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Mandela presents his concerns about AIDS policy to ANC committee

BMJ 2002; 324 doi: (Published 23 February 2002) Cite this as: BMJ 2002;324:446
  1. Pat Sidley
  1. Johannesburg

    Simmering tension over South Africa's AIDS policy within government and ruling party ranks and between the former president, Nelson Mandela, and President Thabo Mbeki burst into the open this week.

    Mr Mbeki's views on the origins of AIDS have paralysed the government, resulting in a consistent refusal to entertain forms of therapy that rely on antiretroviral drugs. Mr Mandela has allowed it to become known over the past months that he was concerned about both the policy and the lack of debate within the government surrounding it.

    During several hours of high level discussion this week, Mr Mandela presented his concerns to a top committee within the ruling African National Congress (ANC) party. The group consisted of President Mbeki, his deputy president, Jacob Zuma, and three other high ranking officials in the party.

    Earlier in the day, defying previous policy, the ANC premier of Gauteng (an area that covers Johannesburg and Pretoria), Mbhazima Shilowa, announced that all provincial hospitals and community clinics with the capacity to do so, would give antiretroviral drugs to all pregnant women who wanted them, to reduce vertical transmission.

    He apportioned 30 million rand (£1.8m; $2.6m; €3m) of public money for this. Also defying government policy, he is to provide antiretroviral treatment for women who have been raped, to avoid the possibility of contracting the virus.

    Mr Mandela left the ANC meeting late in the evening after several hours, and the meeting continued for several hours more, after which a statement was put out saying the ANC and Mr Mandela were in agreement over ANC and government policy on AIDS.

    But before the day was out, high officials had begun squabbling in public. The top civil servant in the health department, the director general of health, Dr Ayanda Ntsaluba, issued a statement responding to the Gauteng move saying the national department had confidence in the province's ability to supply the treatment according to approved protocols. And several hours later, health minister Dr Manto Tshabalala-Msimang issued a statement contradicting her director general and criticising the move.

    It is far from clear at this stage how the moves will unfold. However, it is known that Mr Mandela has sought advice from top AIDS scientists, locally and internationally, activists, and people living with AIDS and is working closely with a group of business people who are anxious to bring adequate treatment to South Africa's ailing population.

    Sources close to this process have indicated that with or without the government, the grouping intends to see to it that people have access to treatment.

    About 25% of the country is HIV positive. Mortality figures indicate that large numbers of younger people are now dying and AIDS has become the leading cause of death in the country. Projections indicate that between half and three quarters of all those currently aged between 15 and 49 years will contract the disease and are likely to die.

    Despite all the indications, however, debate continues to rage around President Mbeki over whether HIV causes AIDS and how to treat the epidemic.