Aids in Afrika

1 INDEX Mbeki - Aids 2000 - Hintergrundtexte 00 08 1998 Blätter des iz3w (FRG) Aids in Afrika - Die Statistik-Seuche: Zweifelhafte Diagnosen und Zahlenspiele zeichnen eine AIDS-Katastrophe in Afrika 23 04 2000 Sunday Times (South Africa) Reciting comfortable catechisms on AIDS is not good enough second opinion 01 07 2000 DOCUMENT The Durban Declaration: A Declaration by Scientists and Physicians Affirming HIV is the Cause of AIDS 03 05 2000 DOCUMENT Presidential Aids Advisory Panel 10 07 2000 DOCUMENT 13TH INTERNATIONAL AIDS CONFERENCE DURBAN: Speech of the President of South Africa at the Opening Session of the Conference 25 07 2000 DOCUMENT Statement by the MEC for Health, Dr M Sefularo, during the Aids Conference Report-Back, 25 July 2000 04 09 2000 TIME EUROPE The Road Ahead # 00 08 1998 Blätter des iz3w (FRG) Aids in Afrika - Die Statistik-Seuche: Zweifelhafte Diagnosen und Zahlenspiele zeichnen eine AIDS-Katastrophe in Afrika< von Christian FiaIa Bei der 12. Welt-AIDS-Konferenz in Genf wurde wieder einmal festgestellt, daß die Epidemie im Süden Afrikas »völlig außer Kontrolle« geraten sei. Die Statistiken über AIDS in Afrika zeichnen ein bedrohliches Bild, nachdem die Krankheit in vielen Staaten des Kontinents inzwischen zur häufigsten Todesursache geworden ist. Doch das Beispiel Uganda zeigt, daß die Hochrechnungen meist auf Vermutungen und Spekulationen basieren. Bis zu seiner Unabhängigkeit im Jahr 1962 galt Uganda als Musterbeispiel britischer Verwaltung, und für Winston Churchill war das Land am Anfang des Jahrhunderts schlichtweg »die Perle Afrikas». Auch das Gesundheitswesen war für damalige Verhältnisse beispielgebend. Doch der Export westlicher Medizin durch Kolonisatoren und später Entwicklungshelfer hat zwar zunächst zur Eindämmung von vielen Infektionskrankheiten, dann aber auch zur Verbreitung anderer geführt. Bereits im Jahr 1958 wurde ein organisiertes Blutspendewesen eingeführt. Innerhalb kurzer Zeit hatte sich dies im ugandischen Gesundheitswesen fest etabliert, nicht zuletzt, weil in dieser Region Infektionskrankheiten weit verbreitet sind, was eine chronische Blutarmut in weiten Teilen der Bevölkerung zur Folge hat. Die Organisation der Blutbank war für damalige Verhältnisse vorbildlich. Die verwendeten Flaschen wurden sterilisiert und die Nadeln bei Bedarf immer wieder geschliffen. So organisierte alleine die Blutbank in der Hauptstadt Kampala Anfang der 70er Jahre für die Krankenhäuser der damals etwa 350.000 Einwohner um die 14.000 Blutspenden jährlich. Der Großteil davon kam entweder von Verwandten der Patienten oder 2 Mbeki - Aids 2000 - Hintergrundtexte von bezahlten Blutspendern. In den meisten Fällen wurde das Blut nicht auf mögliche Infektionserreger untersucht, und HIV-Tests gibt es erst seit Anfang der 90er Jahre. Auch die Einführung von Spritzen, entweder für eine Therapie oder als Impfung, bedeutete besonders bei der Behandlung und Vorbeugung der weit verbreiteten Infektionskrankheiten zunächst einen wesentlichen Fortschritt. Zu den häufigsten Krankheiten zählen Durchfall, Lungenkrankheiten sowie sexuell übertragbare Infektionen wie Syphilis und Gonorrhoe. Die Tatsache, daß nicht sterilisierte Spritzen Krankheitserreger übertragen können, wurde damals allerdings wenig berücksichtigt. Genaue Untersuchungen über die Art und Weise, wie Spritzen sterilisiert wurden, liegen nicht vor. Lediglich aus Anekdoten ist bekannt, daß teilweise hunderte von Menschen mit der gleichen Nadel geimpft wurden. Derzeit werden »jedes Jahr weltweit über 12 Milliarden Injektionen» verabreicht, wie die WHO in einer Publikation festhält, »mindestens ein Drittel davon wird ohne ausreichende Sterilisation gegeben, womit möglicherweise Krankheiten übertragen werden.« Besonders in Afrika ist die Situation besorgniserregend, weil dort laut WJO mehr als 80% der Einmalspritzen mehrfach verwendet werden. In Tansania wurde in einer neueren Untersuchung bei 12 Prozent der Spritzen, welche zur Verwendung hergerichtet waren, noch Blutreste des vorherigen Patienten gefunden. Damit wird deutlich, daß die westliche Medizin nicht nur ein Fortschritt in der Gesundheitsversorgung ist, sondern andererseits auch ideale Bedingungen für die Ausbreitung von Infektionserregern bietet, wenn sie nicht richtig angewendet wird. Das ist seit langem bekannt, es gibt jedoch große Widerstände, über diese Auswirkungen zu reden, ist doch die Medizin der Exportschlager der westlichen Kultur. Konsequenterweise wird die Rolle von Injektionen und Bluttransfusionen bei der Ausbreitung von HIV und anderen Infektionserregern regelmäßig heruntergespielt. Aids ist nicht gleich Aids Die Weltgesundheitsorganisation publizierte 1986 eine Definition der Krankheit Aids für Entwicklungsländer, welche sich wesentlich von der Definition in Europa unterscheidet.1 Darin wird als Aids-krank erklärt, wer zum Beispiel länger als einen Monat Durchfall, starke Gewichtsabnahme und zum Beispiel generalisierten Juckreiz oder Husten hat. Ein HIV-Test ist nach dieser Definition ausdrücklich nicht notwendig und wird auch heute noch aus Geldmangel nur selten durchgeführt. Das heißt, die Krankheit Aids, die nach den Worten von Professor Luc Montagnier, dem Entdecker des HIV, 'keine typischen Symptome hat', wird in den Entwicklungsländern ausschließlich aufgrund vollkommen unspezifischer Symptome diagnostiziert.2 Die indizierenden Symptome sind nicht gerade selten in einem Land, das zwanzig Jahre systematischer Zerstörung hinter sich hat und in dem die durchschnittliche Lebenserwartung wegen der vielen Infektionskrankheiten und der schlechten hygienischen Verhältnisse bei ungefähr 50 Jahren liegt. Und so kann es nicht wirklich verwundern, daß Uganda in den Jahren nach 1986 einen starken Anstieg an »Aids-Fällen« hatte. So waren beispielsweise die Hälfte der Betten auf der Inneren Station in der Makerere Universitätsklinik in Kampala mit Aids-Patienten belegt. Das heißt: Diese Patienten hatten Fieber, Durchfall oder Gewichtsverlust sowie eines der in der Liste aufgeführten Nebenkriterien und wurden, entsprechend der WHO-Definition, ohne HIV-Test als Aids-Patienten deklariert. Dazu kommt, daß viele Länder Afrikas die ursprüngliche WHO-Definition weiter abänderten. So kann Tuberkulose in Uganda ganz offiziell zu einer Aids-Diagnose führen. Im Nachbarland Tansania wurden die Kriterien für eine Aids-Diagnose zunächst enger gefaßt. 3 Mbeki - Aids 2000 - Hintergrundtexte Es waren zwei Haupt- und zwei Nebenkriterien notwendig. Doch das tansanianische Gesundheitsministerium schreibt in seinem Bericht vom August 1990: »Von den 1.987 neu gemeldeten Fällen haben lediglich 667 (33,6%) die erwähnten Kriterien erfüllt. [...] Obwohl 1 320 Fälle (66,4%) genaugenommen keine Aids-Fälle sind, haben wir sie dennoch als solche gezählt, da wir davon ausgegangen sind, daß diejenigen, die sie gemeldet haben, einfach einen Fehler beim Ausfüllen der Formulare gemacht haben.« 3 Beide Länder begründen ihr unterschiedliches Vorgehen damit, daß die WHO-Definition zu ungenau sei und an die nationalen Bedingungen angepaßt werden müßte. Es wird also angenommen, eine Infektionskrankheit würde diesseits oder jenseits der politischen Grenze unterschiedliche Symptome hervorrufen. Diese Aussagen über das 'klassische' AIDS-Land Uganda treffen auch auf viele andere Länder Afrikas zu, in denen die Lebensbedingungen ähnlich sind. Paradoxerweise haben daher auch Länder mit wenig HIV-Infektionen viele »Aids-Fälle«, bedingt durch die Ungenauigkeit der Aids-Definition. So schreibt Dr. Chin, der ehemalige Leiter der Abteilung zur Erfassung der Ausbreitung von Aids bei der WHO: »Es soll betont werden, daß die (surveillance) Definitionen von Aids nicht als verläßliche Zeichen einer HIV-Infektion gedacht sind. In Gegenden, wo es wenig HIV-Infektionen gibt, werden mit der WHO-Definition deshalb in erster Linie Patienten mit Tuberkulose, schwerer Mangelernährung oder Durchfall erfaßt.« Wer bietet mehr? Alle gemeldeten Aids-Fälle werden von der WHO in Genf erfaßt und mit einem Faktor multipliziert, der - und das fällt auf - jedes Jahr höher wird. 1996 lag er noch bei 2, 1997 bereits bei 17. Der WHO wurden in den letzten eineinhalb Jahren 116.000 neue Aids-Fälle aus Afrika gemeldet. Im gleichen Zeitraum hat sie ihre Statistik der geschätzten Fälle jedoch um ganze 4,5 Millionen erhöht - Multiplikationsfaktor 38l. Aus Uganda wurden bisher insgesamt 51.779 Aids-Fälle gemeldet. In ihrem letzten Bericht schätzt die WHO die Zahl der Aids-Fälle aus diesem Land jedoch auf 1,9 Millionen, das sind 10 Prozent der Bevölkerung. Damit addiert die WHO für jeden einzelnen gemeldeten Aids-Patienten jeweils 37 geschätzte Fälle zur Statistik dazu. Geht man von der Zahl derjenigen Fälle aus, die aufgrund der ausgeführten Definitionen gemeldet werden, so ergibt sich lediglich eine einzige Aussage: die meisten Menschen in Afrika sterben an Symptomen, die durch bekannte und behandelbare Infektionskrankheiten, wie Malaria, Lungenentzündung oder Durchfall als Folge der schlechten hygienischen Bedingungen entstehen. Hinzu kommt, daß die Statistiken meist alle Fälle seit Beginn der 80er Jahre aufaddieren, also kumuliert darstellen. Diese Art der Darstellung ist absolut ungewöhnlich in der Medizin, da sie unbrauchbare Resultate liefert. Sie muß zwangsweise ansteigen, auch wenn jedes Jahr nur noch wenige neue Fälle hinzukommen. So schreibt das Deutsche Ärzteblatt unter der Überschrift »Kumulative Verwirrung» bereits 1989: »Kein Mensch denkt daran, die Erkrankungszahlen an Mumps, Tuberkulose oder Scharlach aufzuaddieren von dem Tage an, an dem das Seuchengesetz erlassen wurde.« Folgerichtig sei der einzige Sinn einer solchen Darstellungsform: »Große Zahlen bringen großes öffentliches Geld.