Letter from Durban

CMAJ 2000;163(3):322

The speech given by the South African president, Thabo Mbeki, was televised live. It disappointed many of us because he did not recant his previous statements and state unequivocally that AIDS is primarily a sexually transmitted disease that is caused by HIV, and that his country is in the midst of an epidemic that dwarfs any plague in history.

Instead, he cited United Nations classification #2595 — "extreme poverty" — as the major cause of death in Africa and the developing world. He said his government is only 6 years old and only so much can be done, etc., and was heckled when he blamed "world indifference" and other factors as the cause of the AIDS epidemic.

Response was swift. The conference's first plenary speaker was Edwin Cameron, a white South African judge who is openly gay and HIV positive. He was unambiguous as he criticized Mbeki's government for its ineptitude in handling the epidemic. Judging from the applause, he echoed the feelings of most attendees when he stated that it is criminal and immoral to allow millions of people to die when the means to save lives and prevent infections are available. Cameron acknowledged that he is alive only because his relative affluence allows him to buy antiretroviral drugs. Most of his poor, black countrymen don't have that luxury.

In his speech, Mbeki also indicated that his government has an "AIDS Action Plan" to confront the epidemic, but it includes further "study" to "determine if HIV is the cause of AIDS." This, I think, is what has enraged thousands of scientists who have been working in HIV/AIDS research and treatment for the past 20 years. A group of these scientists has produced a pronouncement called the Durban Declaration, in which they spell out why it is known that HIV causes AIDS.

Cameron said the situation in South Africa can be likened to "a patient in the emergency ward who is dying." He called on government and the pharmaceutical industry, which he said have been engaged in a form of "collusive paralysis," to provide antiretroviral drugs to those who need them most. The announcement that Boehringer Ingelheim will give free nevirapine to African women to prevent the spread of HIV from mother to child was greeted with the usual cynicism, as other drug companies have made similar promises and failed to follow through. However, given that a recent study revealed that a single dose of nevirapine given to a mother in labour and to the child at birth was as efficacious as the more expensive regimen involving zidovudine, delivery on this promise could prevent many infections.

The AIDS deniers were not taken seriously by many people at the conference, although some here still believed that HIV is not the cause of AIDS. However, most African health care workers have clearly accepted the science that unequivocally links HIV with AIDS, and they have been some of the most vocal critics of government inaction.

There has been an interesting shift in the sense of urgency at this meeting. A few of the old ACT-UP types were here, but they were clearly overshadowed by the enormity of the disaster that is unfolding in sub-Saharan Africa, and there have been few of the protests that captured attention at earlier conferences.

Professor Roy Anderson, an epidemiologist from Oxford University, spelled out just how bad things are here. "We're not yet half-way through the epidemic," he said.

At this point there are about 24 million HIV-infected people in sub-Saharan Africa, and there are about 4 million new infections every year. Anderson also warned that new epidemics are already starting in India and China, and those countries must take action now. — Anthony Jeffery, Durban

Send a letter to the editor Envoyez une lettre à la rédaction

© 2000 Canadian Medical Association or its licensors