No Time to Lose: A Life in Pursuit of Deadly Viruses (32 page)

At every point Mbeki came up with arguments that were not insane, indeed all were based on some truth; but they were spurious. And his face and body language were inscrutable. I didn’t know whether he was buying my arguments or not, because this was clearly a man who enjoyed debate, sipping his whisky. I had one too, though I rarely drink hard liquor, because I was rattled and exhausted; by this time it was after 11
P.M.
and I had spent the last 24 hours in the air. Finally, he asked me to send him more information, and agreed to attend the international conference on AIDS in Durban that the International AIDS Society was planning, and mentioned that he would be putting together a panel to launch a national debate on AIDS and the cause of AIDS, at which he wanted “all points of view” to be present. Of course I agreed that UNAIDS should attend. And as I left he said, “Peter, don’t you know, what the real problem is? Western pharmaceutical companies are trying to poison us Africans.”

I was dumbfounded. It was close to midnight. I had a very late supper with Mrs. Zanele Mbeki, a simple goat stew with vegetables—these were people who passed the watch and shoe test—and I think I said barely more than a couple of words to her. I felt that I had failed. Mbeki had stressed time and again the need for an
African
response to what he felt was specifically an African problem. He saw AIDS in Africa as a wholly separate disease to whatever other mystery disease was affecting drug users and gay men in the West. And yet here he was, basing his argument on a lone American’s unfounded theory. Mbeki was an intelligent, indeed coldly rational, man; and yet he was impervious to my reason. What could be the origin of this denialism? I had thought maybe it was economic—the cost of treatment—but after that evening I was convinced that could not be the case. Psychological, then. A blind spot—perhaps we all have one, but here, tragically, the president of the country most affected by AIDS had this specific blind spot: one that would harm enormous numbers of people. I wrote in my notebook: “I am devastated—this can have very negative consequences in Africa.”

I immediately (and confidentially) alerted Kofi Annan and the heads of UN agencies working with us that we had what was potentially a major problem with South Africa’s leadership. But Mbeki acted fast. This was clearly a very important issue for him. A few days later, on April 3, he sent a five-page letter to his colleagues all over the world and to the secretary-general of the UN. The tone was defiant and defensive, though he made some good points when stressing the need for Africa to find its own way of confronting AIDS, as its epidemic and societies are so different from the West’s. He said that a “simple superimposition of Western experience” would “constitute a criminal betrayal of our responsibility to our own people.” Very strong words. He compared criticism of the bizarre claims of AIDS revisionists (such as Duesberg) to “heretics” being “burnt at the stake” and observed that “Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and public because the established authority believed that their views were dangerous and discredited.” He continued, “We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited . . . The days may not be far off when we will, once again, see books burnt and their authors immolated by fire.”

Years later, when the dust had settled over the dark Mbeki years for AIDS, and President Zuma had put the AIDS response on the right track. Professor Malegapuru Makgoba, the eminent immunologist who was head of South Africa’s Medical Research Council and now vice chancellor of the University of Kwazulu Natal in Durban, shared with me another, private, letter on AIDS he had received from Ngoako Ramathodi, the premier of Limpopo province, and thought to reflect President Mbeki’s views. The 22-page letter dedicated a few pages to me: “one of the contributors to the criminal cruel and insulting mythology about AIDS and Africa was none other than the Belgian Professor Piot.” The author compared me to a “European
sangoma
(witch doctor) in Africa,” and implied my attitude stemmed from a colonial approach originating in Belgium’s colonization of Congo. It had become very personal and ugly.

