[Ip-health] (Fwd) Mbeki's AIDS meds denialism demolished (TAC, Salim Abdool Karim, Malegapuru William Makgoba, Sanele Sano Ngcobo, Katherine Furman, Jonathan Berger)

Patrick Bond pbond at mail.ngo.za
Fri Mar 11 08:11:31 PST 2016


(Makgoba: "/As a country we have moved decisively away from the voodoo, 
reputationally-damaging and ignorant days of Mbeki’s ill-advised, 
ill-informed and pernicious policies on HIV/Aids and evidence is 
everywhere for us to be proud and confident that we are on the correct 
path and with scientifically proven evidence-based sound health 
policies. With an estimated 330 000 deaths during his reign, as a result 
of “failure to accept the use of available ARVs, perhaps as South 
Africans we should seriously consider a case of “crimes against 
humanity” to the International Court of Justice/." Mbeki's rave is here 
<http://www.thabombekifoundation.org.za/Pages/A-BRIEF-COMMENTARY-ON-THE-QUESTION-OF-HIV-AND-AIDS.aspx>.)
*
**Mbeki shows no remorse for role in AIDS deaths*
Submitted by Lotti Rutter on Tue, 2016-03-08 12:58

- TAC responds to open letter published by AIDS denialist former President

JOHANNESBURG, 8th MARCH 2016: On March 7, 2016 former president of South 
Africa Thabo Mbeki published a letter titled “A brief commentary on the 
question of HIV and AIDS”. The letter comes seven and a half years after 
Mbeki was forced to step down as President of South Africa and forms 
part of a series of letters attempting to reframe the Mbeki Presidency. 
The letter can be read here.

The Treatment Action Campaign (TAC) has a long history of struggling 
against the state-sponsored AIDS denialism of Thabo Mbeki and his 
Minister of Health Manto Tshabalala-Msimang. In 2002 we won a landmark 
case in the Constitutional Court compelling the state to make 
antiretroviral treatment available to HIV-positive pregnant women. 
Following this ruling we monitored the provision of treatment to 
pregnant women and advocated for a wider rollout of treatment to 
HIV-positive people. Even with a judgement from the highest court in the 
land and continued public pressure, the HIV treatment programme only 
gained significant momentum once Mbeki and Msimang were removed from 
office in 2008.

The impact of Mbeki’s AIDS denialism was catastrophic. Two independent 
studies have estimated that delays in making antiretroviral treatment 
available in the public sector in South Africa resulted in more than 
300,000 avoidable deaths. It also resulted in an estimated 35,000 babies 
being born with HIV who would not otherwise have been HIV-positive. 
Under Mbeki’s watch life-expectancy in South Africa dropped to 54 in 
2005. Life-expectancy has recovered dramatically in the post-Mbeki era 
to 63 in 2015. This increase is widely attributed to the ambitious 
rollout of antiretroviral therapy in the public healthcare system under 
the leadership of Health Minister Aaron Motsoaledi.

Many of our family members, friends and comrades died while Mbeki’s 
government dragged its feet and indulged pseudo-scientific nonsense. 
Yet, neither in his letter, nor in any other forum that we are aware of, 
has Mbeki apologised or showed any remorse or acknowledgement of his 
role in the over 300,000 avoidable AIDS deaths in South Africa. Instead, 
he has chosen to repeat many of the flawed arguments he used in the 
early 2000s. We provide brief notes below in response to some of his 
arguments, but we will not engage with those arguments in more detail, 
nor will we engage with any of the other red herrings in his letter.

The important point, and the point Mbeki still refuses to face,  is that 
he intentionally delayed the introduction of life-saving treatment to 
the people he was trusted to serve. His actions led to at least 300,000 
avoidable deaths. He has refused to take responsibility or to apologise 
to any of those who suffered directly or indirectly because of his 
actions. For this history will judge him harshly. He deserves it.

Notes:
1.     In his letter Mbeki quotes Stats SA figures from 2006 ranking HIV 
as the ninth highest cause of mortality in South Africa. As done 
previously, Mbeki fails to place the Stats SA data in proper context. 
The data he quotes is based on the cause of death written on death 
certificates. There are a number of reasons why this underestimates the 
role of HIV. Firstly, for stigma-related reasons HIV was often not 
written on death certificates. Secondly, in many cases where the cause 
was indicated as TB or pneumonia, HIV would in fact have been the 
underlying cause. Thirdly, many people would have died of AIDS-related 
diseases without ever having known their HIV status – especially so 
given the much lower testing rates in Mbeki’s time. Mbeki’s misuse of 
Stats SA data is nothing new. TAC e.g. published a briefing note on it 
in 2008. Maybe more disturbingly, a 2001 Medical Research Council report 
on the matter seems to have been ignored by the former President.

2.     The latest estimates from the Medical Research Council’s Rapid 
Mortality Surveillance Report show that the average life expectancy in 
South Africa has reached nearly 63 years, an increase of nearly 9 years 
since the low in 2005. We also recommend this 2013 article by Nathan 
Geffen published in the journal HTB South: South Africans are living 
longer: antiretroviral treatment vindicated.

3.     In his letter Mbeki writes “[I must also mention that I never 
said “HIV does not cause AIDS”. This false accusation was made by people 
who benefitted from trumpeting the slogan ‘HIV causes AIDS’ as though 
this was a religious edict. What I said is that ‘a virus cannot cause a 
syndrome’. As you know, AIDS is an acronym for ‘Acquired Immune 
Deficiency Syndrome’ – therefore AIDS is a syndrome, i.e. a collection 
of well-known diseases, with well-known causes. They are not, together, 
caused and cannot be caused by one virus! I said that HIV might be a 
contributory cause of immune deficiency – the ID in AIDS!]” Mbeki is 
simply wrong. A virus can cause a syndrome and it has long ago been 
proven that HIV causes AIDS. His word games in this regard are a 
cowardly form of confiscation.

4.     We will not engage with Mbeki’s quotations from the document 
“Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics”, 
nor with his quotations from an AIDS denialist film. We see no point in 
responding to patently absurd conspiracy theories. For those interested 
in revisiting stale old AIDS denialist arguments and our responses to 
them we recommend the website AIDS Truth.