« In seltener Offenheit bringt dieser Artikel im Deutschen Ärzteblatt auf den Punkt, worum es in der Gesundheitspolitik geht: Wer am lautesten schreit, und wer die Bevölkerung in Angst versetzt, bekommt die größte Unterstützung. In dieser Hinsicht waren die Institutionen, welche sich gegen Aids engagieren, in den letzten 15 Jahren absolut erfolgreich. Die absurden Aids-Definitionen und Zahlenmanipulationenen haben vielerorten dazu geführt, 4 Mbeki - Aids 2000 - Hintergrundtexte daß ein großer Teil der Budgets in Maßnahmen zur Veränderung des Sexualverhaltens investiert wird und damit für die medizinische Versorgung nicht mehr zur Verfügung steht. Die WHO »glaubt«, daß das HIV in Afrika im wesentlichen sexuell übertragen wird. Diese Aussage ist in mehrfacher Hinsicht bemerkenswert. Erstens ist nach mehr als 15 Jahren eindeutig, daß es in Europa keine Epidemie unter der heterosexuellen Bevölkerung gibt. Warum also in Afrika? Zweitens wird häufig das angeblich besondere Sexualverhalten von Afrikanern angeführt. Dabei werden in den USA die Sexualpartner am häufigsten gewechselt, gefolgt von Frankreich, Australien und Deutschland. Südafrika liegt hingegen, ebenso wie Thailand abgeschlagen im hinteren Mittelfeld.4 Im Widerspruch zu wissenschaftlichen Daten werden deshalb Anekdoten generalisiert, um in Fortführung der langen christlichen Tradition über das angeblich so ausschweifende Sexualleben der Afrikaner zu phantasieren. (siehe auch »Wer hat Angst vor'm schwarzen Mann?« in iz3w Nr 200) AIDS wird zum wichtigsten Gesellschafts- und Gesundheitsproblem stilisiert. Dabei ist nach wie vor Malaria die häufigste Krankheit in Afrika, obwohl sie Anfang dieses Jahrhunderts in Europa und in manchen tropischen Gegenden erfolgreich besiegt worden ist. Die Malariaprogramme in Entwicklungsländern führen ein stiefmütterliches Dasein, das Geld geht an die Aids-Organisationen. Selbst das Engagement für sauberes Trinkwasser (in Uganda haben nur 30% der Bevölkerung Zugang dazu), elementare Grundlage für jedes erfolgreiche Gesundheitssystem, mobilisiert in Europa kaum jemanden. Von denselben Menschen, die kein Geld für sauberes Trinkwasser haben, wird erwartet, sich für jeden Verkehr ein Kondom zu kaufen - eine AIDS-Politik, die zynischer kaum sein kann. Christian Fiala hat als Arzt u.a. in Thailand, Frankreich und Guadeloupe gearbeitet. Er ist Autor des Buches »Lieben wir gefährlich?«, das im Verlag Deuticke in Wien erschienen ist. Anmerkungen: 1 WHO Global programme on AIDS; Provisional WHO clinical case definition for AIDS, Wkly Epidemiol Rec, 1986; March 7; no 10: 72-3 2 Luc Montagnier; Von Viren und Menschen, Rowohlt, 1997 3 Ministry of Health, National Aids Control Programme, Aids Surveillance, Report No 3, August 1990, Dar es Salaam, Tanzania 4 Durex, Global Sex Survey, London, 1997, http://www.durex.com Anzahl der »Aids-Fälle« in Afrika laut WHO-Berechnung WHO-Bericht von gemeldete geschätzte MultiplikaFälle tionsfaktor (kumuliert) (in Mio) Juli 1994 0,33 2,68 8 Januar 1995 0,35 3,15 9 Juli 1996 0,5 5,93 12 November 1997 0,62 10,4 17 - alle Aids-Fälle seit Ende der 70-er Jahre, einschließlich der bereits verstorbenen Menschen Aids-Waisen Besonders abenteuerlich ist der Umgang mit Statistiken und Zahlen über Aids-Waisenkinder. "Ungefähr 830.000 Kinder leben mit HlV/Aids. Aber die Auswirkungen der HIV-Epidemie sind viel schwerwiegender, als die bereits große Zahl an infizierten Kindern vermuten läßt", beschreibt die WHO die Situation mit dramatischen Worten in ihrer Pressemitteilung vom 28. November 1996 und fährt fort: »Das Waisen-Projekt in New York schätzt in einer Studie, daß in sieben Ländern insgesamt mehr 5 Mbeki - Aids 2000 - Hintergrundtexte als eine Million Kinder unter 14 Jahren durch Aids zu Waisen geworden sind. 95 Prozent dieser einen Million Kinder leben in Kenia, Ruanda, Uganda und Sambia. [...] Wenn wir von der vorsichtigen Schätzung ausgehen, daß die Zahl der bereits verwaisten Kinder in Uganda etwa 10 Prozent der HIV-lnfizierten Mütter entspricht, so bedeutet dies, daß alleine in diesem Land mehr als drei Millionen Kinder von den Auswirkungen der Epidemie betroffen sind.« In Uganda gibt es derzeit ungefähr acht Millionen Kinder unter fünfzehn Jahren. Dieses unfaßbare Verhältnis - drei von acht Kindern wären demzufolge HIV-positiv relativiert ein anderer WHO-Bericht zu dem gleichen Thema: »Pflege und Unterstützung von Kindern HIV-infizierter Eltern« lautet der unscheinbare Titel. Auf Seite zwei steht zunächst folgender Hinweis: "Der Inhalt dieses restricted Dokuments darf ausschließlich denjenigen Personen zugänglich gemacht werden, an die es ursprünglich adressiert wurde. Es darf in keiner Weise weiter verteilt oder vervielfältigt werden und sollte in keiner Literaturliste aufgeführt oder erwähnt werden." Es werden dann einige Fakten zu Aids-Waisen aufgeführt, die man eigentlich in den Pressemitteilungen der WHO erwartet hätte. "Es herrscht Verwirrung darüber, was mit dem Begriff Waisenkind gemeint ist. (...) Studien der WHO und anderer Organisationen, in denen die Zahl geschätzt wurde, haben verschiedene Definitionen angewendet." Und im weiteren Verlauf werden einige davon weiter erklärt: "Die UNICEF definiert ein Kind dann als Waisenkind, wenn seine Mutter verstorben ist. Für die WHO ist jedes Kind ein Waisenkind, das beide Eltern oder nur die Mutter verloren hat. (...) In der Uganda Studie wurden, entsprechend der maßgebenden ugandischen Waisendefinition, alle diejenigen Kinder als Waisen gezählt, die einen oder beide Elternteile verloren haben." Verloren heißt hier jedoch nicht verstorben, sondern abwesend, weshalb die WHO auch eine weitreichende Einschränkung macht: "Einer der verwirrenden Aspekte ist das Ausmaß, in dem die Abwesenheit eines Elternteils in machen Gesellschaften den Normalfall darstellt." Schließlich weisen die Autoren auch auf die zwanzig Jahre Terrorherrschaft, Krieg und Bürgerkrieg von 1966 bis 1986 hin, während derer etwa eine Million Menschen getötet wurden - für die WHO sind selbst diese Kinder "AIDS-Waisen". INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 6 Mbeki - Aids 2000 - Hintergrundtexte # 23 04 2000 Sunday Times (South Africa) Reciting comfortable catechisms on AIDS is not good enough second opinion< Thabo Mbeki TOWARD the end of last year, speaking in our national Parliament, I said that I had asked our minister of health to look into various controversies taking place among scientists on HIVAIDS and the toxicity of a particular anti-retroviral drug. In response to this, among other things, the minister is working to put together an international panel of scientists to discuss all these issues in as transparent a setting as possible. As you know, AIDS in the US and other developed Western countries has remained largely confined to a section of the male homosexual population. US AIDS deaths for the period January 1996 to June 1997 were stated by the US Centre for Disease Control as amounting to 32 750. On May 13 1999, UNAIDS and World Health Organisation reports had said that AIDS was responsible for one death in five in Africa, or about two million people. It quoted a Dr Awa Coll Seck of UNAIDS as saying that there are 23 million carriers of HIV in Africa. This Sapa-AFP report quotes Dr Coll Seck as saying: "In Southern Africa, the prevalence of the (HIV) infection has increased so much in five years that this region could, if the epidemic continues to spread at this rate, see its life expectancy decline to 47 by 2005." (Interestingly, the five years to which Dr Coll Seck refers coincide closely with the period since our liberation from apartheid, white minority rule in 1994.) The report went on to say that almost 1 500 people are infected in South Africa every day and that, at that point, the equivalent of 3.8 million people in our country carried the virus. Again as you are aware, whereas in the West HIV-AIDS is said to be largely homosexually transmitted, it is reported that in Africa, including our country, it is transmitted heterosexually. Accordingly, as Africans, we have to deal with this uniquely African catastrophe that: Contrary to the West, HIVAIDS in Africa is heterosexually transmitted; Contrary to the West, where relatively few people have died from AIDS, itself a matter of serious concern, millions are said to have died in Africa; and Contrary to the West, where AIDS deaths are declining, even greater numbers of Africans are destined to die. It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical. Such proceeding would constitute a criminal betrayal of our responsibility to our own people. It was for this reason that I spoke as I did in our Parliament, in the manner in which I have indicated. I am convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of AIDS in the West. We will not, ourselves, condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV-AIDS. I make these comments because our search for these specific and targeted responses is being stridently condemned by some in our country and the rest of the world as constituting a 7 Mbeki - Aids 2000 - Hintergrundtexte criminal abandonment of the fight against HIV-AIDS. Some elements of this orchestrated campaign of condemnation worry me very deeply. It is suggested, for instance, that there are some scientists who are "dangerous and discredited" with whom nobody, including ourselves, should communicate or interact. In an earlier period in human history, these would be heretics that would be burnt at the stake! Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and in public because the established authority believed that their views were dangerous and discredited. We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited. The scientists we are supposed to put into scientific quarantine include Nobel prize winners, members of academies of science and emeritus professors of various disciplines of medicine! Scientists, in the name of science, are demanding that we should co-operate with them to freeze scientific discourse on HIV-AIDS at the specific point this discourse had reached in the West in 1984. People who otherwise would fight very hard to defend the critically important rights of freedom of thought and speech occupy, with regard to the HIVAIDS issue, the front line in the campaign of intellectual intimidation and terrorism which argues that the only freedom we have is to agree with what they decree to be established scientific truths. Some agitate for these extraordinary propositions with a religious fervour born by a degree of fanaticism, which is truly frightening. The day may not be far off when we will, once again, see books burnt and their authors immolated by fire by those who believe that they have a duty to conduct a holy crusade against the infidels. It is most strange that all of us seem ready to serve the cause of the fanatics by deciding to stand and wait. It may be that these comments are extravagant. If they are, it is because, in the very recent past, we had to fix our own eyes on the very face of tyranny. I am greatly encouraged that all of us, as Africans, can count on your unwavering support in the common fight to save our continent and its peoples from death from AIDS. This is an edited excerpt from a letter written by President Thabo Mbeki to world leaders earlier this month INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 8 Mbeki - Aids 2000 - Hintergrundtexte # 01 07 2000 DOCUMENT The Durban Declaration: A Declaration by Scientists and Physicians Affirming HIV is the Cause of AIDS< "Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of people from around the world are gathered in Durban, South Africa to attend the XIII International AIDS Conference. At the turn of the millennium, an estimated 34 million people worldwide are living with HIV or AIDS, 24 million of them in sub-Saharan Africa (1). Last year alone, 2.6 million people died of AIDS, the highest rate since the start of the epidemic. If current trends continue, Southern and South-East Asia, South America and regions of the former Soviet Union will also bear a heavy burden in the next two decades. Like many other diseases, such as tuberculosis and malaria that cause illness and death in underprivileged and impoverished communities, AIDS spreads by infection. HIV-1, the retrovirus that is responsible for the AIDS pandemic, is closely related to a simian immunodeficiency virus (SIV) which infects chimpanzees. HIV-2, which is prevalent in West Africa and has spread to Europe and India, is almost indistinguishable from an SIV that infects sooty mangabey monkeys. Although HIV-1 and HIV-2 first arose as infections transmitted from animals to humans, or zoonoses (2), both are now spread among humans through sexual contact, from mother to infant and via contaminated blood. An animal source for a new infection is not unique to HIV. The plague came from rodents. Influenza and the new Nipah virus in South-East Asia reached humans via pigs. Variant Creutzfeldt-Jakob disease in the United Kingdom came from 'mad cows'. Once HIV became established in humans, it soon followed human habits and movements. Like other viruses, HIV recognizes no social, political or geographic boundaries. The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous. This evidence meets the highest standards of science (3-7). The data fulfill exactly the same criteria as for other viral diseases, such as poliomyelitis, measles and smallpox: Patients with acquired immune deficiency syndrome, regardless of where they live, are infected with HIV (3-7). If not treated, most people with HIV infection show signs of AIDS within 5-10 years (6, 7). HIV infection is identified in blood by detecting antibodies, gene sequences or viral isolation. These tests are as reliable as any used for detecting other virus infections. Persons who received HIV-contaminated blood or blood products develop AIDS, whereas those who received untainted or screened blood do not (6). Most children who develop AIDS are born to HIV-infected mothers. The higher the viral load in the mother the greater the risk of the child becoming infected (8). In the laboratory HIV infects the exact type of white blood cell (CD4 lymphocytes) that becomes depleted in persons with AIDS (3-5). Drugs that block HIV replication in the test tube also reduce viral load and delay progression to AIDS. Where available, treatment has reduced AIDS mortality by more than 80% (9). Monkeys inoculated with cloned SIV DNA become infected and develop AIDS (10). Further compelling data are available (4). HIV causes AIDS (5). It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives. 9 Mbeki - Aids 2000 - Hintergrundtexte In different regions of the world HIV/AIDS shows altered patterns of spread and symptoms. In Africa, for example, HIV-infected persons are 11 times more likely to die within 5 years (7), and over 100 times more likely than uninfected persons to develop Kaposi's sarcoma, a cancer linked to yet another virus (11). As with any other chronic infection, various co-factors play a role in determining the risk of disease. Persons who are malnourished, who already suffer other infections or who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. However, none of these factors weaken the scientific evidence that HIV is the sole cause of AIDS. In this global emergency, prevention of HIV infection must be our greatest worldwide public health priority. The knowledge and tools to prevent infection exist. The sexual spread of HIV can be prevented by monogamy, abstinence or by using condoms. Blood transmission can be stopped by screening blood products and by not re-using needles. Mother-to-child transmission can be reduced by half or more by short courses of antiviral drugs (12,13). Limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of HIV infection. People already infected can be helped by treatment with life-saving drugs, but high cost puts these treatments out of reach for most. It is crucial to develop new antiviral drugs that are easier to take, have fewer side effects and are much less expensive, so that millions more can benefit from them. There are many ways to communicate the vital information about HIV/AIDS. What works best in one country may not be appropriate in another. But to tackle the disease, everyone must first understand that HIV is the enemy. Research, not myths, will lead to the development of more effective and cheaper treatments, and hopefully a vaccine. But for now, emphasis must be placed on preventing sexual transmission. There is no end in sight to the AIDS pandemic. By working together, we have the power to reverse the tide of this epidemic. Science will one day triumph over AIDS, just as it did over smallpox. Curbing the spread of HIV will be the first step. Until then, reason, solidarity, political will and courage must be our partners." References 1. UNAIDS. AIDS epidemic update. December 1999. www.unaids.org/hivaidsinfo/documents.html 2. Hahn, B. H., Shaw, G. M., De Cock, K. M., Sharp, P. M. (2000). AIDS as a zoonosis: scientific and public health implications. Science, 287, 607-614. 3. Weiss R.A and Jaffe, H.W. (1990). Duesberg, HIV and AIDS. Nature, 345, 659-660. 4. NIAID (1996). HIV as the cause of AIDS. www.niaid.nih.gov/spotlight/hiv00/default.html 5. O'Brien, S.J. and Goedert, J.J. (1996). HIV causes AIDS: Koch's postulates fulfilled. Current Opinion in Immunology, 8, 613-618. 6. Darby, S.C. et al., (1995). Mortality before and after HIV infection in the complete UK population of haemophiliacs. Nature, 377, 79-82. 7. Nunn, A.J. et al., (1997). Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort study. BMJ, 315, 767-771. 8. Sperling, R. S. et al., (1996). Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N. Engl. J. Med. 335, 1678-80. 10 Mbeki - Aids 2000 - Hintergrundtexte Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report 1999; 11, 1-44. 10. Liska, V. et al., (1999). Viremia and AIDS in rhesus macaques after intramuscular inoculation of plasmid DNA encoding full-length SIVmac239. AIDS Research & Human Retroviruses, 15, 445-450. 11. Sitas, F. et al., (1999). Antibodies against human herpesvirus 8 in black South African patients with cancer. N. Engl. J. Med., 340, 1863-1871. 12. Shaffer, N. et al., (1999). Short course zidovudine for perinatal HIV-1 transmission in Bangkok Thailand: a randomised controlled trial. Lancet, 353, 773-780. 13. Guay, L. A. et al., (1999). Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet, 354, 795-802. Signed by 5,228 physicians and scientists from 84 countries who are dedicated to the control of HIV/AIDS. INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 9. 11 Mbeki - Aids 2000 - Hintergrundtexte # 03 05 2000 DOCUMENT Presidential Aids Advisory Panel< Statement on Cabinet Meeting Government continues fight against HIV/AIDS Prof Salim Abdool-Karim, Head of the HIV/AIDS Research Unit, Medical Research Council, RSA. Prof Bialy, Harvey. Dr Stephen Chindawari, Director of the Blair Institute of Research, Zimbabwe (Facilitator). Dr Bertozzi, Stefano. Prof de Harven, Etienne, Professor Emeritus of Pathology, University of Toronto, former Electronmicroscopist at the Sloan Kettering Institute, New York. Dr Duerr, Ann, Centres for Disease Control, Atlanta, USA. Prof Duesberg, Peter Dr Fiala, Christian, Specialist Physician with experience in the African AIDS situation, Vienna, Austria Dr Gayle, Helene, Director, National Centre for HIV/AIDS and TB Prevention, Centres for Disease Control and Prevention, Atlanta, USA Dr Giraldo, Roberto, MD, Specialist in Infectious and Tropical Disease, New York, USA. Dr Herxheimer, Andrew, Clinical Pharmacologist, Emeritus Fellow, Cochrane Centre, United Kingdom. Dr Koehnlein, Klaus, Swiss AIDS Practitioner, critical analyst with very practical experiences in treating AIDS patients in Africa Dr Kothari, D. India. Dr Lane, Clifford Director: National Institutes for Health, Washington DC, USA. Prof Makgoba, Malegapuru, President, Medical Research Council, RSA Prof Fred Mhalu, Professor of Microbiology and Immunology, Dean of the Faculty of Medicine, Muhimbili, University College of Health Sciences, Dar-es-Salaam, Tanzania. Prof Mhlongo, Sam, Chief Specialist and Head, Department of Family Medicine, Medical