Ten years ago, South Africa hosted the world’s largest AIDS conference – the first time the event was held in a developing country. The meeting was marked by both hope and controversy and set standards that future such events would strive to meet.
Millions of people had died from the disease – most in sub-Saharan Africa - by the time the 13th International AIDS Conference was held in Durban in July 2000. Anti-retroviral drugs were not readily available on the continent, and fear and ignorance about the disease were widespread.
Professor Jerry Coovadia was chairman of the conference – also known as AIDS2000.
“My view and that of many other people,” he says, “is that without exaggerating its impact it certainly is considered one of the landmark AIDS conferences in the world. And that includes those which have been held recently.”
Coovadia, Emeritus Professor of Pediatrics and Child Health at the University of KwaZulu-Natal, says the event brought many controversial issues to light.
“When one looks back at the HIV/AIDS epidemic,” he says, “and the world’s response to it, it really should be considered as being integral to what AIDS conferences are all about.”
The full horror
AIDS2000 has been described by many as putting a human face on the epidemic and view it not just from a scientific perspective.
“I think it’s more than that,” Coovadia says, “It brought to bear the full horror and extent and scale of the epidemic in terms of the global size of the problem…. The majority of the cases of the cases of HIV/AIDS…about two-thirds of them are in developing countries and mostly in…Africa.”
Ten years ago, there was little access to antiretroviral drugs on the continent. Coovadia says, “It made the problem really one of exceeding anguish and a great reflection of the extent of poverty, which determined availability of health resources throughout the world.”
Opening day
Addressing participants on the first day of the 13th International AIDS Conference, the chairman said, “We have a monumental task ahead of us. And there’s not a second to look back to our yesterdays, to look back at our fears and frustrations. We have no other choice but to go forward and to keep our minds on acting firmly on the knowledge we already have; and of uncovering new ideas and new knowledge on what should be done.”
Coovadia thinks the conference met that “monumental task partly.”
“The very nature of the epidemic, first of all, necessitates us looking realistically at what we can achieve or what we have achieved. So, although I may have sounded as if we might get a vaccine and prevent heterosexual and homosexual transmission, etc, much more successfully than we have, certainly we’ve gone in the right direction,” he says.
Denying the cause
However, he says his remarks also related to the controversy swirling around the conference – the apparent denial by then president Thabo Mbeki that a virus (HIV) was the cause of AIDS.
“We had at that time already a really dreadful history of a schism between the state – by which I mean mainly President Mbeki – and the scientific community and parts of civil society,”
In fact, Mbeki’s position prompted some 5,000 scientists from around the world, including about a dozen Nobel laureates, to issue a statement prior to the conference supporting HIV as the cause of the disease. They warned that denial of scientific research could lead to many more deaths.
Mbeki had put together an advisory panel that included “AIDS dissidents,” who rejected the link between HIV and AIDS. At the same time, Mbeki said a World Health Organization report on the many health problems facing Africa caused him to reconsider the virus theory.
“It seemed to me that we could not blame everything on a single virus. It seemed to me also that every living African, whether in good or ill health, is prey to many enemies of health that would interact one upon the other in many ways within one human body,” said Mbeki on opening day.
“It was so discouraging,” says Coovadia, “that our first democratic government could have descended to the level of trying to challenge certain essential methods of arriving at the truth through science…. The problem was so large and so urgent and so terrifying that we had to deal with the present and the future rather than dwelling too much on the past.”
He says AIDS2000 was a call to Mbeki “to start with us anew in this endeavor to recapture lost ground and to use the best the world had available at that time and in the future for the betterment of our society.”
That didn’t happen.
What’s more, Coovadia says Mbeki’s position delayed the availability of life-saving treatment.
“He disputed the efficacy of some of the (antiretroviral) drugs, which is in a way just as bad or even worse because it prevented access to drugs, which could have been affordable at least to South Africa.”
Mandela steps in
Former President Nelson Mandela, who gave the closing address at the Durban AIDS gathering, spoke directly to the controversy.
“So much unnecessary attention around this conference had been directed towards the dispute that is unintentionally distracting from the real life and death issues we are confronted with as a country,” said Mandela.
He added, “In the face of the great threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people…. Let us not equivocate. A tragedy of unprecedented proportion is unfolding in Africa.”
Coovadia says Mandela’s words nearly moved him and others to tears. He remembers the South African icon receiving an “absolute, unqualified and spontaneous standing ovation.”
“Although the opening ceremony is remembered for Mbeki and his foibles and his serious flaws, the closing ceremony reminded us that South Africa had something very, very important. And it had the quality of its people and its president, Mr. Mandela, who was a good reminder of what people of integrity and standing and belief in the workings of science can do.”
Beat juice and garlic
However, he describes the Mbeki administration as the “worst years” in fighting HIV/AIDS. He says Mbeki made matters worse by appointing a very controversial health minister, Manto Tshabalala-Msimang.
Tshabalala-Msimang, who died last December at age 69, promoted the use of garlic, lemons, beet juice and olive oil to treat HIV/AIDS.
“She was a complete disaster. The problem is I don’t think she was her own woman. She was really reflecting the views of the president. So Mbeki holds the responsibility for all the problems that arose during that period and those problems were immense.”
Those problems included the lack of access to AIDS medicine.
“So you probably had thousands of children, who got infected because mothers were not given antiretrovirals to prevent mother-to-child transmission. And there’s been one calculation that because antiretrovirals were not given to people, who were already infected, adults mostly, we lost something like 330,000 lives,” he says.
Coovadia adds “The immensity of Mbeki’s…unscientific views has not been accurately assessed. Maybe it can never be done.”
Dr. Coovadia is now a member of President Zuma’s 26-member National Planning Commission.
“For the first time in our country’s history we will begin to chart our way forward in a purposeful manner with a view to the country’s long-term interests,” said Zuma on the inaugural meeting of the commission May 11th.