For more information and to arrange interviews contact:
Lotti Rutter 081 818 8493
Mary-Jane Matsolo 079 802 2686
*
****
*
*/Business Day/
*//
**Mbeki rekindles AIDS denialism debacle in letter*
by Tamar Kahn, 08 March 2016, 05:37

TOP HIV scientist Salim Abdool Karim dismissed on Monday former 
president Thabo Mbeki’s latest pronouncements on AIDS as unscientific 
"drivel".

Prof Abdool Karim, who is co-director of the Centre for AIDS Research in 
Africa at the University of KwaZulu-Natal, said Mr Mbeki was "still lost 
in a past we have long moved on from".

In a letter published on his institute’s website, Mr Mbeki identified 
himself as the author of a controversial document that influenced the 
views of many senior ANC members in his administration and said he had 
never claimed HIV did not cause AIDS.

The letter is the latest in a series of missives Mr Mbeki has released 
aimed at clarifying his positions on issues while he was in office.

He was SA president from 1999 to 2008 when SA’s HIV/AIDS epidemic soared 
to become one of the world’s worst.

Mr Mbeki’s administration refused to provide antiretroviral (ARV) 
treatment, a stance that influenced the premature death of 330,000 
people between 2000 and 2005, according to Harvard University researchers.

By 2014, an estimated 6.8-million South Africans were infected with HIV 
and the government now runs the world’s biggest treatment programme, 
reaching more than 3-million people.

Since the provision of ARVs began in earnest under President Jacob 
Zuma’s administration, life expectancy has risen from its low of just 
under 43 years in 2004, to 62.5 years last year, according to Statistics 
SA figures.

"What I said is that ‘a virus cannot cause a syndrome’. As you know, 
AIDS is an acronym for Acquired Immune Deficiency Syndrome — therefore 
AIDS is a syndrome, i.e. a collection of well-known diseases, with 
well-known causes. They are not, together, caused and cannot be caused 
by one virus!" said Mr Mbeki in his letter.

"He is simply ill-informed," said Prof Abdool Karim. "The truth is 
viruses can cause syndromes, and HIV is one that does."

Mr Mbeki was one of the authors of a widely circulated document written 
in 2002 entitled, "Castro Hlongwane, Caravans, Cats, Geese, Foot and 
Mouth and Statistics", a diatribe against what it calls "the thesis of 
HIV/AIDS".

It was distributed ahead of a key ANC national executive council meeting 
that supported his opposition to provision of ARVs.

"The title is enough to tell you it is nonsensical drivel. It’s a bunch 
of quotations that are so out of context, it is reduced to half-truths," 
said Prof Abdool Karim.

In his letter, Mr Mbeki wrote that AIDS was only the ninth most common 
cause of death in SA in 2006, and was not deserving of the attention it 
garnered.

"Why did it come about that so much noise was made internationally about 
the ninth leading cause of death in our country‚ with not even so much 
as a whimper about the first leading cause of death‚ tuberculosis? Did 
this have to do with the fact that SA could be a lucrative market for 
the sale of ARVs‚ as it now is?" he asked.

Prof Abdool Karim said that at the time, the stigma associated with HIV 
was such that it was under-reported as a cause of death. Mr Mbeki’s 
figures were out of date, as the three most recent mortality reports 
from Statistics SA identify HIV and TB as the two leading causes of 
death, he said.

Section27 executive director Mark Heywood, who was among the activists 
who led the civil society campaign for access to antiretroviral 
treatment, said Mr Mbeki’s letter "cast doubt over his suitability for 
any public role".

"We knew that a letter on AIDS was inevitable, but I think many of us 
expected that it would be in the form of claims that he was 
misrepresented and only acting with the best interests of the 
population," Mr Heywood said.

"Instead, what we have is a letter that more frankly than ever allies 
himself with AIDS denialism, (that) picks selectively at ad hoc bits of 
‘evidence’ that seem to support (his) thesis and ignores everything that 
has happened since then," he said.

The letter was a distraction, but would do little harm, said Mr Heywood.

"Our response to HIV is now too deeply entrenched."

***
*
Mbeki's foot-in-mouth syndrome*

THE STAR / 10 Mar '16
By: Malegapuru William Makgoba

In trying to explain his approach to HIV and Aids during his term, Thabo 
Mbeki is digging himself an even deeper hole, writes Malegapuru William 
Makgoba.

Medical doctors and scientists make diagnoses from four interdependent 
factors: history; examination; investigation and treatment. Heart 
attacks are often diagnosed from history alone because the description 
of the symptoms by the patient is often so classical.
Former president Thabo Mbeki, whose Aids policy is blamed for the early 
deaths of about 300 000 South Africans, has triggered fresh criticism by 
defending some old pronouncements about the disease. File picture: Anja 
Niedringhaus/A. Credit: AP

However, some diseases are often easily diagnosed by taking a history 
followed by medical examination. The examination reveals what doctors 
call signs, while the patient provides symptoms in the history.

Mbeki's Aids comments a distraction: Sanac

But many other diseases are better diagnosed through investigations, 
which take many forms following the taking of history and medical 
examinations. The investigations often reveal the underlying pathology 
for the explanation of symptoms and signs of the patient.

Rarely a diagnosis is made by giving specific treatment which leads to 
specific response and recovery. The anaemias, especially vitamin B12 
deficiency, fall into this category. Most often response with recovery 
to specific treatment confirms the diagnosis.

Understanding these two basic terms of symptoms and signs is the 
hallmark of medical training and practice and at the heart of former 
president Thabo Mbeki’s misunderstanding and confusion in his letter. 
Symptoms are from patients and signs are findings by a trained doctor.

The diagnosis defines a medical condition or a disease and determines 
treatment, in this case Aids. A correct diagnosis leads to correct 
treatment just as a wrong diagnosis leads to wrong treatment with at 
times dire consequences. Such is the importance of diagnosis.