University of Southern Africa, RSA. Prof Ephraim Mokgokong, Chancellor of the Medical University of Southern Africa, RSA. (Facilitator) Prof Montagnier, Luc (France) Dr Owen, Stephen, Professor of Law and Public Policy, University of Victoria, British Columbia, Canada. (Facilitator-in-Chief) Prof Padadopulos-Eleopulos, Eleni, Bio-physicist, Royal Perth Hospital, Australia. Dr Paranjape, Ramesh S, Officer in Charge and Acting Director, National AIDS Research Institute, Pune, Mahareshtra, India. Dr Perez, George, AIDS Expert from Havana, Cuba. Prof Prozesky, Wally, Chief of the South African Vaccine Initiative, RSA. Prof Rasnick, David Mr Scondras, Dave, MA, MS, United States of America Dr Sonnabend, Joseph Dr Stein, Zena, Director: Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, USA. Prof Stewart, Gordon, Professor Emeritus of Public Health, University of Manchester, England. Former WHO Advisor on Aids. 12 Mbeki - Aids 2000 - Hintergrundtexte Dr Turner, Val, Physician, published articles of the AIDS-dogma. Dr Vella, Stefano, Istituto Superiore di Sanita, Rome, Italy. Dr Carolyn Williamson, RSA Dr Zuniga, Jose M. Issued by: Government Communication and Information System, 3 May 2000 STATEMENT ON CABINET MEETING - 3 MAY 2000 Cabinet today reviewed the launch of the National Coat of Arms and expressed appreciation at the efforts of all those involved. The meeting noted that the majority of South Africans had received the Coat of Arms warmly, and that the next task was to ensure its widest possible promotion, and phased introduction in various departments and other institutions of state. Detailed announcements in this regard will be made in due course. Cabinet examined various proposals on wages and conditions of employment in the public service, which will be discussed with the public sector unions. Further, Cabinet decided to terminate the current Voluntary Severance Package with immediate effect. A new Exit Management Framework will be tabled for negotiation at the Bargaining Chamber. Cabinet received a briefing on current economic developments, including the state of the country's currency. The meeting noted that, while the Rand's exchange rate against the US Dollar had declined by some 10% in the past few weeks, other currencies such as the Australian Dollar and the Euro had depreciated by more than this percentage against the US Dollar. These developments therefore are not a reflection on South Africa's fundamentals, nor are they a response to developments in the sub-region, as some analysts would have society believe. Cabinet was briefed on progress made in the convening of the Presidential AIDS Advisory Panel whose first meeting will take place on 6 and 7 May. The Panel [see attached list] is made up of local and international scientists of great repute; and 36 of the 40 invited have agreed to take part in the panel. 32 will be available over the weekend. A meeting of such eminent scientists, holding a variety of views on the issue of HIV/AIDS, is a first for South Africa, and it will be of major significance far beyond our borders. The terms of reference for the Panel include: the causes of immune deficiency resulting in death from AIDS; the most efficacious response to the cause(s); the difference in prevalence and transmission between developed and developing countries; the role of therapeutic interventions in developing countries and so on. After two days of face-to-face discussions, these and other scientists will, over a period of about six weeks, exchange views over a "closed Internet"; and meet again in South Africa to finalise and present their findings and recommendations. Cabinet also emphasised that the multifaceted campaign against HIV/AIDS remains in place and will be intensified. Government will weigh the findings and proposals of the scientists carefully - all in the interest of saving lives. Cabinet was briefed on the discussions with the United Nations about the possible role that South Africa can play in peacekeeping operations in the Democratic Republic of the Congo. It was also informed of the Statement to the Nation that President Thabo Mbeki will make tomorrow, on the situation in Southern Africa. The meeting also approved the decision of the Inter-Ministerial Co-ordinating Committee (on restructuring of public enterprises) to sell a 3% stake in Telkom to an empowerment company, Ucingo Holdings, in line with broad principles adopted earlier. 13 Mbeki - Aids 2000 - Hintergrundtexte The following Bills were approved for submission to Parliament: Termination of Integration Intake Bill, which brings to an end, at a given deadline, to the process of absorbing individuals in certified personnel registers into the SANDF; Transnet Pension Fund Bill which splits the fund into three categories for easier management. Two Deputy Directors-General were appointed, one in Foreign Affairs (Corporate Services), and another in the Department of Communications (Telecommunications Policy). For further information contact Joel Netshitenzhe, 082-900-0083 Issued by: Government Communications (GCIS), 3 May 2000 INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 14 Mbeki - Aids 2000 - Hintergrundtexte # 10 07 2000 DOCUMENT 13TH INTERNATIONAL AIDS CONFERENCE DURBAN: Speech of the President of South Africa at the Opening Session of the Conference< By Thabo Mbeki Office of the Presidency 9 July 2000 Chairperson, Participants at the 13th International AIDS Conference; Comrades, ladies and gentlemen: On behalf of our government and the people of South Africa, I am happy to welcome you to Durban and to our country. You are in Africa for the first time in the history of the International AIDS Conferences. We are pleased that you are here because we count you as a critical component part of the global forces mobilised to engage in struggle against the AIDS epidemic confronting our Continent. The peoples of our Continent will therefore be closely interested in your work. They expect that out of this extraordinary gathering will come a message and a programme of action that will assist them to disperse the menacing and frightening clouds that hang over all of us as a result of the AIDS epidemic. You meet in a country to whose citizens freedom and democracy are but very new gifts. For us, freedom and democracy are only six years old. The certainty that we will achieve a better life for all our people, whatever the difficulties, is only half-a-dozen years old. Because the possibility to determine our own future together, both black and white, is such a fresh and vibrant reality, perhaps we often overestimate what can be achieved within each passing day. Perhaps, in thinking that your Conference will help us to overcome our problems as Africans, we overestimate what the 13th International AIDS Conference can do. Nevertheless, that overestimation must also convey a message to you. That message is that we are a country and a Continent driven by hope, and not despair and resignation to a cruel fate. Those who have nothing would perish if the forces that govern our universe deprived them of the capacity to hope for a better tomorrow. Once more I welcome you all, delegates at the 13th International AIDS Conference, to Durban, to South Africa and to Africa, convinced that you would not have come here, unless you were to us, messengers of hope, deployed against the spectre of the death of millions from disease. You will spend a few days among a people that has a deep understanding of human and international solidarity. I am certain that there are many among you who joined in the international struggle for the destruction of the anti-human apartheid system. You are therefore as much midwives of the new, democratic, non-racial and non-sexist South Africa as are the millions of our people who fought for the emancipation of all humanity from the racist yoke of the apartheid crime against humanity. We welcome you warmly to South Africa also for this reason. Let me tell you a story that the World Health Organisation told the world in 1995. I will tell this story in the words used by the World Health Organisation. This is the story: 15 Mbeki - Aids 2000 - Hintergrundtexte " The world's biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5 - extreme poverty. "Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable and why mothers die in childbirth. It is the underlying cause of reduced life expectancy, handicap, disability and starvation. Poverty is a major contributor to mental illness, stress, suicide, family disintegration and substance abuse. Every year in the developing world 12.2 million children under 5 years die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die because they are poor... "Beneath the heartening facts about decreased mortality and increasing life expectancy, and many other undoubted health advances, lie unacceptable disparities in wealth. The gaps between rich and poor, between one population group and another, between ages and between sexes, are widening. For most people in the world today every step of life, from infancy to old age, is taken under the twin shadows of poverty and inequity, and under the double burden of suffering and disease. "For many, the prospect of longer life may seem more like a punishment than a gift. Yet by the end of the century we could be living in a world without poliomyelitis, a world without new cases of leprosy, a world without deaths from neonatal tetanus and measles. But today the money that some developing countries have to spend per person on health care over an entire year is just US $4 - less than the amount of small change carried in the pockets and purses of many people in the developed countries. "A person in one of the least developed countries in the world has a life expectancy of 43 years according to 1993 calculations. A person in one of the most developed countries has a life expectancy of 78 - a difference of more than a third of a century. This means a rich, healthy man