South African Health Ministry Report ‘Challenges’ Government’s AIDS Policy

A confidential document issued by the South African Ministry of Health "directly challenges many of" South African President Thabo Mbeki's HIV/AIDS policies, stating that they are "increasingly politically dangerous" and encourage the country's health system to provide "inadequate" care for people with HIV, the London Guardian reports. The report, which was obtained by the Guardian, was drafted in July, before Mbeki wrote a "controversial" letter to South African Health Minister Dr. Manto Tshabalala-Msimang instructing her to "consider a cut" in the country's HIV/AIDS budget. The report states that it is government policy to "'not provide any meaningful care' for large numbers of South Africans" with HIV/AIDS. The health ministry states that it has prevented public hospitals from "disintegrating under the demand for HIV treatment" through a policy of "providing 'inadequate quality of care' for some, and 'not providing any meaningful care for a proportion of those with HIV/AIDS, especially in areas with generally poor access to health care.'" However, the report states that these policies are "'increasingly unstable' from a political, moral and legal perspective" as HIV infection rates rise, especially among the poor. "Failing to provide care for population sub-groups (primarily the rural poor with poor access to health care) will become increasingly politically dangerous as the absolute number of people sick with AIDS rises among poor and vulnerable groups," the ministry writes. Mbeki has "consistently rejected" offering antiretroviral drugs in public hospitals, stating that the medicines are toxic. However, the report refutes his statements and calls for the creation of trial distribution programs of antiretrovirals.

Refuting Mbeki's Other Claims
In the report, the ministry also challenges a number of Mbeki's other positions on HIV/AIDS, including his questioning of the causal link between HIV and AIDS and his declaration that AIDS-related causes are responsible for only a "tiny proportion" of annual deaths in South Africa. The report "concede[s]" that HIV causes AIDS, that antiretroviral drugs "extend lives" and that 3.5 to 4.5 million South Africans will have died of AIDS-related causes by 2010, a figure much higher than Mbeki's claim, based on 1995 WHO data, that AIDS-related causes lead to approximately 5,000 deaths each year in the country. The health ministry document "confirms" what the WHO has said: that AIDS is "the single largest killer" in South Africa. Health ministry officials urge the government to allocate "much greater funding" toward AIDS treatment and broaden access to antiretroviral drugs. The authors of the report include health ministry officials "known to be unhappy" with the South African government's AIDS policies, but it is unclear whether the report has the backing of Tshabalala-Msimang (McGreal, London Guardian, 9/21).

Groups Call for Swift Release of MRC Report
A number of religious, labor and AIDS groups gathered in South Africa this week to "challeng[e]" the South African government to "overcome the denial syndrome" of HIV/AIDS and release a Medical Research Council report that supposedly points to AIDS as the country's leading cause of death, Reuters reports. The Anglican and Catholic churches, the Congress of South African Trade Unions and the AIDS group Treatment Action Campaign met on Monday to draft a statement asking the government to "acknowledge the scale of the HIV/AIDS epidemic" in South Africa. The coalition said that it has created a program to help government officials and others overcome their "denial" of HIV/AIDS. However, the delegates declined to say whether Mbeki numbered among those "in denial." COSATU delegate Derrick Cele said, "We don't want to separate the president from the government. We are making a call on the government, led by the president." The group has also called for the "immediate release" of the MRC report, which, according to media reports, states that AIDS-related causes accounted for 40% of deaths of South Africans ages 15 to 49 in 2000 and names AIDS "the country's biggest killer" (Boyle, Reuters, 9/20). The MRC report compiles the official South African mortality figures for 1997 through 2000 and is scheduled to be released by the end of the year (Kaiser Daily HIV/AIDS Report, 9/20). Catholic Bishop Reginald Cawcutt said, "[The government] cannot withhold that report. It is our report. It was paid for with taxpayer's funds and it belongs to the people." TAC Chair Zackie Achmat said that his group has written to Tshabalala-Msimang, giving her one week to publish the report. After that, he said, TAC will take the issue to court (Reuters, 9/20).