South Africa: President Mbeki again downplays AIDS epidemic

President Thabo Mbeki of South Africa has written to Health Minister Manto Tshabalala-Msimang, ordering her to consider a cut in the AIDS budget. He claims to have discovered World Health Organisation (WHO) statistics from 1995 on the Internet showing that HIV/AIDS causes only a relatively tiny number of deaths in South Africa—2,653.

Mbeki cynically warned her that the figures would “provoke a howl of displeasure and a concerted propaganda campaign from those who have convinced themselves that HIV/AIDS is the single biggest cause of death in our country.” He continued, “These are the people whose prejudices led them to discover the false reality, among other things, that we are running out of space in our cemeteries as a result of unprecedented deaths caused by HIV/AIDS.

“Nevertheless, whatever the intensity of the hostile propaganda that might be provoked by the WHO statistics, we cannot allow that government policy and programmes should be informed by misperceptions, however widespread and well-established they may seem to be.”

The WHO said it is considering a protest to the South African government over what one official described as the “deliberate misinterpretation of old statistics for political ends”. The organisation says the latest figures show that AIDS is undoubtedly the single biggest cause of death in South Africa. Gregory Hartl, a spokesman for the WHO was quoted in the Guardian on September 11 saying that the death toll from AIDS was much higher than the president suggests. “The most recent figures the WHO uses, show 4.2m people living with HIV/AIDS in South Africa. We estimate 20% of adults are HIV-positive. Two hundred and fifty thousand people died of AIDS-related causes in 1999,” he said.

According to United Nations estimates, seven million South African will die from AIDS-related diseases within this decade.

Another WHO official pointed out, “These figures [for 1995] are totally out of date but even back then, there’s a lot of hidden data behind these statistics. Because of the stigma of AIDS, people are more likely to say the death was from something else. The same figures list TB deaths at 5.3 percent. A lot of those will be AIDS-related,” he said. In the same WHO document, nearly 14 percent of deaths are listed as deaths from “signs, symptoms and other ill-defined conditions”, which are also thought to be mostly AIDS related.

UNAIDS, the UN agency dealing with the disease confirmed last Tuesday that deaths from immune deficiency disease in South Africa had massively increased since 1995. In a statement they said, “Routine reporting of causes of death always has a tendency to underestimate AIDS as a cause of death. The reason for this is simply the fact that AIDS ‘has many faces’, which often leads to a diagnosis other than AIDS, for example tuberculosis, as the cause of death.”

A report from the South African Medical Research Council (MRC), due to be published soon, is expected to confirm that AIDS has become the leading cause of death, and may even outweigh all other causes together. The MRC, mindful of the fact that its report will come under vigorous scrutiny from the government, is submitting its data to further checks, to ensure the figures are “beyond reproach”. It was reported in Business Day that the MRC has come under government pressure to delay the release of the report. But Council President Malegapuru Makgoba has insisted that the report will come out on time within the next two weeks.

The Mbeki government has already shown itself to have little commitment to reducing the incidence of HIV/AIDS in South Africa. The Treatment Action Campaign (TAC)—an alliance of medical practitioners, AIDS patients and others— has sued the government in an attempt to force it to make available life-prolonging anti-HIV drugs it estimates could protect 35,000 new born babies a year from becoming infected by their HIV infected mothers. On cost and safety grounds the government has refused to make the funds available.

Clearly, by this use of outdated and misleading statistics, Mbeki is attempting to justify making cuts in the special AIDS fund of 125-million rand ($14-million) that has been set aside by the government. In his letter, Mbeki asks the following questions: “What social policies have we put in place to reduce the incidence of death, bearing in mind the causes of death by rank? Do our health policies and therefore the allocation of resources reflect the incidence of death as reflected by these figures?”

Last year, Mbeki caused uproar when he disputed the link between HIV and AIDS, implying that the disease in Africa was somehow different to that in the West.

A few days before the letter was despatched to the Minister of Health, Mbeki told Tim Sebastian in an interview on the BBC, “You know what the largest single cause of death in South Africa is? The largest single cause of death as we sit here is what in the medical statistics is called ‘external causes’ and that is violence in this society.”

“Law-and-order” is the one area that Mbeki is prepared to spend more money on, to police a country that is facing an unprecedented social catastrophe.