can live twice as long as a poor, sick man. "That inequity alone should stir the conscience of the world - but in some of the poorest countries the life expectancy picture is getting worse. In five countries life expectancy at birth is expected to decrease by the year 2000, whereas everywhere else it is increasing. In the richest countries life expectancy in the year 2000 will reach 79 years. In some of the poorest it will go backwards to 42 years. Thus the gap continues to widen between rich and poor, and by the year 2000 at least 45 countries are expected to have a life expectancy at birth of under 60 years. "In the space of a day passengers flying from Japan to Uganda leave the country with the world's highest life expectancy - almost 79 years - and land in one with the world's lowest - barely 42 years. A day away by plane, but half a lifetime's difference on the ground. A flight between France and Cote d'Ivoire takes only a few hours, but it spans almost 26 years of life expectancy. A short air trip between Florida in the USA and Haiti represents a life expectancy gap of over 19 years... "HIV and AIDS are having a devastating effect on young people. In many countries in the developing world, up to two-thirds of all new infections are among people aged 15-24. Overall it is estimated that half the global HIV infections have been in people under 25 years - with 60% of infections of females occurring by the age of 20. Thus the hopes and lives of a generation, the breadwinners, providers and parents of the future, are in jeopardy. 16 Mbeki - Aids 2000 - Hintergrundtexte Many of the most talented and industrious citizens, who could build a better world and shape the destinies of the countries they live in, face tragically early death as a result of HIV infection." (World Health Report 1995: Executive Summary, WHO.) This is part of the story that the World Health Organisation told in its World Health Report in 1995. Five years later, the essential elements of this story have not changed. In some cases, the situation will have become worse. You will have noticed that when the WHO used air travel to illustrate the import of the message of the story it told, it spoke of a journey from Japan to Uganda, another from France to the Cote d'Ivoire and yet another from the United States to Haiti. From developed Asia, Europe and North America, two of these journeys were to Africa and the third to the African Diaspora. Once again, I welcome you to Africa, recognising the fact that the majority of the delegates to the 13th International AIDS Conference come from outside our Continent. Because of your heavy programme and the limited time you will spend with us, what you will see of this city, and therefore of our country, is the more developed world of which the WHO spoke when it told the story of world health in 1995. You will not see the South African and African world of the poverty of which the WHO spoke, in which AIDS thrives - a partner with poverty, suffering, social disadvantage and inequity. As an African, speaking at a Conference such as this, convened to discuss a grave human problem such as the acquired human deficiency syndrome, I believe that we should speak to one another honestly and frankly, with sufficient tolerance to respect everybody's point of view, with sufficient tolerance to allow all voices to be heard. Had we, as a people, turned our backs on these basic civilised precepts, we would never have achieved the much-acclaimed South African miracle of which all humanity is justly proud. Some in our common world consider the questions I and the rest of our government have raised around the HIV-AIDS issue, the subject of the Conference you are attending, as akin to grave criminal and genocidal misconduct. What I hear being said repeatedly, stridently, angrily, is - do not ask any questions! The particular twists of South African history and the will of the great majority of our people, freely expressed, have placed me in the situation in which I carry the title of President of the Republic of South Africa. As I sat in this position, I listened attentively to the story that was told by the World Health Organisation. What I heard as that story was told, was that extreme poverty is the world's biggest killer and the greatest cause of ill health and suffering across the globe. As I listened longer, I heard stories being told about malaria, tuberculosis, hepatitis B, HIV-AIDS and other diseases. I heard also about micro-nutrient malnutrition, iodine and vitamin A deficiency. I heard of syphilis, gonorrhoea, genital herpes and other sexually transmitted diseases as well as teenage pregnancies. I also heard of cholera, respiratory infections, anaemia, bilharzia, river blindness, guinea worms and other illnesses with complicated Latin names. As I listened even longer to this tale of human woe, I heard the name recur with frightening 17 Mbeki - Aids 2000 - Hintergrundtexte frequency - Africa, Africa, Africa! And so, in the end, I came to the conclusion that as Africans we are confronted by a health crisis of enormous proportions. One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defence against attack by many viruses and bacteria. Clearly, if we, as African countries, had the level of development to enable us to gather accurate statistics about our own countries, our morbidity and mortality figures would tell a story that would truly be too frightening to contemplate. 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 that would interact one upon the other in many ways, within one human body. And thus I came to conclude that we have a desperate and pressing need to wage a war on all fronts to guarantee and realise the human right of all our people to good health. And so, being insufficiently educated, and therefore ill prepared to answer this question, I started to ask the question, expecting an answer from others - what is to be done, particularly about HIV-AIDS! One of the questions I have asked is - are safe sex, condoms and anti-retroviral drugs a sufficient response to the health catastrophe we face! I am pleased to inform you that some eminent scientists decided to respond to our humble request to use their expertise to provide us with answers to certain questions. Some of these have specialised on the issue of HIV-AIDS for many years and differed bitterly among themselves about various matters. Yet, they graciously agreed to join together to help us find answers to some outstanding questions. I thank them most sincerely for their positive response, inspired by a common resolve more effectively to confront the AIDS epidemic. They have agreed to report back by the end of this year having worked together, among other things, on the reliability of and the information communicated by our current HIV tests and the improvement of our disease surveillance system. We look forward to the results of this important work, which will help us to ensure that we achieve better results in terms of saving the lives of our people and improving the lives of millions. In the meantime, we will continue to intensify our own campaign against AIDS, including: a sustained public awareness campaign encouraging safe sex and the use of condoms; a better focused programme targeted at the reduction and elimination of poverty and the improvement of the nutritional standards of our people; a concerted fight against the so-called opportunistic diseases, including TB and all sexually transmitted diseases; a humane response to people living with HIV and AIDS as well as the orphans in our society; contributing to the international effort to develop an AIDS vaccine; and, further research on anti-retroviral drugs. You will find all of this in our country's AIDS action plan which I hope has been or will be distributed among you. You will see from that plan, together with the work that has been going on, that there is no substance to the allegation that there is any hesitation on the part of our government to 18 Mbeki - Aids 2000 - Hintergrundtexte confront the challenge of HIV-AIDS. However, we remain convinced of the need for us better to understand the essence of what would constitute a comprehensive response in a context such as ours which is characterised by the high levels of poverty and disease to which I have referred. As I visit the areas of this city and country that most of you will not see because of your heavy programme and your time limitations, areas that are representative of the conditions of life of the overwhelming majority of the people of our common world, the story told by the World Health Organisation always forces itself back into my consciousness. The world's biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty. Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour! On behalf of our government and people, I wish the 13th International AIDS Conference success, confident that you have come to these African shores as messengers of hope and hopeful that when you conclude your important work, we, as Africans, will be able to say that you who came to this city, which occupies a fond place in our hearts, came here because you care. Thank you for your attention. Issued by the Office of the Presidency, 9 July 2000 Enquiries: Tasneem Carrim 083 650 7119 (transmitted by RETHINKING AIDS HOMEPAGE) INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 19 Mbeki - Aids 2000 - Hintergrundtexte # 25 07 2000 DOCUMENT Statement by the MEC for Health, Dr M Sefularo, during the Aids Conference Report-Back, 25 July 2000< INTRODUCTION The 13th International Aids Conference brought to our country more than 12 000 people from across the globe. At least 4000 delegates from Africa participated in this conference. We all gathered in Durban for a week, motivated by a desire to "break the silence" on the HIV\AIDS epidemic. Consistent with the theme, the conference presented many of us with that rare opportunity to hear different voices and alternative views on HIV\AIDS. It was also an opportunity for ordinary people from ordinary communities, including people living with AIDS, to share their views and experiences. For the first time, the voice of those that carry the greatest burden of HIV infection, the people of the developing world and Africa, in particular, was heard. The Conference drew more than 5 000 speakers who delivered papers along the following tracks: Basic Science Clinical science Epidemiology, Prevention and Public Health Social Science Human Rights, Politics and Communication Community Session At the end of the conference, the fundamental message remained the same: "HIV causes AIDS. There is no cure for AIDS. There is no vaccine for HIV". For now, the best defence against HIV\AIDS remains prevention. We also had the privilege of hearing many voices of hope from countries that have done remarkably well in the battle against HIV and AIDS. Whilst the HIV\AIDS picture may appear gloomy and hopeless, we must, at the same time, acknowledge that HIV\AIDS is not the first epidemic or pandemic to confront humanity, Africa or Southern Africa. The sun is not necessarily setting on humanity! There are numerous examples in history that show what can happen when an unfamiliar infection attacks a population for the first time. Bubonic plaque The bubonic plague pandemic, otherwise known as the Black Death of fourteen century Europe is the chief example, followed by the cholera epidemics of the nineteenth century. We were later to see Rinderpest invading Africa in 1891, killing up to 90% of domesticated cattle as well as antelope and other wild species. (1) Measles Measles followed hard on the heels of small pox, spreading through Mexico and Peru in 1530-31. In Europe, the first outbreak of the influenza epidemic which lasted from 1556 to 1560 killed no less than 20% of the population in England. Today, in our country, the average prevalence of HIV is 20%. (2) In 1959 a new human disease called O'nyong nyong fever appeared in Uganda. India was later to be host to dengue fever. Europe, Asia, the Americas, Africa have all at some point in history been confronted by new and seemingly overwhelming disease outbreaks. (3) HOPE Indeed, individuals, families, communities, nations and people living with AIDS have turned what appears to be a death sentence to a life of hope. Our hope is further strengthened by the determination of the people of the world, represented by delegates at the 13th 20 Mbeki - Aids 2000 - Hintergrundtexte International AIDS Conference to overcome AIDS. There is also a glimmer of hope for a vaccine, although it is at least seven years away. We have come back from Durban to report-back to our people in the North West, to share our experience of the conference and the experience of other nations. We have also come back to share with our people in the province the reasons for hope. We have come to call for action. LET US BREAK THE SILENCE Our hope to defeat the scourge of HIV/AIDS lies in our courage to break the deafening silence. We must break our silence on each of the following: Sex Myths and misconceptions about sexuality Prisons, sex and AIDS Intravenous drug use Girl child \ parent dialogue on sexuality Mother to child or seropositivity Homosexuality Fear of social sanction and gender norms Partners \ couples HIV Serostatus Health care professionals Participating in conferences Shelter Political commitment Effectiveness of prevention methods Alcohol and drugs (youth) Religious communities Stigma and rejection Polygamy Media (journalists, TV and radio) Family Global access to medicine Coca-cola Cross-border Child sexual abuse Human rights Professional secret Sex workers Gender approach Cultural practice University students' sexual practices Employment sector Support for health care workers Organised labour and professional organisations Performing arts Marketing agencies Deaf and hard of hearing 21 Mbeki - Aids 2000 - Hintergrundtexte Traditional medicine Private sector Men's consciousness Counsellors Sports Poverty Research The army and police HIV test In keeping with the theme, I urge our people to go for voluntary HIV testing to enable infected people to start early treatment to slow down the progression of the sickness. THE PRESIDENT AND HIV\AIDS It is unfortunate that President Thabo Mbeki has been misunderstood on the question of HIV and AIDS. The President has never denied either the existence of AIDS nor the causal relationship between HIV and AIDS. He has never said that HIV does not cause AIDS. What we are saying or asking is - "What is it about us in Sub-Saharan Africa, about the HIV virus, about our condition, culture, beliefs, our relationship to the rest of the world and our response to the HIV that has allowed AIDS to so catastrophically destroy individuals, families and communities to a point where it is possible that our economic development, freedom, security and our very existence as a people and a nation may be reduced to nothing? That is the challenge. We reiterate our view that it is inappropriate to blame everything around this epidemic on the HI virus. Clearly, the relationship between HIV and other social ills afflicting our society such as poverty and disease, particularly TB and STDs, is complex. We reaffirm our view that a comprehensive response in our country needs to recognise this reality. OPPORTUNISTIC INFECTIONS Earlier this year, the government released guidelines on the treatment of opportunistic infections. We have also strengthened our STD (Sexually Treatment Diseases) and TB programmes. We are also strengthening our national response to other public health challenges such as poverty and the provision of adequate safe water and sanitation. We do so because we believe that the presence of these infections accelerates viral replication and therefore increases the rate of transmission. It is evident that countries that are resource-constrained like ours need to begin with these interventions because this is an effective response against HIV and AIDS. MOTHER-TO-CHILD TRANSMISSION The South African government has supported ongoing research in South Africa both on AZT and Niverapine. We have indicated clearly some of the concerns that are well-known about side-effects of these drugs, including the development of resistance. We also recognise that Niverapine, if it were to be proven to have a positive benefit \ risk profile, would present a better option for developing countries like ours. This is because of its ease of administration as well as a relatively more favourable cost profile. ACCESS TO AFFORDABLE DRUGS Our country continues to fight for an international dispensation that ensures greater access to ALL drugs for people in the developing world and the economically marginalised in the North. In this context, we also include the availability of all effective treatment to deal with the epidemic of HIV\AIDS. 22 Mbeki - Aids 2000 - Hintergrundtexte The South African government is encouraged by the growing support for such interventions as parallel importing, compulsory licensing and local manufacturing, and we support these initiatives fully. We are convinced that these interventions will improve the capacity of developing nations to ensure greater access to drugs. We recognise the benefits that accrue to those who can afford the use of anti-retrovirals, but stress that in our context, this is far from reality. We also recognise that the cost of these drugs is not the only deterrent to their use. We need to systematically invest in and build our health infrastructure so that advances in drug treatment can be made available to those who need it. HIV/AIDS AND THE YOUTH A key element of our plan is to escalate our prevention efforts. This is focussed particularly at the youth and includes the introduction of life-skills programmes in schools as a compulsory part of our curriculum. It also includes peer education and social mobilisation. The latest report of the United Nations Programme on HIV\AIDS (UNAIDS) confirms that most of the affected people are young \ adolescents. Clearly, the impact of HIV\AIDS on our youth is particularly devastating. We are beginning to witness deaths of adults in their thirties and forties who were infected when they were young. According to UNAIDS, in countries such as South Africa and Zimbabwe, where a fifth or a quarter of the adult population is infected, AIDS is set to claim the lives of around half of all 15-year olds. In the North West Province, the 1999 figures suggest that we have registered the most significant increases in the age-groups 14-19 years, 25-29 years and 25-39 years. The least increase has been in the age groups 20-24 years, 30-34 years and over 40 years. We are particularly concerned that the rate of infection is higher among girls and women than it is among men. Some are listening while others, especially teenagers are not responding to our message and the evidence of the seriousness of the HIV\AIDS epidemic. YOUTH HEALTH CENTRES Many of our health facilities are not youth-friendly. Young people encounter too many obstacles as they seek information to help them cope with their sexuality, enhance their reproductive health and protect themselves against HIV and teenage pregnancy. The department is confronting the challenge of making sexual health services more accessible and more user-friendly to the youth as part of our strategy to prevent HIV\AIDS. Programmes that focus specifically on youth will help us win the war on HIV\AIDS. It is for this reason that the department has decided to establish five multi-purpose youth centres in the province. This has been made possible by a partnership involving the British Government's Department for International Development, the United Nations Population Fund and the Planned Parenthood Association of South Africa (PPASA). At the end of this financial year, we shall have launched five youth centres in all our regions. VULNERABILITY The Department is confident