JOHANNESBURG, Oct. 24 – A new book by the special UN envoy to Africa on AIDS brings to light an extraordinary breach between the organization and South Africa over the crisis, under which the government has effectively banned the envoy from carrying out his duties here for the past year.
The book, written by Stephen Lewis, singles out South Africas government and its president, Thabo Mbeki, for what it calls bewildering policies and a lackadaisical (uinteresseret) approach to treatment of the nations millions of HIV-positive citizens.
Virtually every other nation in eastern and southern Africa “is working harder at treatment than is South Africa with relatively fewer resources, and in most cases nowhere near the infrastructure or human capacity of South Africa,” Mr. Lewis says in the book, “Race Against Time” (House of Anansi Press).
Mr. Lewis, a Canadian who has served since 2001 as the special envoy to Africa on AIDS for UN secretary general, Kofi Annan, wrote that “every senior UN official, engaged directly or indirectly in the struggle against AIDS, to whom I have spoken about South Africa, is completely bewildered by the policies of President Mbeki.”
He contended that his colleagues are “incredulous” (stiller sig vantro overfor) at how Health Minister Manto Tshabalala-Msimang has exaggerated the possible side effects of antiretroviral drugs and wrongly suggested that a diet of sweet potatoes and garlic (hvidløg) can be as important as antiretrovirals in treating AIDS.
Such public criticism is highly unusual for an official of Mr. Lewis rank. His criticism largely mirrors that of civic groups and advocates for AIDS patients here. Those groups have long lambasted (hudflettet) Mr. Mbeki and his health minister for what they call the governments halfhearted efforts to tackle the crisis head on.
In response, a spokesman for South Africas Health Ministry called Mr. Lewis a biased (forudindtaget) and uninformed judge of South Africas response to the epidemic.
– No other country has increased treatment at the pace at which we are implementing our program, the spokesman, Sibani Mngadi, said, adding: – Soon we are going to have the highest number of people on treatment of anywhere in the world.
Mr. Lewis rift with the South African government dates from a July 2004 international AIDS conference during which Ms. Tshabalala-Msimang publicly questioned the safety of a widely accepted drug treatment used to lower the risk of transmission of HIV, the virus that causes AIDS, during pregnancy.
Several international officials objected to her comments, including Mr. Lewis, who lamented (beklagede) South Africas lack of progress in offering antiretroviral therapy to hundreds of thousands in need of treatment.
Ms. Tshabalala-Msimang then publicly invited Mr. Lewis to visit South Africa “and realize how little he knows about the South African health system.” But when he tried to take her up on the offer, Mr. Lewis said in a written response to questions, the minister fired back a missive (officiel skrivelse) “bristling with (untenable – uholdbare) accusations, and said I could not come to South Africa until I had apologized to many individuals and groups, the president and herself included.”
After consulting with his superiors at the UN, he said, he wrote back to the minister, telling her he had nothing to apologize for.
Mr. Mngadi, the ministers spokesman, acknowledged that Ms. Tshabalala-Msimang had demanded an apology.
– The whole approach of Stephen Lewis was to question whether we as a government had a right to take particular approaches, and in that situation it really requires an apology, he said. South African officials have worked constructively with other United Nations representatives on AIDS, he noted adding that they had “never experienced the kind of fallout that we have with Mr. Lewis.”
Mr. Lewis book is a compilation of lectures he delivered as a private citizen during the past year. In his last chapter, he commends South Africa for devoting an ample (tilstrækkelig/rigelig) share of its budget to AIDS problems and for its efforts to prevent new infections.
“But on treatment, it is lagging unconscionably,” Mr. Lewis wrote adding: “What troubles me, and troubles me deeply, is that the United Nations knows that something is terribly wrong, and yet we feel we cannot say anything about it.”
About 6,3 million of South Africas 47 million citizens are infected with the AIDS virus, up from an estimated 5,3 million in 2003.
The World Health Organization estimated that about 837.000 South Africans urgently needed antiretroviral (livsforlængende) drugs by the end of 2004. Only about 78.000 of them (less than ten per cent) now receive drugs through the governments programs, which began last year after a fusillade (kanonade) of criticism over delays. Health analysts say that perhaps 60.000 more South Africans are treated through private programs.
That leaves South Africa far behind countries like Botswana and Uganda, which by the end of last year were already reaching at least half of those in need. The World Health Organizations goal is to have 375.000 South Africans in treatment by the end of this year.
President Mbekis decision in late 2003 to triple the AIDS budget and his governments efforts over two years to roll out free antiretroviral drugs has somewhat lowered the level of frustration.
But many groups condemn his continuing silence on the epidemic and say Ms. Tshabalala-Msimang continues to sow confusion about the safety and effectiveness of antiretroviral therapy, the only proven defense against AIDS.
– There are continually mixed messages, and there is almost increasing confusion in the mind of the average Joe, said Rob Stewart, a health researcher helping the Health Ministry monitor treatment programs.
The latest controversy erupted Wednesday with disclosures that two self-proclaimed specialists were invited to argue to the National Health Council that antiretroviral drugs are toxic and ineffective.
Mark Sonderup, a spokesman for the South African Medical Association, said that his organization was “flabbergasted” (lamslået) by the presentation, and that government officials were trying “to torpedo their own programs.”
His organization represents three-fourths of the nation’s doctors.
The ministry spokesman, Mr. Mngadi, insisted that the ministry was fully behind antiretroviral treatment. -If we were denialists, why would we invest so much money in treatment? he asked.
Kilde: The Push Journal
