iClinic - September 21, 2000

In one of the clearest explanations of his position on HIV/AIDS yet, President Thabo Mbeki shared his doubts that HIV can cause AIDS when answering questions posed by Democratic Alliance leader Tony Leon and the ACDP's Cheryllyn Dudley in parliament on Wednesday. But he emphasised that all government HIV/AIDS policies are based on the premise that HIV causes AIDS.

"All HIV/AIDS programmes of this government are based on the thesis that HIV causes AIDS," said Mbeki, adding "There is absolutely no confusion about what to do." But he went on to ask "Does HIV cause AIDS? Can a virus cause a syndrome? How? It can't, because a syndrome is a group of diseases resulting from acquired immune deficiency." He said that the question still unresolved by scientists is: what contribution does HIV make to the collapse of the immune system? "Indeed, HIV contributes, but other things contribute as well," said Mbeki.

He said that what is not yet resolved and what is being investigated by the International AIDS panel is: what do HIV tests measure? "Scientists from both sides of the divide have identified this as an essential question to be resolved in order to provide comprehensive treatment," says Mbeki, adding that "We need to understand all these complexities so that our intervention can be more effective, even though many people do not want to study this question." Leon wanted to know whether the SA National AIDS Council has made any recommendations about the use of anti-retroviral drugs to prevent mother-to-child transmission of HIV (MTCT).

Mbeki replied that antiretroviral nevirapine has not been registered for MTCT anywhere in the world and that the World Health Organisation is still considering its use for this purpose.

"A National Steering Committee on MTCT has already met and will finalise its report mid-October," says Mbeki.

On the question whether he believes that HIV is a minor or major cause of AIDS, Mbeki replied that "there is a serious AIDS problem".

On the question of AIDS orphans, Mbeki replied that "orphans result from the health crisis in SA, caused by many diseases".

He pointed to 1999 WHO estimates of the causes of death in Africa, which stated that 12% of deaths are caused by HIV/AIDS, but heart diseases is still the biggest killer. "All these cause orphans," says Mbeki.

On the question why there is a delay in MTCT in other provinces when the Western Cape, the only province not controlled by the ANC, has successfully implemented free treatment, Mbeki replied that "This matter will be dealt with through the Steering Committee on MTCT".

On the call to go for an HIV test by PAC spokesperson Patricia de Lille, who went for a public HIV test recently to spur on other politicians to lead by example, Mbeki replied that "It is important to know what the state of one's health is - in my capacity as president of this country I go for regular health check-ups".

On the controversial debate whether HIV causes AIDS sparked by Mbeki's courting so-called AIDS dissidents in his presidential AIDS panel, Mbeki replied that "The way we have handled the complex scientific questions around HIV/AIDS may have been confusing, but there is nothing confusing about what government HIV/AIDS programmes are based on and are trying to do".

It was the second time this year that Mbeki replied to questions from MPs in parliament, in terms of new rules for parliamentary question time.

The questioning follows weeks of controversy over Mbeki and Health Minister Manto Tshabalala-Msimang's refusal to state outright whether HIV causes AIDS.

Standard government replies to this question have been that AIDS has multiple causes and that the answer can be read in the policies and programmes set up by government, which operate from the premise that HIV causes AIDS.