that all units and sectors of the South African nation will join government in spreading information and knowledge about HIV and AIDS, supporting and caring for the infected and affected. Ultimately, we must address those social, economic and environmental factors that make the majority of our people poor, ignorant, powerless and prone to many diseases that place limitations on their freedom and quality of life. PREVENTION The department encourages individuals to practice safer sex by abstaining from sex where necessary and possible, remaining faithful to their sex partners when they are in a relationship and finally to always use a condom whenever there is a possibility of an 23 Mbeki - Aids 2000 - Hintergrundtexte unwanted pregnancy or of being infected with HIV and other sexually transmitted infections. The government will continue to provide access to treatment for those who have sexually transmitted infections, counselling and tests for those that would like to know their HIV status. All of us need to take up the challenge of breaking the silence, for "in the end we die not in the hands of our enemies but in the silence of our friends. (4) CONCLUSION Let me in conclusion, address those that have accused the government of not caring about HIV and AIDS or for persons, mothers and children infected with HIV or dying from AIDS. It suggests that before the ANC-led government came into office, something was being done in this country to fight HIV and care for those that have AIDS. What is the reality? HIV AIDS emerged in this world in the 80's and was treated as a non-specific infection. Many countries embraced a programme to combat it at that point, but South African government only introduced it as an item on the health budget in 1992/93, allocating R20,9 million. (5) The last budget to drawn up by the white minority regime in 1994/95 doubled that amount to R40,6 million. But by 1996, the new government had raised it to R80,4 million. The figure for last year was R109 million, climbing to R144,6 million this year. (6) This year, Cabinet set aside R75 million for an integrated programme of Life Skills Education, Care for Orphans and Children, Home Based Care and Voluntary Counselling and Testing. This is in addition to the R144,6 million.` You will receive information on these programmes. Our plea is that you should leave this meeting with a determination to ensure the success of those programmes. Following the launch of the South African National AIDS Council, we were all urged as province to launch AIDS Councils. We in the North West chose to start with the people by launching Local and Regional AIDS Councils. We believe that these should be the structures that will give life and action to the Provincial AIDS Council in a manner that will give all our citizens a chance to contribute and benefit. We also believe that the integrated programmes can only succeed if they are based on the collective knowledge, commitment, skills and action of our people across all sectors. We therefore ask you to work hard towards the launch of your Local and Regional AIDS Council by the end of August. If we did all of the above, I believe that the North West will one day be held up as a glorious example of how a people can rise above the most serious challenges and threats. If we can succeed, we, our children, our nation and Africa will be saved. References 1,2,3 William H. McNeil 4 Martin Luther King Junior 5,6 Mathata Tsedu (The Star), 24 July 2000 INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg 24 Mbeki - Aids 2000 - Hintergrundtexte # 04 09 2000 TIME EUROPE The Road Ahead< An interview with South African president Thabo Mbeki Click here for the magazine version of the interview In the 16 months since he succeeded Nelson Mandela, the man who led the victorious struggle against apartheid, Thabo Mbeki has stamped his mark on the South African presidency. Dressed in an immaculately-cut grey suit, Mbeki spoke last week in Pretoria with TIME Atlantic editor Christopher Redman and South Africa bureau chief Peter Hawthorne. TIME: Have whites done enough to combat racism in South Africa? Mbeki: It's not just a white community problem. I think it has to be an understanding of what racism is. The answer to that question, from blacks and whites, tends to be insulting someone, hurting someone, doing something physically discriminatory against them. And we have legislation that deals with that sort of thing. But the most important thing about racism is to end the socioeconomic divisions. There hasn't been sufficient focus on this. When we discuss for instance the question of Africanization, it is politicized. So we jostle about it. Whereas if people understood more fundamentally what it means there wouldn't be that debate about it. The German Chamber of Commerce here in South Africa has about 500 members and you'll be lucky if you find 10 of them are Africans. Even German companies working in South Africa, surely they should have made some effort to get black people into management positions. But they haven't. But they aren't racists, they say. They've never sworn at anybody. So, yes, you have to address offensive language, offensive behavior and so on. But to address the fundamental issue I don't think people, black and white, have responded with the speed that is possible. All of us actually have an obligation to de-racialize our society. It guarantees our security and addresses the possibility of some explosion further down the line. TIME: Some people are concerned about the change in style from the Mandela presidency to yours. They say it's too centralized, even secretive. Is this true? Mbeki: Yes, I've heard these comments. There's nothing centralized about it. There is an ongoing process of addressing the effectiveness of government. It requires various aspects, starting with the system of national cabinet which we inherited in which the agenda of the national government was decided by whatever legislation the various ministers thought they should bring before the cabinet. Your capacity to coordinate is weakened by the fact that your national agenda is determined by bills that ministers bring and the impact of the presidency on that system of government is determined by the same things. TIME: So what the outside world sees, or accuses you of doing - by-passing your own cabinet - is really an attempt to impose a more efficient decision-making government? Mbeki: Well, sure. I don't know what is meant by by-passing and the like. There's no such thing. What we are trying to do is to say, we are a government, we are not a federation of ministries. We are a government that has to have a policy, that has to be coherent, that has to hang together. We now have a system that enables the whole government to sit together and say what's our strategical approach to investment, for instance, and let all of the ministers discuss the question so then by the time you go back into your government departments you are fully informed on all the elements of one story. TIME: Does South Africa have a role to play in the global economy? 25 Mbeki - Aids 2000 - Hintergrundtexte Mbeki: The challenge facing everybody is to address poverty and underdevelopment in the world. Now I'm not talking about welfare handouts but about investment, knowledge transfers, all the things that enable economies to grow faster [and] modernize. As part of that group of countries and particularly in the African context, South Africa is a major player. The Bank of International Settlements in a report two years ago said, if you took just 1% of the portfolio holdings of the institutional investors of the G7 countries those would amount to two-thirds of the total Latin American economy. That gives you a measure of the volume of capital available. The challenge in my view is to find ways and means by which you are able to encourage larger volumes of that capital into direct investment. As you can see, a tiny fraction of the totality of the assets of those institutional investors put into direct investment would make an enormous difference. And obviously it is in the interests of the major companies in developed countries to address the issue of poverty among billions of people who cannot afford to buy their products. The question is: How do we manage this larger transfer of these productive resources into the underdeveloped world? TIME: Why aren't more outsiders investing in South Africa? Mbeki: We've attracted many high quality investments. Car companies, for instance, see us as an important base to produce not just for the domestic market but for foreign markets. It's not industry which may employ a very large number of workers. These are plants and operations that are high-quality. BMW, for instance, supplies the whole world with one particular model of car exclusively from here. Mercedes has done the same with a decision on one of its particular cars. Ford Motor Company now has a major operation here for the rest of the world. South Africa is now a major platform for the manufacture of Rolls Royce engines. So maybe instead of making projections on investment since post-apartheid Day One ... perhaps we would have understood the matter better in [in terms of] what this country is likely to do is attract more high quality investment. TIME EUROPE Monday, September 4, 2000 The Road Ahead Page One | Two TIME: What about the country's reputation for violence? Mbeki: At the suggestion of many of these large corporate investors our new Investment Advisory Council has put the issue of communications top of its agenda. They are saying that they are very disturbed at what is being communicated about South Africa to the rest of the world because they say it is not a reflection of the truth. They are saying that there is a negative message put out about South Africa to the rest of the world which impacts on foreign investment and which actually does not reflect the reality of South Africa. The fund manager of a major