The simple English Oxford Dictionary’s definition of a syndrome is “a 
group of symptoms and signs which consistently occur together, or a 
condition characterised by a set of associated symptoms or a disease or 
disorder that involves a group of signs and symptoms or a group of signs 
and symptoms that occur together and characterises a particular 
abnormality or condition, a medical disease or condition”. The emphasis 
of the definition is on signs and symptoms. So, Aids is a disease or a 
medical condition that fulfils this uncomplicated definition.

In an article titled “I never said HIV does not cause Aids” Mbeki, if 
quoted correctly wrote: “What I said is that a virus cannot cause a 
syndrome’.”

He further wrote: “Aids is an acronym for Acquired Immune Deficiency 
Syndrome - therefore Aids is a syndrome; ie a collection of well-known 
diseases, with well known causes. They are not, together caused and 
cannot be caused by one virus! I said HIV might be a contributory cause 
of immune deficiency - the ID in Aids’.”

For Mbeki, the definition of syndrome is a “collection of well-known 
diseases, with well known causes”, and for the trained medical doctor, a 
syndrome is a collection or group of signs and symptoms that occur 
together to define a medical condition. From this simple statement, it 
is obvious but not surprising that Mbeki does not understand the 
language of medicine or science.

Clearly Mbeki’s definition and understanding of a syndrome is wrong as 
defined in simple English. In Mbeki’s world a virus (HIV) cannot cause a 
syndrome (Aids). This is another misunderstanding as medical literature 
provides many examples of viruses causing syndromes.

Every well trained doctor knows that poor nutrition causes generalised 
immune deficiency but this is not Aids. Equally many doctors recognise 
that tuberculosis as a specific disease is not Aids. So a “collection of 
medical conditions with known causes” is not Aids but these may be 
Aids-related. Understanding these subtleties in medical sciences are 
what distinguishes hospital and patient-based trained medical doctors 
from naive internet-surfing trained medical charlatans.

By twisting the common English definition of syndrome Mbeki creates his 
own medical encyclopaedia and in effect confirms that “HIV does not 
cause Aids” because it is a virus and a “virus cannot cause a syndrome”; 
a statement he denies. Perhaps the most serious lesson and conclusion is 
this: a president cannot create his own medical and/or scientific 
definitions and/or assumptions and that one cannot, no matter how 
powerful, learn to be a good doctor or good scientist by surfing the net.

Here are basic facts: HIV is a retrovirus. It is the cause of Aids. The 
specific destruction of CD4 cells by HIV leads to Aids. Aids is a 
specific condition, with a specific cause, a specific pathology and a 
specific treatment. Luc Montagnier and Francoise Barre-Sinoussi would be 
first to admit these as they discovered the virus in the lymph nodes of 
a patient. For this breakthrough discovery, they were awarded the Nobel 
Prize.

As the cause of Aids, HIV has fulfilled the classic Koch’s postulate, 
the litmus test for an infectious agent to be accepted as the cause.

A response to specific treatment serves to confirm a specific agent as a 
cause of disease. ARVs are designed specifically for the treatment of 
HIV. South Africa has the largest ARV programme in the world. Since the 
introduction of ARVs to the treatment of HIV/Aids patients, mortality 
has been drastically reduced, many lives have been saved, many patients 
are active and live productive lives, the life expectancy has risen and 
mother-to-child transmission of HIV has plummeted from 25% to less than 
1%. How specific can you get in understanding this causal relationship 
between this virus and this syndrome?

When so many lives and talent were lost and so much untold suffering 
occurred in our country, that Mbeki seems to show no remorse, unable to 
simply say “HIV causes Aids” but hellbent on using outdated statistics 
and wrong medical definitions and assumptions in his long latest letter 
is not only astounding but also so regrettable. The letter removes any 
lingering doubt or ambiguity about his true stance: dissident and denialism.

As a country we have moved decisively away from the voodoo, 
reputationally-damaging and ignorant days of Mbeki’s ill-advised, 
ill-informed and pernicious policies on HIV/Aids and evidence is 
everywhere for us to be proud and confident that we are on the correct 
path and with scientifically proven evidence-based sound health policies.

With an estimated 330 000 deaths during his reign, as a result of 
“failure to accept the use of available ARVs, perhaps as South Africans 
we should seriously consider a case of “crimes against humanity” to the 
International Court of Justice.

***


  Open letter to Thabo Mbeki by a clinical associate

By Sanele Sano Ngcobo 
<http://www.health-e.org.za/author/sanelesanongcobo/> on March 8, 2016 
in HIV – Antiretrovirals (ARVs) 
<http://www.health-e.org.za/hiv-antiretrovirals-arvs/>, Opinion & 
Commentary <http://www.health-e.org.za/opinion-commentary/>

*Sanele Sano Ngcobo is a clinical associate. He pens this letter to 
Former President Thabo Mbeki in the wake of Mbeki’s latest letter 
attempting to explain his controversial stance on HIV.*

Sanele Sano Ngcobo is a University of Pretoria junior lecturer. He is an 
executive member of the International Academy of Physician Assistants 
and the Secretary General of Professional Association of Clinical 
Associates in South Africa.

Dear Honourable Thabo Mbeki,

In response to your latest letter 
<http://www.thabombekifoundation.org.za/Pages/A-BRIEF-COMMENTARY-ON-THE-QUESTION-OF-HIV-AND-AIDS.aspx>, 
I would like to challenge you to admit that you took a wrong decision. 
Your article is indirectly denying the proven facts that antiretrovirals 
(ARVs) have saved lives of many South Africans.

I would like to share few ARV success stories with you.

In 2005, life expectancy in South Africa was 51 years and today it is 61 
years. Zimbabwe’s life expectancy in 2000 was 44 years and today it is 
60 years. Both South Africa and Zimbabwe introduced massive ARV programmes.

Due to ARVs, HIV-related deaths went down by:

  * 58 percent in South Africa
  * 71 percent in Ethiopia
  * 64 percent in Thailand, and
  * 87 percent in Senegal.

All these countries started massive ARV programmes. What more proof do 
we need that ARVs are saving lives of our people?