The following month there was a two-day meeting of a South African “Presidential AIDS Panel” to debate the cause of HIV, with Senegalese Awa Coll-Seck participating on behalf of UNAIDS. It essentially gave equal time to real science and to denialist quackery, only muddying the waters. For years, Mbeki’s active opposition to antiretroviral treatment was a formidable headache for me and an obstacle to a much needed emergency response to AIDS in southern Africa. The whole South African diplomatic corps was enrolled in this crusade, personified by Mbeki’s Minister of Health Manto Tshabalala-Msimang. At every international meeting they made sure to distinguish the virus and syndrome as separate, unrelated afflictions—HIV
and
AIDS—rather than grouping them as “HIV/AIDS.” Language and symbols mattered for Mbeki, and he succeeded in imposing his semantics: the AIDS community started to use the same terminology, not realizing what it actually meant. Regardless, very few African leaders had the interest and guts to stand against Mbeki, even if in private most disagreed with him, and the Western powers needed the new South Africa for stability on the continent. So I knew that I could not count on our usual allies because of macropolitics.

But the net result of these “higher politics” was more dead bodies. In November 2008 the
Journal of Acquired Immune Deficiency Syndromes
published a Harvard study that estimated that 365,000 people died because South Africa did not provide antiretroviral treatment to pregnant women and other AIDS patients in the eight years of Mbeki’s presidency. To this should be added deaths in countries in the region that slowed down their AIDS response because of Mbeki. This failure also did him a lot of harm politically. He had been seen as a shining leader in Africa but in the end, when he resigned in September 2008, he was widely contested, and the scandal of his mismanagement of his country’s most dramatic health problem was an important element in that loss of reputation.

Thabo Mbeki was not alone in adopting conspiracy theories. In June 2000, in Geneva, his colleague Sam Nujoma, president of neighboring Namibia, deviated from his keynote speech for the annual conference of the International Labour Organization, which under Juan Somavia’s leadership later became the eighth cosponsoring agency of UNAIDS. In front of nearly all the ministers of labor of the world, as well as business and union leaders, Nujoma suddenly put his speech aside and stated that AIDS is a man-made disease. He continued, “States that produced chemical weapons to kill other nations are known—they are probably here, and they have the responsibility to clean up this AIDS mess.” I was sitting next to the rostrum, and nearly fell off my chair. This was not as sophisticated as Mbeki’s views, but I suspected that the aging Nujoma said loudly what many secretly thought. In my speech, which followed his, I set the record straight, and over lunch I tried to convince him that besides the absurdity of the conspiracy, the technology was not there yet to create a new virus. He clearly did not believe me.

THAT YEAR, FOR
the first time, the International AIDS Conference took place in a developing country: Durban, South Africa’s biggest port, was the host city. Mbeki would speak at the opening ceremony, as would I, and we had agreed that then we would fly together to Togo for the summit of the Organization of African Unity. But when Mbeki arrived at the huge Kingsmead cricket stadium where the opening ceremony had started in a chilly sea breeze, his chief of party said there would be no space for me in Mbeki’s plane, and that he would speak before me and then leave. It seemed as if he didn’t want to hear my speech.

The first speaker at the opening ceremony was a very young boy living with HIV I had met during a previous visit to Johannesburg, Nkozi Johnson, who gave a very moving speech that left many people in tears. (He died a year later, aged twelve.) Then came Mbeki, who started reading page after page, verbatim, of an old WHO report on poverty and health: his message was, “
This
is Africa’s problem: it’s poverty.” Which is indeed a crucial problem in Africa, but he did not say much about AIDS. It wasn’t just disappointing, it was chilling. The audience was silent, disgusted, I thought, at what was a collective insult and provocation. And when his speech ended all eyes turned to me.

I was angry but I could not afford to burn all bridges. I started by saying loud and clear that HIV causes AIDS. Applause—the audience’s outrage and frustration came out. I spoke about the need to do more, to offer treatment, but my main message was a universal one: I felt strongly that we should not let Mbeki’s ideas hijack the conference, the movement. What I said was: “This is the time to move from the M word to the B word. We need billions, not millions, to fight AIDS in this world. We can’t fight an epidemic with peanuts.” I was convinced that we had no chance to defeat this epidemic and save the lives of the millions already infected with a small incremental increase of the current resources (then about $300 million for Africa). We needed a qualitative leap forward. Some donors did not forgive me, and already during the conference an aid official called me to say that someone in my position should not make this kind of irresponsible statement and that the money was not there: I should stop dreaming.

