LONDON. Is HIV the only cause of AIDS? How much does it matter when a country is doing the most that it can to stop a massive epidemic? Jasper Morch of UNICEF, Chairman of the UNAIDS Theme Group in South Africa, wishes the issue would just go away so everyone could get on with their work. But it flared up again last month after
This report was then followed by a rash of claims and counterclaims in the South African media, with several major institutions — including the African National Congress, the Anglican Church, and the trades union congress COSATU — reportedly asking Mbeki to clarify the government's position. Government advertisements on the matter did not seem to help, and even Nelson Mandela weighed in to try to dampen the controversy.
But Jasper Morch does not criticize Mbeki or the government. Morch lays some of the blame for the recent controversy at the feet of the South African media, for its overheated coverage of the
"You sit down with colleagues to talk about what needs to be done, but before you can count to three you are talking about the latest gossip on the controversy. The result is we simply can't concentrate, we can't spend the time required on action," Morch said.
"To some extent Mbeki has been paying the price of being a committed, interested head of state. If he had been less committed there would have been much less controversy… A lot of this is speculation on what the President means or thinks."
"But there is no question that South Africa has a very strong and vocal movement that is very seriously engaged in the struggle against HIV/AIDS. There's not a single cabinet minister in this country that doesn't know exactly what his or her brief is on that struggle. There's no question that the government is providing strong leadership. If you look at the strategic plan, the many sectoral plans, there's no question there's been tremendous progress over the last couple of years.
"Of course, it's not been done exclusively by the government. A lot of it has been done by a very vocal and active academic community; certainly the medical community, and by community-based organizations; I think we have come a very long way in breaking the silence and stigma around HIV/AIDS.
"The country has come very far, but there's been a tremendous reluctance to commend each other. And that is true across the board to some extent, and that has then this year taken a very hostile shape and made it almost impossible to move forward… There is a tendency towards animosity in South Africa — everyone is suspicious of each other. There is not as much tolerance as those of us from outside the country, who were not part of the long struggle [against apartheid], could wish for.
Now, Morch suggests, it would be better to agree to disagree. "I thought President Mandela put this well at the World AIDS Conference in Durban this July. He suggested there comes a time in a debate where neither side is completely right or completely wrong. We all wish those words had been heeded and that that was the last we had heard of it."
Morch also lays some blame with the World Health Organization — for having raised doubts about the usefulness of antiretroviral (nevirapine) therapy in controlling mother-to-child HIV transmission (MTCT), one of the central practical interventions which — it has been claimed — is being held up by the debate. In fact, the government is waiting for international WHO trials to be completed, including in South Africa.
"MTCT is one of the key issues in the debate," said Morch. "There's a very strong feeling among activists from the NGO community [such as the Treatment Action Campaign] and the medical establishment that the government should have moved faster on the provision of drugs."
And what is Morch's view? "I can't give you an unequivocal answer. I represent the Theme Group, and I am the UNICEF representative. UNICEF is very concerned about this. I won't point fingers, but I regret that WHO earlier this year suggested that nevirapine needed further study before it could be recommended. WHO said hold your horses and don't just apply this freely. And the Government of South Africa reacted to that and is waiting for new advice from the WHO."
"Meanwhile the government has agreed that nevirapine trials [part of WHO's global study] can be expanded to all nine provinces. So it's not that there's no action whatsoever. Hostility tends to blur the facts. But the most significant damage in this whole debate has been over the treatment of pregnant mothers with nevirapine," Morch said.