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