100,000 people and has less than a quarter of South Africa's HIV infections. Its prevention and treatment programmes are incomparably better than South Africa.* Botswana is treating approximately 15,000 and Cameroon approximately 7,000 people.
TAC believes that confronting HIV, and mitigating its impact on the progress of our country, demands that we are truthful with ourselves and that we enter into genuine partnerships for HIV prevention and treatment.
The continued failure of the President and Minister of Health to deal appropriately or caringly with the epidemic is undermining the delivery of decent health-care to millions of poor people. This is one of the most important challenges facing South Africa; the President and Minister of Health must lead not confuse and obfuscate.
Footnote 1: See http://www.statssa.gov.za/Archives/Publications/Causes%20of%20death/Causes%20of%20death.pdf and http://www.mrc.ac.za/bod/complete.pdf
Footnote 2: See http://www.hsrcpublishers.co.za/index.html?e-lib.html~content.