EPA

The father of the nation is worried

MADIBA, as Nelson Mandela is fondly known, is trying to shift the South African government's policy on AIDS. This week he met senior members of the ruling African National Congress, including his successor as president, Thabo Mbeki, to argue for government to do more to stop the spread of the disease. Two weeks ago he told journalists and AIDS campaigners in Cape Town that the government should not delay in giving anti-AIDS drugs to all who need them. In December in an obvious reference to Mr Mbeki he said the country's leaders, and their wives, were doing far too little to tackle the disease. A rift is emerging between the former president and the current one, because of AIDS. Can government's policy be shifted?

Mr Mbeki has an unpopular and stubborn approach to AIDS. He doubts if HIV really causes the disease, and trawls the Internet for alternative theories. He does not like talk about sex and condoms. He does not believe that AIDS kills many people, despite evidence from a government-funded report last year that it accounted for 40% of all deaths of those aged 15-49 in South Africa in 2000. He says that anti-retroviral drugs, widely used in the western world and by rich South Africans to limit the impact of AIDS, could be as “dangerous as the disease itself”. His government does not encourage the use of drugs that prevent mothers passing on HIV to newborn children. It also tells doctors in state hospitals not to give anti-AIDS drugs to rape victims, even though an estimated two-fifths of young South African men, the most likely rapists, are thought to have HIV.

That is terrible for South Africa, the country in the world most blighted by AIDS. Although little Botswana and Zimbabwe probably have a higher rate of infection, South Africa, with more than 40m people, has the biggest problem anywhere. A quarter of pregnant women are found to be infected. In some provinces, such as Kwa-Zulu-Natal, over a third of them have HIV. A report by the Medical Research Council last year found that between 4m and 7m people will die of the disease within a decade. The government tried to suppress its publication, and then when that failed dismissed the findings. But this is stupid. The result of the AIDS plague is being felt everywhere in South Africa. Because of it life expectancy is plummeting towards 40 years, and an estimated 2m children will be orphaned by AIDS within a decade.

Such figures are staggering. Despite Mr Mbeki's scepticism, the government is doing something to fight the disease. Spending on public health care grew by 9% a year throughout most of the 1990s. A campaign to increase awareness of the cause of AIDS, has been very successful—just about everyone knows what it is. Efforts to reduce other sexually-transmitted diseases, such as syphilis, which help spread AIDS, have been quite effective. But the government has made two very important mistakes. It has encouraged a culture of denial about AIDS; and it refuses to enlist cheap, effective and relatively safe drugs in its fight against the disease.

Denial is particularly problematic. Mr Mbeki prefers to talk about tuberculosis and malaria, not AIDS. He summoned a medical panel of HIV sceptics and others to advise him on the disease. He has done almost nothing to reduce the huge social stigma that exists about dying from a sexually transmitted illness, or having one. People have been stoned to death when they admit they have AIDS. Very few public personalities admit they have the disease, even when it is obvious. One of Mr Mbeki's own spokesmen (who has since died of the illness), many members of parliament, businessmen and sports people have the disease, but just a handful admit it publicly. Former archbishop of Cape Town, Desmond Tutu, laments that “we are really fiddling while our Rome is burning” by denying in this way that a huge problem exists. The result has been that, despite massive awareness of the causes of AIDS, there has been almost no change in sexual behaviour among South Africans.

The government's position on drugs is almost as bad. Although it successfully forced drug companies to drop their prices last year, it is understandably worried by the money, nursing resources and infrastructure needed to provide anti-AIDS drugs to all. Some, like Mr Mbeki, still doubt if they are safe or useful. Too many believe conspiracy theories that foreign drug companies, aided by their lackeys among medical charities and non-government organisations, exaggerate the threat of AIDS in order to sell their products.

These attitudes have produced a shameful reluctance to save tens of thousands of people, mostly newborn babies, from HIV infection. Nevirapine, a simple drug, is cheap, easy to take and effective at preventing mothers infecting their children. Despite widespread public pressure, the government has allowed only two hospitals in each of nine provinces to dispense the drug. Doctors in some provinces have been forced to smuggle in the drug, and to dispense it at night. Some have been punished for doing so. But in three provinces, Western Cape, Kwa-Zulu-Natal and Gauteng, hospitals have started to defy central government, and have begun to distribute Nevirapine more widely. Defiance of other AIDS policies, for example on giving drugs to rape victims, is also beginning.

Reuters

Defiance by those provinces and others has helped raised the pressure on the government. AIDS campaigners who smuggle cheap, generic anti-retrovirals from Brazil, or buy them in South Africa, have shown eager newspapers and TV-news shows “miracle” cases of dying AIDS patients who have been brought back to health. Drug companies have given permission for generic producers to set up factories in South Africa. The opposition, archbishops, members of the ANC, the African Union and others have all demanded a change of policy. In December the High Court ruled that government policy on Nevirapine was unconstitutional. Mr Mbeki's home affairs minister, Chief Mangosuthu Buthelezi, last week told parliament it was time for a change.

Now, to crown it all, the revered Madiba (Mr Mandela), has made a public intervention. He seems to feel that when he was president he did too little to fight AIDS. He said as much in Cape Town this month. If Mr Mandela, Mr Tutu and a host of famous anti-apartheid campaigners, who talk of this as the “new struggle”, cannot persuade government to stop its policy of denial, it is hard to imagine who could. The lives of many thousands are at stake.