You have argued that the US pharmaceutical companies wanted to benefits 
from provision of ARVs, however on 19 April 2001 
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119675/> your government 
successfully protected a law allowing the domestic production of 
cheaper, generic medicines – including ARVs – against a lawsuit filed by 
transnational pharmaceutical companies.

Why didn’t you invest in domestic companies to produce ARVs?


      Asking questions wasn’t wrong. Not acting was

“You were doing the right thing by asking questions, but while you were 
asking questions there should have been some interventions rather than 
watching our people helplessly dying”

I am not saying you shouldn’t have asked questions. You were doing the 
right thing by asking questions, but while you were asking questions 
there should have been some interventions rather than watching our 
people helplessly dying in the eye of the so-called democratic government.

In your letter, you make many good points with no solutions. There is no 
alternative.

You had two options: Give ARVs to our people or let them die. You chose 
not to give them ARVs and they died.

The letter you wrote is an insult to the victims of your decisions. You 
are not sympathising with those who lost their loved ones because of 
you. Instead, you are saying there is no need to give ARVs.

Your decision resulted in more than 300 000 people 
<http://www.hsph.harvard.edu/news/magazine/spr09aids> unnecessarily 
dying from HIV. More than 35 000 babies 
<http://www.hsph.harvard.edu/news/magazine/spr09aids> were born HIV 
positive because of your decisions. How do you feel about this?

It doesn’t help to hide behind a 2006 Statistics South Africa report, 
saying “HIV disease” was the 9th leading causes of death in South Africa 
in that year.

Do you believe this?

If you were living in South Africa in 2006, you would know that most of 
our people were dying of AIDS and that AIDS-related deaths were 
misclassified. An HIV-positive patient who died of tuberculosis wouldn’t 
be counted amongst those who died of HIV and you know that fact. 
According to the World Health Organisation, as many as 94 percent of all 
AIDS-related deaths were misclassified from 1995 to 2006.

You are saying we couldn’t afford ARVs. The big question is can we 
afford ARVs today?

The same US government that you keep on accusing has spent more than R65 
billion in a fight against HIV through the U.S. President’s Emergency 
Plan for AIDS Relief (PEPFAR).


      Out of touch

In 2002 <http://www.irinnews.org/fr/node/251105>, your government was 
ordered by the court to provide the ARV nevirapine to pregnant woman to 
prevent the mother-to-child transmission of HIV. You appealed a decision 
to prevent children from getting HIV from their parents. [2002 links to ]

Even Honourable Former President Nelson Mandela tried to intervene by 
saying:

    “If the government says, ‘Don’t make any move until we have
    completed our research’, young people and babies are going to die in
    scores every day. The government must allow people, while it
    conducts its research, to go anywhere they want (to get nevirapine).
    If we do that, we will remove the perception that we don’t care
    about our people who are dying.”

You argued we couldn’t give the ARVs to pregnant woman because it was 
expensive. Were you more concerned about money versus lives of our children?

It seems as if you never took HIV seriously. Instead of promoting HIV 
counselling and testing, you had better things to do and so a 2000 
article 
<http://www.iol.co.za/news/politics/mbeki-has-no-time-for-aids-test-trivia-35117> 
quoted your former spokesperson Parks Mankahlana as saying:

    “The president is not prepared to engage in trivia. He has got more
    important things to worry about than testing for HIV/Aids. Those who
    want to go and test for HIV/Aids must do so.”

In 2003, you confessed HIV had not personally affected you. You were 
disconnected from the reality. You were not a good example to our people.

I would advise that as an expert in economics, your articles focus on 
that field and leave the health-related issues to the health experts.

Your article undermines the hard work of Health Minister Dr Aaron 
Motsoaledi and we are not going to allow you to take us back.

You did enough damage in the health sector. Now please allow those who 
are fixing it to do so peacefully.

Thank you.

Best Regards,

Sanele Sano Ngcobo

/Sanele Sano Ngcobo is a University of Pretoria junior lecturer. He is 
an executive member of the International Academy of Physician Assistants 
and the Secretary General of Professional Association of Clinical 
Associates in South Africa (PACASA). He writes in his personal capacity. 
Follow him on Twitter at @sanosanele/

***


  How Mbeki’s character and his Aids denialism are intimately linked

03 Mar 2016 08:43 Katherine Furman <http://mg.co.za/author/katherine-furman>

Critics say that Thabo Mbeki's character matters less than his AIDS 
denialism, but these things are actually intimately linked.

Former South African president Thabo Mbeki’s character was a salient 
feature of his presidency. Accusations that he suffered from character 
flaws – such as being aloof and paranoid – were widespread at the time 
and have become part of the lore surrounding his time in office.

Some have gone as far as to argue that Mbeki would actively seek out 
critics to lash out against and humiliate 
<https://www.foreignaffairs.com/articles/south-africa/2005-10-01/mbekis-south-africa>. 
This is not all that is remembered about his character. He was also 
famously hard working as well as studious. And, some believe, he had the 
courage to stand his ground against the odds.

In a public letter campaign 
<https://www.facebook.com/permalink.php?story_fbid=10153669102314713&id=38131714712> 
that kicked off at the beginning of 2016, Mbeki is disputing the 
negative labels attributed to him. He wants people to know that he is 
not aloof. Nor, he argues, was he a “paranoid” leader who was overly 
“sensitive to criticism”.

Some critics have responded 
<http://www.rdm.co.za/politics/2016/02/02/why-mbeki-s-reputation-is-in-tatters.-and-it-has-nothing-to-do-with-being-aloof> 
by saying that Mbeki’s character is irrelevant. They argue that what 
really matters are the AIDS denialist policies he adopted during his 
presidency. These were based on his false belief that HIV does not cause 
AIDS – and they had tragic consequences 
<https://afraf.oxfordjournals.org/content/107/427/157>.

But such criticisms miss the intimate connection between Mbeki’s 
character and his denialism. They also don’t take into account the 
impact that this connection has on assessing his moral responsibility.

