In South Africa, AIDS and a Dangerous Denial
By Ronald Bayer and Mervyn Susser
Washington Post- Thursday , April 20, 2000
Two tragedies are unfolding simultaneously in South Africa. The first is epidemiological, with millions of men, women and
children infected with HIV destined to develop AIDS. The second is political, with President Thabo Mbeki seriously
entertaining a discredited view that challenges the role of HIV as the cause of AIDS. Together, the tragedies may well
exacerbate the epidemic in South Africa, an outcome that will be measured in untold suffering and death.
The spread of AIDS in southern Africa, almost entirely the consequence of heterosexual transmission, follows a pattern
profoundly affected by apartheid. The mining industry, from its outset in the 19th century, had a legally enforced migratory
black labor system. Because African men were denied the right to settle with their families, a large sex imbalance resulted, with
an excess of males in urban areas and of females in rural areas. At any one time, most men in their reproductive years were
separated from their homes and from the sexual norms of settled rural societies.
Under a racist regime, black South Africans were deprived of education, access to adequate health care, housing and
employment. Confined in squalid conditions, rural or urban, men and their female partners were made vulnerable to the HIV
epidemic being carried southward from Central Africa. By 1989, one percent of black women in the well-attended prenatal
clinics across the country were infected with HIV, a good indicator of epidemic spread.
In the years since the fall of the apartheid regime in 1994, the epidemic has continued its rise unabated. In some rural areas of
the country, the level of HIV infection among black pregnant women has reached 40 percent, and the rest of the country will
not be far behind. With the onset of AIDS in the infected and the slew of other AIDS-related infections, already millions are
destined to crowd the hospitals and die.
In wealthy nations, remarkable advances have altered the face of AIDS. Powerful antiretroviral therapies have delayed the
onset of AIDS symptoms and prolonged the lives of those who have fallen ill. The drug AZT can reduce transmission from
infected women to their babies during pregnancy by up to two-thirds. In the United States, pediatric AIDS is on the verge of
But for poor nations, and even nations such as South Africa--which, within the context of Africa, is relatively well off--these
achievements remain cruelly beyond reach. True, a shortened and cheaper course of AZT during pregnancy might reduce the
risk of maternal transmission by half. An even cheaper therapy involving the drug nevirapine has been shown in one trial to
reduce maternal-fetal transmission by at least as much. But for the most part, life-extending drugs are too costly to make them
Even were drug prices to fall, the infrastructure for distribution does not exist. Drug companies' desire for profits--and a limited
commitment by industrialized nations to provide access to AIDS therapy for the poor--has produced a morally deplorable
This is the context within which the recent pronouncements of the leadership of South Africa must be viewed. The Ministry of
Health under President Nelson Mandela courageously challenged the inequities of pricing policies of the international
pharmaceutical industry. But Mbeki and his political allies have chosen to align themselves with Peter Duesberg, who argues,
despite vast epidemiological, clinical and laboratory evidence, that HIV does not cause AIDS. They belittle prevention and
safe-sex programs and promote the discredited view that AZT is a poison that kills.
Such nonsensical claims will weaken already weak prevention campaigns and diminish the reach and use of vaccines now under consideration. More men, women and adolescents will find justification for reckless exposure to a deadly infection. The moral claim to make anti-HIV drugs affordable so that those who are infected may live longer, symptom-free lives will be blunted.
The world's scientific community must support South Africa's scientists in their effort to persuade Mbeki not to give credence to the disruptive claims of dangerous scientific cranks. To pursue such a path in the face of worldwide scientific consensus would doom the people of South Africa to immense suffering.
Ronald Bayer is a professor in Columbia University's school of public health. Mervyn Susser is professor of epidemiology
emeritus there. He was long engaged in the anti-apartheid struggle from outside South Africa and founded the Committee on
Health in Southern Africa.
© 2000 The Washington Post Company