company recently told me that at the last meeting of his board he realized that their volume of investment in South Africa is the same as the volume in Brazil. His board was also aware of the levels of crime in South Africa but were surprised to learn of the levels of crime in Brazil. General Electric has business in Poland on a smaller scale than in South Africa and has had 300 of its cars hijacked in Poland and not single car hijacked in South Africa. TIME: You've been criticized for playing down the link between HIV and AIDs. Where do you now stand on this very controversial issue? Mbeki: Clearly there is such a thing as acquired immune deficiency. The question you have to ask is, what produces this deficiency? Now, if you go through the literature, ordinary standard literature available in medical schools, there will be a whole variety of things [that] 26 Mbeki - Aids 2000 - Hintergrundtexte can cause the immune system to collapse. Endemic poverty, the impact of nutrition, contaminated water, all of these things, will result in immune deficiency. If you take the African continent you add to that things like repetitive infections of malaria, ordinary STDs [sexually transmitted diseases] - syphilis, gonorrhea etc. All of these will result in immune deficiency. Now it is perfectly possible that among those things is a particular virus. But the notion that immune deficiency is only acquired from a single virus cannot be sustained. The problem is that once you say immune deficiency is acquired from that virus your response will be anti-retroviral drugs. But if you say the reason we are getting collapsed immune systems is a whole variety of reasons, including the poverty question which is very critical, then you have a more comprehensive response to the health condition of a person. TIME: Are you prepared to acknowledge that there is a link between HIV and AIDS? Mbeki: This is precisely where the problem starts. No, I am saying that you cannot attribute immune deficiency solely and exclusively to a virus. TIME: But would you acknowledge that HIV is a causal factor in AIDS? Mbeki: I am saying sure, no problem at all, there may very well be a virus. But there is a lot of debate among scientists which is why we said let all these different factions come together. Let's all get together ourselves and sort out this question. There cannot be any dispute about all these other things which result in immune deficiency. It's in the medical school textbooks at university. So one of the first things they are going to try to answer is, when you take a person's blood and measure it, what are you measuring? Are you measuring a virus or what? For what has been said is that these tests are measuring HIV. But what are these tests really measuring? The scientists are not agreed among themselves that what they are measuring is a virus. They are measuring the response of the immune system to something attacking it. But TB [tuberculosis], for example, destroys the immune system and at a certain point if you have TB you will test HIV positive because the immune system is fighting the TB. Then you will go further to say TB is an opportunistic disease of AIDs whereas in fact TB is the thing that destroyed the immune system in the first place. But if you come to the conclusion that the only thing that destroys immune systems is HIV then your only response is to give them anti-retroviral drugs. There's no point in attending to this TB business because that's just an opportunistic disease. What is fundamental is the AIDs. So much so that even in everyday language AIDs is said to be a disease. It's no such thing. AIDs is a syndrome. It's a whole variety of diseases which affect a person because something negative has happened to the immune system. If the scientists come back and say this virus is part of the variety of things from which people acquire immune deficiency, I have no problem with that. But to say this is the sole cause therefore the only response to it is anti-retroviral drugs, I am saying we'll never be able to solve the AIDs problem. TIME: The so-called African renaissance isn't looking so good. Aren't you disappointed about what you're seeing in your continent? Mbeki: No, I'm not disappointed. The change in Nigeria, for instance, is an important step with regard to an African renaissance. You can look around the continent and see that kind of progress. Look at the situation in Algeria. The conflict there hasn't come to an end but I sense that they are getting on top of it. Look around this southern African region where there's been a whole series of elections - in Namibia, Mozambique, Botswana, Malawi. In Zimbabwe one of the interesting things in that election was that you had a ruling party which came close to losing power. Yes, there were problems and violence but despite those problems it confirmed the viability of the democratic process. We are making progress in 27 Mbeki - Aids 2000 - Hintergrundtexte the Congo. I have just met with a delegation from President Kabila and I'm absolutely certain we're going to solve that problem. It's taken too long but the discussions I have been having now with President Kabila and his emissaries come down to a need to stop all this talking and really take actual, practical steps. Let's move these foreign forces into real process of disengagement and then out of the Congo. Let's move on this internal dialogue. I'm going to see Kabila when I come back from the U.S. and we'll move that process along. The Congo process has a direct bearing on what happens in Burundi, of course. The Burundi problem is at an important stage and even the parties that didn't sign the peace accord have indicated to the facilitator, Mr. Mandela, that they will sign. We are working with the Secretary General of the U.N. to provide some form of security, not a peacekeeping force, for the process to continue. We are in dialogue with the leaders and the rebels in Rwanda towards a process of integration. We are also having discussions with the government in Angola where there is no doubt from our point of view that only a political solution is possible to the conflict there. TIME: How do you respond to those who say you aren't being tough enough on these issues? Mbeki: You can swear twenty thousand times at President Kabila, it won't change the situation in the Congo. We have to deal with these matters in the necessary detail. The details you cannot avoid. We have been having discussions with the Angolan government for instance for a very long time. We are saying that a military solution in Angola is not possible. You need a fundamental acceptance of this that will open the way to other things. But I can't beat President dos Santos over the head with a stick until he agrees. We have to continue to engage him. Now we are in the position where we are agreed with the Angolan government that a military solution is not possible. We are trying to assist the return to a stable and democratic system of rule in the Côte d'Ivoire. But these matters require detailed engagement. In the last few months I've done a lot of traveling abroad. What we are saying to world leaders is that we have to respond to the challenge of African development. We can't proceed from a position of fatalistic acceptance. Given what is happening, if you look at the African continent in detail, not just the impression, the bulk of the current political leadership will at least say, 'We have to abandon previous experiences of military governments, military coups and we really have to work hard at this democratic system.' They are saying, 'We have to abandon the failed economic policies of the past.' And I've been saying to the leadership of the developed world that they need to respond positively so that even if it is to challenge us, to say this is what you say but we want to see practical action from you consistent with what you are saying. I talked to the E.U. summit in Portugal, I went to see the Nordic prime ministers and the G7 and G8 groups. I am very pleased with the outcome. The world is responding to the challenge. For the first time the G8 summit actually focused and identified the development challenge. Then the E.U., the U.S. President, the Nordics, the Japanese, the World Bank, the IMF, everybody asked me, 'What is the next step?' The next step must be we as Africans, we will come back to you with a realistic, practical program to help Africa's underdeveloped countries. So they have said, 'Fine, we will wait for that.' We now have agreed at the OAU summit to lead this process of the elaboration of the African development agenda. And absolutely everybody has said we have to respond in particular ways to this African development challenge. All of us. I am very hopeful that we will get some movement out of that. 28 Mbeki - Aids 2000 - Hintergrundtexte Clearly there is a commitment. But it has to be driven by credible activity on our part as Africans that shows that we ourselves are as committed to development as we are asking other people to be. I have spoken to a number of African presidents to say, this is what we have done but for us to succeed we need to act in a manner which does not discredit our commitment to the perspective of a peaceful, democratic Africa. TIME: How would you characterize the task you face as President? Mbeki: In the Mandela years we put together the policies needed for the post-apartheid era ... In education, for instance, we had to de-racialize the schools, open up the system of school governments, improve quality of education. Now the policy framework is there and we are ready to bring about actual change. That's what we are about now. And I think in the end what we must really account for as a government and a society is whether in fact these changes are happening. If they are not happening then clearly we have failed. But we won't fail because the policies don't exist. INDABA Internet Datenbank Afrika - Institut für Afrika-Kunde, Hamburg