But perhaps the most vivid voice at the conference was that of the Treatment Action Campaign. TAC opened the conference with a massive march for access to treatment, and ended it by kicking off a “defiance campaign” to import generic fluconazole, made in India, to South Africa. (A treatment for fungal infection, one of the most common among the opportunistic infections in AIDS patients, generic fluconazole was much cheaper than its brand-name equivalent of Pfizer’s, but generics were still not permitted in the country.) Founded late—at the end of 1998—to campaign for access to affordable treatment for all people with HIV in South Africa, TAC was in my opinion the smartest AIDS activist group of all, worldwide. They combined three strategies: street demonstrations and civil disobedience; a broad alliance with churches, the Communist party, business leaders, academics, the Chamber of Mines, and just about everyone else, including some people in the ANC; and legal tactics to enormous effect. South Africa, in contrast to many other African countries, enjoyed the rule of law and a functioning and independent legal system. And TAC’s constant lawsuits ultimately forced Mbeki’s government to provide nevirapin to prevent mother-to-child transmission.

By this time TAC had become a mass movement, with thousands of totally devoted members, and Zackie Achmat was its mastermind. Zackie was in the first place a genius political strategist and organizer, hardened by the struggle against apartheid and by his campaigning for gay rights; moreover, he was clever, quirky, and articulate. By refusing to accept antiretroviral treatment for himself until it could be made available to all, he used his own body as a billboard for TAC’s campaign. I sought Zackie’s advice at crucial moments for UNAIDS, even if TAC also put constant pressure on us to do more. During the years of ineffective government action, UNAIDS funded TAC directly, which annoyed the government, and we also helped them to raise funds from others, by facilitating a tour of North America.

South Africa’s health minister Manto Tshabalala-Msimang went into overdrive at the conference, trying to control all the messages, attacking the 5000 scientists who had signed a declaration affirming unambiguously that HIV causes AIDS, questioning Mbeki’s position on this, questioning the effectiveness of treatment in general and of methods to prevent mother-to-child transmission of HIV. I had several very tense meetings with her, and at one point she even threatened to take away the citizenship of Hoosen M. “Jerry” Coovadia—a remarkable professor of pediatrics in Durban, a long-standing antiapartheid supporter, and co-chair of the conference. (Of course a minister of health has no legal power over citizenship.) In no other country had AIDS become so political and confrontational, and this situation continued for another five years.

The conference ended on a real high: rumor was that former President Mandela would close the conference, and so he did. Over 10,000 participants chanted “Nelson Mandela!” when he entered, doing the Madiba walk to the music of Hugh Masekela. Mandela called upon the world to join forces to provide HIV treatment, and though he stopped short of criticizing his successor, he saved the honor of South African politicians.

The Durban conference was where the debate on access to treatment in developing counties really got out into the open, though still basically limited to the global AIDS community. At that time, besides groups such as Médecins Sans Frontières, only France and Brazil and UNAIDS were backing such treatment in the developing world. Neither WHO nor any major aid agency was on board in this fight.

But Mbeki’s inexplicable notions about HIV and the AIDS epidemic had continuing repercussions throughout the region. He became a real militant of his own ideas, trying (without much success) to convince other African heads of state of his position, particularly through his minister of health, who insisted on treating AIDS with beetroot, garlic, and more or less fraudulent “medications.” A few years before Mbeki resigned, in 2008, the country’s AIDS policies improved very swiftly. But it was so late, following such a horrible waste.

In September we had another defining moment. The largest-ever gathering of 160 heads of state and government, at the first UN General Assembly of the millennium in New York, agreed on 10 goals to make the world a better place by accelerating action on very concrete issues, including poverty, hunger, maternal deaths, and child mortality. Millennium development goal number six was “Combat HIV/AIDS, malaria and other diseases,” with a target for 2015: “Halt, and begin to reverse, the spread of HIV/AIDS.”