*Possible excuses
*When people do things with harmful consequences we might take them to 
be initially morally responsible until they offer a plausible excuse for 
their action. If the babysitter feeds a peanut butter sandwich to a 
child who has a nut allergy, we might hold her morally responsible for 
the harmful consequences until she provides a convincing excuse for why 
she did it.

One good excuse is ignorance 
<http://onlinelibrary.wiley.com/store/10.1111/j.1520-8583.2004.00030.x/asset/j.1520-8583.2004.00030.x.pdf?v=1&t=ikx6fk9n&s=804de2d64c88a9f2597394edf29df2887a39344a&systemMessage=Wiley+Online+Library+will+be+unavailable+on+Saturday+27th+February+from+09%3A00-14%3A00+GMT+%2F+04%3A00-09%3A00+EST+%2F+17%3A00-22%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience>. 
Perhaps the babysitter did not know about the allergy. But ignorance 
only succeeds as an excuse if such ignorance is not itself blameworthy. 
The babysitter is not going to get off the hook morally if she was 
explicitly warned about the allergy but was distracted by something 
trivial at the time and ignored what she was told.

Similarly, given how severe the consequences of Mbeki’s action were, 
there’s an initial case available for holding him personally morally 
responsible for the consequences of his denialism.

Hypothetically, he might then offer an excuse for his action and 
ignorance might provide an excuse. He might argue that had he /really/ 
known HIV causes AIDS he would have made treatment available. Mbeki has 
never made such an attempt, but let us imagine the possibility.

The problem is that it seems unlikely an excuse of ignorance would be 
very convincing in this case.

*Scientists explicitly disagreed
*The international scientific community made its disagreement with him 
explicit in the form of the Durban Declaration 
<http://www.nature.com/nature/journal/v406/n6791/full/406015a0.html>, a 
petition signed by more than 5000 scientists that endorsed the 
mainstream scientific view on HIV and AIDS.

It is clear that Mbeki should have taken the objections from scientists 
seriously, given that they are the experts. But part of what went wrong 
in the Mbeki case was that he was confused about who exactly the real 
scientific experts were. He believed that the denialist scientists he 
supported were an oppressed minority group 
<http://www.virusmyth.com/aids/news/lettermbeki.htm> who had been 
unfairly treated by the scientific community – a feeling that was all 
too familiar to him emerging from the struggle against apartheid.

We could concede, albeit grudgingly, that maybe Mbeki’s confusion was 
understandable under the circumstances. But even when presented with the 
Durban Declaration, Mbeki didn’t step back and re-examine his views. 
This is an astonishing response.

It is almost a matter of received wisdom that you should at least pay 
attention to what the experts have to say on a matter even if you decide 
to go a different way when looking at all the evidence. Instead Mbeki’s 
spokesman Parks Mankahlana said shortly after receiving the declaration 
that it would: “… find its comfortable place among the dustbins of the 
office 
<http://www.iol.co.za/news/south-africa/scientists-tread-fine-line-ahead-of-summit-42390>.”

So why was Mbeki so unshakeable in his beliefs?

*Rejecting dissent
*Within the disagreement literature in epistemology – the philosophical 
study of beliefs and knowledge – there is a position known as the 
“conciliationist view”. This argues that a person should revise their 
beliefs when encountering disagreement from their epistemic peers 
<http://www.academia.edu/1207815/Who_is_an_epistemic_peer>. An epistemic 
peer is anyone who has similar reasoning abilities to you and similar 
access to evidence.

The underlying idea here is that disagreement indicates one of you is 
wrong, and you cannot tell from the mere fact of disagreement which one 
of you that is.

If anyone would have counted as Mbeki’s epistemic peers, it would have 
been other members of the African National Congress. It is safe to 
assume that they had similar reasoning abilities to him and would have 
had access to similar evidence. What, then, was the state of 
disagreement with Mbeki from within the ANC? This is where it gets tricky.

There seems to have been very little explicit disagreement with Mbeki 
from within the party, even though some members did /actually/ seem to 
disagree with him. By all accounts 
<http://www.amazon.co.uk/After-Party-Corruption-Africas-Uncertain/dp/1844676277>, 
this was because ANC members were afraid of him and it was understood 
that one had to toe the party line.

Ignoring disagreement from the international scientific community and 
creating a climate of fear speak exactly to the kind of character flaws 
that Mbeki is now trying to contest. They are also the kind of character 
flaws that prevented him from getting at the truth about HIV and AIDS 
and ultimately led to the tragedy of AIDS denialism in South Africa.

Mbeki ultimately relented and ARVs become available via the public 
health system in 2004, but this seems to have had more to do with legal 
intervention <http://www.saflii.org/za/cases/ZACC/2002/16.html>, rather 
than a change in Mbeki’s personal beliefs on the matter.

Mbeki has been notoriously unwilling to speak about the era of his AIDS 
denialism. Perhaps his letters 
<https://theconversation.com/why-mbekis-contested-articles-have-a-role-to-play-in-south-africas-history-54355>, 
a clear attempt to redeem his character, are as close as we will get. 
Either way, his character is not irrelevant.

Katherine Furman 
<http://theconversation.com/profiles/katherine-furman-227641>, PhD 
Candidate in Philosophy, /London School of Economics and Political 
Science 
<http://theconversation.com/institutions/london-school-of-economics>/

This article was originally published on The Conversation 
<http://theconversation.com>. Read the original article 
<https://theconversation.com/how-mbekis-character-and-his-aids-denialism-are-intimately-linked-54766>.


***

/The Con
/http://www.theconmag.co.za/2016/03/11/commentary-on-mbekis-brief-commentary/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheCon+%28The+Con%29

*On Mbeki’s Brief Commentary*

     by Jonathan Berger    on March 11, 2016


I like a Monday. It’s a rest day after a long Sunday run, meaning a 
chance to sleep in just a little, and the beginning of the week’s 
episodes of MasterChef Australia. And it’s the day before the house gets 
cleaned, the laundry finds it way from the basket to the closet, and the 
garden gets its “manicure”. So one can be a bit more relaxed about mess 
and disorder, or what others call living.

