Issue 51

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Africa's AIDS crisis

THE HEALTH committee of the ruling African National Congress (ANC) in South Africa has accused the government of 'fiddling while the masses are dying'. With at least 10% of its citizens HIV-positive, 4,000 babies born with HIV each month, and 1,700 new infections everyday, South African society is being lashed by the global AIDS storm.

Of the 35 million people infected with human immunodeficiency virus (HIV) - the virus which causes AIDS, acquired immunodeficiency syndrome - 25 million (70%) live in sub-Saharan Africa. In Zambia, life expectancy has plummeted from 60 years to 37. The number of orphaned children is expected to reach five million by 2005.

The AIDS catastrophe unfolding in these countries certainly has a wide range of causal 'co-factors', alongside the HIV virus. These include government public health policies and individuals' sexual behaviour.

Sub-Saharan Africa lacks a developed social infrastructure. The relentless advance of AIDS is partly due to the inability of healthcare systems to cope with basic diseases which leave the body's immune system more open to infection. There is an insufficient number of health education workers and limited budgets for the promotion of safer-sex practices which would help contain the spread of the virus.

Added to this is a scarcity of clean water, ineffective sewerage disposal, and social dislocation caused by migration from rural areas to cities. There is also a need to tackle patriarchal attitudes which inhibit the ability of women and girls to resist men's demands for unsafe sex.

At the same time, international debate on HIV/AIDS has been dominated by the conflict between neo-colonial countries and the multi-national pharmaceutical companies.

From the mid-1990s, AIDS death rates in the advanced capitalist countries dropped dramatically after the introduction of combination therapies, involving complex packages of 'anti-retroviral' drugs. These have been generally successful in containing and reversing the levels of HIV in an infected person.

Governments of impoverished states in Africa and Asia have been desperately trying to obtain AIDS drugs at lower prices by buying 'generic' drugs from patent-holders, as opposed to the monopoly market leader. And they have taken advantage of the emergency provisions in WTO treaties to manufacture domestic products under 'compulsory licences' at knock-down prices.

The US administration, through vice-president Al Gore, responded by threatening trade sanctions against countries which contemplated such steps, which are seen as jeopardising the profit levels of the large drug firms (see Socialism Today No.42, October 1999). In the face of protests by gay organisations, HIV/AIDS activists and African-Americans during the early stages of Gore's presidential campaign, the Clinton administration backed-off, pledging $254 million to fight AIDS in Africa. This sum, however, as Robin Lustig pointed out, is "pitifully inadequate, less over 12 months than the nations of sub-Saharan Africa spend on debt repayments every week". (The Guardian, 11 July)

Meanwhile, for their own public relations' reasons, five large drug companies have cut the price of selected products in the underdeveloped countries from $16 to $2 per day. Sarah Boseley, the Guardian's health correspondent, commented: "It is clear that the cost will still be prohibitive for governments and ordinary individuals in sub-Saharan Africa". (8 July)

For the first time, July's International AIDS Conference took place at a Third World venue - South Africa. When president Thabo Mbeki agreed to address the event, South Africans living with HIV/AIDS, health workers and campaigners, community activists and scientists, saw this as an opportunity to raise their demands directly with Western governments and multi-national pharmaceutical companies.

Instead Mbeki reiterated statements which cast doubt over the link between HIV and AIDS. Quoting from a 1995 World Health Organisation survey on Africa, he insisted that the chief killer on the continent was poverty, not AIDS. Mbeki concluded: "As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus. It seemed to me also that every living African, whether in good or ill health, is prey to many enemies of health". (Guardian, 10 July)

Edwin Cameron, a HIV-positive gay judge from South Africa, attacked Mbeki's speech for having "shaken almost everyone responsible for engaging the epidemic. It has created an air of unbelief amongst scientists, confusion amongst those at risk of HIV, and consternation amongst AIDS workers". (Guardian, 11 July)

Two months earlier, Cameron had attacked Mbeki's administration for flirting with so-called 'AIDS dissident' scientists, such as Dr Peter Duesberg of the University of California. Under pressure over his government's AIDS policies, including the refusal to prescribe the drug AZT to expectant mothers, Mbeki appointed Duesberg and other 'dissidents' to sit on a commission examining South Africa's response to the AIDS pandemic.

For several years it has been known that some people can become HIV-positive yet not contract 'full-blown' AIDS, as a result of natural immunity which has yet to be explained. This and other gaps in scientific understanding have been used by dissident scientists to assert that AIDS is not caused by HIV. During the dissidents' heyday, their views were used to promote the idea that AIDS was a 'gay plague' and those infected had brought a misfortune on themselves through a 'deviant lifestyle', rather than merely comprising a high-risk group in a pandemic which threatens humankind as a whole.

The re-hashed AIDS dissidents' arguments are, the Guardian commented, "attractive to Mr Mbeki, who talks of Africa needing her own solutions, not answers from the West. If Prof Duesberg is right, then he does not have a full-scale medical epidemic on his hands... (but) the normal diseases of poverty, which investment from the West could help to solve". (10 July)

The ANC government faces chronic shortages of resources on many fronts. But rather than just being an eccentric whim, Mbeki's denial of the role of HIV in causing the AIDS pandemic is a political stance, which reflects the ANC government's reluctance to take on the multi-national corporations.

Lionel Wright