The South African President, Tambo Mbeki has become embroiled in a new controversy over the impact of AIDS in the country, as a legal challenge is mounted to force the government to offer drugs to pregnant women.
A World Health Report (WHO) using 1995 data is being used by Mbeki to support his claim that AIDS is not a major killer in South Africa. The WHO report, which Mbeki found on the organisation's website, shows that 'AIDS disease' caused just over two percent of deaths in South Africa in 1995, the last year for which figures are available, ranking twelfth - well behind homicide and suicide, circulatory disease and tuberculosis as causes of death.
In a letter to the South African Health Minister, the President instructed her to use the data to see if South African health resources were being targeted appropriately, and said "Needless to say these figures will provoke a howl of displeasure and a concerted propaganda campaign among those who have convinced themselves that HIV/AIDS is the single biggest cause of death in our country."
However, Mbeki's arguments have been severely undermined by a report from the South African Medical Research Council, which found that AIDS is already the leading cause of death amongst South Africans and could claim as many as six million lives in the country by 2010 unless meaningful preventative measures are put in place. Based on evidence from the South African Government's ante natal survey and the model developed by the Actuarial Society of South Africa to predict the course of the disease in the country, the MRC identified what it called "rapid changes" in mortality amongst young South African adults since 1997.
Last year, they report, 40 percent of deaths amongst South Africans aged 15 to 49 were caused by AIDS and they further warn that by 2010 population growth will be halted, AIDS deaths will account for twice as many deaths as all other causes of mortality combined and there will be a "threefold" increase in AIDS deaths in infants aged one to five.
Support for the South African MRC findings came from researchers working for the South African Development Community, who in their 2000 regional development report said that southern African economies would be devastated by 10 million AIDS related deaths by 2015.
President Mbeki was further involved in controversy as the South African Government prepared to defend itself against a law suit brought by the Treatment Action Campaign (TAC), the group which has led demands for access to treatment in South Africa.
The TAC suit accuses both national and regional government in South Africa of breaching the constitution by failing to provide anti-HIV drugs to HIV-positive pregnant women.
TAC is arguing that by denying HIV-positive mothers access to nevirapine or AZT, which have been shown to dramatically reduce mother to baby transmission of HIV, the government is denying women their constitutional right to life and basic healthcare. The lawsuit also maintains that the government policy discriminates against black women, who form the overwhelmingly majority of thosde using state ante natal resources.
It is estimated that 70,000 children are born HIV-positive each year and that this figure could be cut by half if appropriate treatment and support were given to pregnant and nursing mothers.
TAC hopes to use the case to force to government not only to provide treatment to HIV-positive pregnant women, but also to develop an HIV national plan for pregnant women with HIV, which would include the provision of counselling about the dangers of breast feeding and the use of formula milk.
Any hope the South African government had of providing a united front in opposition to the case was shattered when the regional government for the Western Cape told TAC that it would be developing a comprehensive plan to combat mother-to-baby transmission, and that it would be engaging a separate legal team and defending itself separately from the national government and other regional authorities.
The drug company, Boehringer Ingleheim, who make nevirapine, has offered to supply the drug free of charge in South Africa to cut mother to baby transmission. The drug is used worldwide as a safe and relatively cheap treatment to prevent a mother infecting her baby with HIV. A widely quoted South African HIV doctor said last week: "The treatment is safe, effective and cheap. there is no reason not to use it...It makes no sense [to withhold its use]."