It’s also the day when we’re treated, or subjected, to former President 
Thabo Mbeki’s weekly online letter. Until this week, his attempts to 
clarify – some would say rewrite – history had done little either to 
excite or annoy me. Okay, I lie – they annoyed me a bit. But not enough 
to get me to do anything more than kvetch just a little more than I 
usually do.

So there I was on Monday, quietly working on some technical legal 
opinion, when I took a Facebook break. And this is what I read about 
letter number nine, posted by a friend and former colleague:

“We learn some things from Mbeki’s piece on HIV/AIDS today:

1. It’s now confirmed that he co-authored Castro Hlongwane, an 
embarrassing conspiracy-laden AIDS denialist document that was 
circulated to ANC branches. …

2. Mbeki continues to misrepresent or misunderstand death statistics, 
despite this having been explained over and over.

3. He is unrepentant about his AIDS denialism.

And that’s when the day went pear-shaped.

In response to one of a series of online posts I made that morning, a 
colleague of mine noted that Mbeki should have kept quiet: “I imagine 
this latest series of articles is like reconnecting with an ex”, he 
mused, “and then recalling just why you broke up.”

I giggled, pressed the like button, and noted that I hadn’t forgotten. 
You know what they say about Jewish Alzheimer’s: you forget everything 
except the faribels? Except this was no mere faribel — a grudge, held 
for years, over some trivial slight that has long since been forgotten — 
it was something a whole lot worse.

The article I had retweeted, a piece entitled “Mbeki explains his stance 
on HIV/AIDS during his tenure as president”, had angered me. “He 
explains nothing”, I remarked: “He simply rehashes what he always said. 
And remains defiantly non-apologetic. Sies!” “I was dumbfounded when I 
saw the headline”, wrote one friend; “Sies indeed”, posted another.

So what was Mbeki’s stance on HIV during his term of office?

By the time he became president, South Africa had already seen a couple 
of HIV-related scandals. There was Sarafina II, which involved the 
department of health’s funding of a musical production with deeply 
flawed HIV prevention messages. It had come under fire primarily because 
tender processes had not been followed.

And there was Virodene, which saw Cabinet support for an alleged cure 
for AIDS – in fact a toxic industrial solvent – that had been tested on 
human subjects without the approval of the Medicines Control Council. It 
is an offence to conduct unauthorised clinical trials. To date, no-one 
had been held to account for allowing these trials to happen.

These scandals were unfortunate, given the good work that had been done 
post-1994.

Within months of former President Mandela taking office, a national AIDS 
plan – which included a focus on law and human rights – had been adopted 
as official policy. A new HIV/AIDS directorate in the department of 
health had sought and received assistance from the AIDS Law Project 
(ALP) – now SECTION27 – on the implementation of a rights-based 
approach. And numerous court decisions and legislative developments had 
given substance to constitutional protections against unfair 
discrimination and unjustifiable limitations of the right to privacy.

These developments had marked a radical shift away from the 
apartheid-era response.

The first reported AIDS-related deaths in South Africa in the early 
1980s had been described as “isolated cases”, with PW Botha’s government 
assuring the public that there was no need to panic as only gay men were 
considered to be at “high risk”. In 1987, regulations were promulgated 
to provide for foreign nationals with HIV to be denied entry to and/or 
to be deported from South Africa. A year later, 1000 foreign mineworkers 
with HIV were repatriated after their contracts were “not renewed”.

The early 1990s witnessed a significant shift. Shortly after its 
unbanning, the ANC hosted a health conference in Maputo that recognised 
the need to prioritise HIV prevention. At that conference, Chris Hani 
warned against “allow[ing] the AIDS epidemic to ruin the realisation of 
our dreams.” Noting that “statistics indicate that we are still at the 
beginning of the AIDS epidemic in our country”, he predicted that if 
left “unattended”, the epidemic would “result in untold damage and 
suffering”. Hani was right.

Soon thereafter, the ANC worked closely with the then department of 
health to set up an umbrella body to co-ordinate the country’s response 
to HIV. It was that body that produced the national AIDS plan that was 
adopted as official policy in July 1994 by the government of national unity.

But it was not all plain sailing thereafter, with HIV activists and the 
Minister of Health, Dr Nkosazana Dlamini-Zuma, clashing from time to 
time on a number of issues. Dlamini-Zuma’s plans in April 1999 to make 
AIDS a notifiable condition, which would have included an obligation on 
medical practitioners to inform immediate family members and caregivers 
of the “diagnosed” person, drew fierce criticism. So too did her October 
1998 withdrawal of support for pilot sites to prevent mother-to-child 
transmission of HIV (MTCT).

At that stage, the state’s concern was primarily about cost. As a 
Treatment Action Campaign (TAC) letter sent to Dlamini-Zuma’s successor 
on June 11 2001 noted:

“In January 1999, TAC learnt that the government’s Inter-Ministerial 
Committee supported the decision by Minister Zuma and all the provincial 
Health Ministers not to provide AZT to pregnant women [to prevent 
vertical transmission of HIV]. … The summary from minutes of the 
Inter-Ministerial Committee on HIV/AIDS reads as follows:

‘… Based on the cost estimates and the limited health budget available, 
with the provincial health departments experiencing financial 
difficulties in providing basic health services, the Health MINMEC took 
a decision on 2 October 1998 not to introduce the AZT regimen at this 
point of time.  However, this decision will be continuously evaluated as 
new scientific information on cost-effective interventions appropriate 
to our situation in South Africa becomes available including findings 
from the on-going PETRA (Perinatal Transmission) studies which are being 
conducted at the Chris Hani Baragwanath and King Edward Hospitals.’”

So on April 30 1999, just before the second democratic elections, 
Dlamini-Zuma met with TAC representatives and agreed on the need for 
united action to reduce the price of AZT. In a joint statement, the 
parties noted that the price of AZT was the major barrier to the 
introduction of an MTCT prevention programme. Dlamini-Zuma promised that 
government would take action.

TAC kept its side of the bargain. The state did not.

In a speech delivered in the National Council of Provinces (NCOP) on 28 
October 1999, just six months after coming into office, Mbeki began his 
public questioning of the use of antiretroviral (ARV) medicines. In 
responding to the call to make AZT available to prevent HIV transmission 
from mother to child, and for post-exposure prophylaxis following rape, 
Mbeki spoke about the existence of “a large volume of scientific 
literature alleging that, among other things, the toxicity of this drug 
is such that it is in fact a danger to health.”

And then, after indicating that the Minister of Health had been tasked 
with “go[ing] into all these matters so that, to the extent that is 
possible, we ourselves … are certain of where the truth lies”, he ended 
with this:

“To understand this matter better, I would urge the Honourable Members 
of the National Council to access the huge volume of literature on this 
matter available on the Internet, so that all of us can approach this 
issue from the same base of information.”

Here was the great philosopher king, the leader of the African 
Renaissance, advising elected representatives to inform themselves by … 
surfing the web. Despite having direct access to world leaders in HIV 
clinical research, South Africa’s parliamentarians were being told to do 
it for themselves, just as they would if they were looking for advice on 
when to plant rhododendrons, or information on which bakery sells the 
best koeksisters.

In writing this piece, I decided to follow his advice. Using Google, as 
one does, I typed in the words AZT, HIV and toxicity. In addition to 
reading some reasonably balanced entries, I came across a bunch of 
denialist posts. By referring to denialism, I mean the belief that HIV 
does not cause AIDS. For some denialists, HIV does not exist; for 
others, it is a “harmless passenger virus” that has no relationship to AIDS.

An article posted on virusmyth.com by David Chiu and Peter Duesberg of 
the University of California at Berkeley concludes that “AZT, at the 
dosage prescribed as an anti-HIV drug, is highly toxic to human cells.” 
Duesberg is well-known for his 1996 book Inventing the AIDS Virus, which 
made the claim that not only does HIV not cause AIDS, but it is a 
harmless passenger virus. More on Duesberg a little later.

Another piece, also published on virusmyth.com, describes AZT as a 
“medicine from hell”. That piece was written by Anthony Brink, who has 
claimed the credit for “sparking” Mbeki’s “enquiry into the safety of 
the drug, announced in the National Council of Provinces on 28 October 
1999”.

Brink’s claim is recorded in a fascinating Labour Court judgment, in a 
matter in which he unsuccessfully sued Legal Aid South Africa in 2014, 
claiming that he had been discriminated against on the basis of him 
being “an acutely unpopular and widely reviled leading dissident 
activist in the most politically inflamed and morally polarised domestic 
policy dispute in the democratic era, the AIDS treatment controversy.”

And then there’s “Poisoning Our Babies — The Lethal Dangers of AZT”, by 
Neville Hodgkinson, a British journalist who also denies the link 
between HIV and AIDS. At the end of the piece, under the heading “For 
More Information”, Hodgkinson refers to Christine Maggiore’s book What 
If Everything You Thought You Knew About AIDS Was Wrong?, describing it 
as “an accessible introduction to problems in AIDS science and policy.”

According to Maggiore’s website, to which Hodgkinson refers, she has 
“abundant good health and live[s] without pharmaceutical treatments or 
fear of AIDS.” Maggiore, who was diagnosed with HIV in the 1990s, died 
in 2008. She had refused to take ARVs to reduce the risk of transmission 
during her pregnancy in 2001. Her daughter, who was never tested for 
HIV, died in early 2005 of an AIDS-defining illness. She was not yet 
four at the time of her death.

So much for my Google search. Now back to the timeline.

In early 2000, Mbeki established an international AIDS advisory panel 
tasked with – among other things – advising him on whether HIV causes 
AIDS. Its terms of reference posed a number of questions that “needed to 
be addressed in dealing with this issue of the evidence of viral 
aetiology of AIDS and related concerns about pathogenesis and 
diagnosis”, including this gem: “What causes the immune deficiency that 
leads to death from AIDS?”

The panel was comprised of equal numbers of “orthodox” scientists and 
denialists – or in the language of the “synthesis report of the 
deliberations by the panel of experts”, an equal number of “panellists 
who do not subscribe to the notion of HIV causing AIDS” and those who do 
subscribe to this “notion”. Interestingly, Duesberg – whose name popped 
up on my rough-and-ready Google search – was a member of the panel.

Predictably, the panel reached deadlock, and – in respect of key issues 
– made contradictory recommendations. For their part, the “panellists 
who do not subscribe to the causal linkage between HIV and AIDS” 
recommended the suspension of all HIV testing, as well as the suspension 
of “the dissemination of the psychologically destructive and false 
message that HIV infection is invariably fatal and assist in reducing 
the ‘hysteria’ around HIV and AIDS.”

A friend who wrote on health for a major national weekly at that time 
remembers reporting on the panel. Not one to mince her words, she 
describes it as Mbeki’s “assembly of nutcase dissidents dragged out from 
their crop circles and worm holes”. For months, she says, she was 
harangued by them for being a non-believer in their cause. “It was a 
very bleak period in South Africa’s history”, she writes, describing it 
as “[t]he start of the failure of compassion post 1994.”

Perhaps more disturbing is her recollection of having accompanied the 
late Dr Manto Tshabalala-Msimang, then the newly appointed health 
minister, and government officials on a visit to Uganda to learn about 
efforts to reduce HIV infection rates. In a piece written a little over 
a decade later, not long after Tshabalala-Msimang had died, she 
revisited that trip to Uganda, quoting from an article she had published 
in April 2000:

“It was a political triumph because it affirmed African strategies for 
dealing with the HIV/AIDS pandemic, and a personal triumph for the 
minister as it allowed her to carve out a role for the Department of 
Health in determining what course of action the government should take.

Her excitement and enthusiasm were palpable. She said then: ‘I was so 
excited after the first day, I phoned Brigitte [Mabandla, the Deputy 
Minister of Arts, Culture, Science and Technology], who was in the room 
next door, at 4am and said: We can do this. We can make it work.’”

The trip to Uganda took place in mid-1999; Mbeki’s address to the NCOP 
followed just a few months later.

I mention these events not in an attempt to disprove Mbeki’s version of 
history, but rather to provide just a glimpse into the toxic context 
within which public health policies and programmes were to be devised 
and implemented.

In my view, it does not matter whether there is anything substantively 
different between saying that HIV does not cause AIDS, and saying that a 
virus cannot cause a syndrome. What matters is whether there was a 
causal link between Mbeki’s views, and the state’s delay in developing 
and implementing ARV-based programmes to prevent and treat HIV infection.

For a period of ten years, starting in early 2002, I worked for the ALP 
(and then SECTION27). With a particular focus on access to medicines for 
preventing and treating HIV infection, I was part of a team that fought 
the good fight in various ways: such as using the law to reduce the 
costs of ARV medicines, because the state had no interest in doing so; 
compelling the department of health to procure ARV medicines so as to 
implement the treatment plan that TAC and its allies had forced the 
state to adopt; and getting the department of correctional services to 
comply with health policy and implement a treatment plan at Westville 
Correctional Centre.

At every step of the way, we encountered obstruction, obfuscation, and a 
willingness to use any and all legal processes to frustrate and delay. 
It was, without doubt, a war of attrition. We knew it, and they knew it. 
And I believe that they knew that we knew.

Even in smaller skirmishes, the same tactics were at play. In February 
2004, for example, we requested access to certain documents to which the 
state’s ARV treatment plan, published just three months earlier, had 
referred. It was only months later, after we had jumped through all 
manner of hoops, including filing application papers to compel the 
health minister to make the documents available, that we received an 
answer: the references to the documents in the plan had been an error; 
no approved annexes existed.

This was not an isolated example.

In another relatively minor skirmish, also about access to information, 
the correctional services minister waited until filing his answering 
affidavit – seven months after the request for access had been made – to 
inform us that the document in question was not in his possession. That 
document was a report prepared by the then Inspecting Judge of Prisons 
into the death of an ALP client at Westville Correctional Centre. On the 
basis of an expert’s analysis of his medical file, we alleged that he 
had accessed ARV treatment too late.

In his judgment, Justice Southwood concluded that:

“the Minister’s denial that he received the report and any suggestion 
that the report was not received by the Department and is not in the 
Department’s possession cannot be accepted. It is so far-fetched and 
untenable that it must be rejected.”

The Minister was ordered to produce the report. We got it from the 
Inspecting Judge, who was authorised in the court order to release his copy.

In the bigger battles, not only did we have to deal with similar 
annoying tactics, but also elements of denialism, which popped up at 
regular intervals. The cases speak for themselves: the Constitutional 
Court decisions in the MTCT case; the High Court decision dealing with 
“Dr” Matthias Rath’s unauthorised clinical trials on vitamins; and 
attempts to prevent Sibongile Manana, then provincial health minister in 
Mpumalanga, from evicting a provider of post-exposure prophylaxis 
services for rape survivors from a public hospital.

Collectively, these cases provide some evidence to show that the state 
sought to do everything in its power to undermine the use of ARVs; the 
actions of Mbeki’s loyal foot soldiers were not simply limited to 
preventing the public provision of ARVs, at state expense. More had to 
be done. And it was. Those who advocated for their appropriate use were 
smeared; those who spoke out were sidelined. But those willing to do the 
denialists’ bidding, and the denialists themselves, were promoted and 
protected.

In 2005, for example, when Rath was peddling his vitamin remedies as an 
alternative to ARV treatment, and conducting his illegal trials, Mbeki’s 
health minister, Tshabalala-Msimang, defiantly stated that “Rath’s work 
complies with and complements our programmes.” In response to a 
parliamentary question asking whether she would publicly distance 
herself from Rath’s claims that AIDS could be cured by vitamins and that 
ARVs are poison, she said that she would only distance herself from him 
if it could “be demonstrated that the vitamin supplements that he [was] 
prescribing are poisonous for people infected with HIV.”

Later that year she invited two prominent AIDS denialists – Professor 
Sam Mhlongo and Dr David Rasnick – to address the National Health 
Council. Established under the National Health Act, the Council is made 
up of the minister and her deputy, provincial health ministers, and 
senior officials in the national and provincial departments of health, 
amongst others. It is required to play a central role in advising the 
health minister on health policy, legislation and research.

Rasnick, who is best known for his denialist views, had been a member of 
Mbeki’s international advisory panel. At the time of the presentation to 
the Council, Mhlongo was head of the illegal clinical trial being run by 
Rath’s foundation in Khayelitsha. Three years earlier, he had 
unsuccessfully sought to be admitted as a friend of the court in the 
MTCT case in the Constitutional Court. In his unsuccessful labour matter 
against Legal Aid, Brink claimed “that he had opposed the TAC in the 
case by way of an urgent amicus curiae application … which he drew for 
the late Professor Sam Mhlongo”.

Rasnick and Mhlongo had been invited to present their “findings” on the 
Khayelitsha trial to the National Health Council. Mhlongo, then a 
professor at the University of Limpopo’s Medunsa campus (now Sefako 
Makgatho Health Sciences University), had sought – but failed – to 
secure ethical approval for the study from his home institution. And 
after their 90-minute presentation, Rasnick is reported to have said 
that he had advised the Council that ARVs are “toxic and ineffective”.

Much more has been written on the topic. For example, there’s Nathan 
Geffen’s Debunking Delusions; and The Virus, Vitamins & Vegetables, 
edited by Kerry Cullinan and Anso Thom. There’s also The Deadly Hand of 
Denial: Governance and Politically-instigated AIDS Denialism in South 
Africa, published by the Centre for Social Science Research’s Aids and 
Society Research Unit at UCT, and authored by Geffen and Justice Edwin 
Cameron.

These publications, and others on the same topic, make for compelling 
reading. They also put beyond doubt that the former president’s personal 
views were translated into government practice. So whatever Mbeki 
thought, or said, or thought that he said, matters for nothing. He used 
his position to undermine an evidence-based response to the epidemic. 
And for that, nothing short of a sincere mea culpa will suffice. I’m not 
holding my breath.





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