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The continued reluctance of the South African government to accept the scientific consensus on the cause of AIDS could undermine broader efforts to promote sustainable development.

How much longer can South African president Thabo Mbeki continue to deny the international scientific consensus on the link between HIV and AIDS? In political terms, the current answer could be: not very long. Events over the past two weeks suggest that domestic political pressure, from both within South Africa?s ruling African National Congress and former president Nelson Mandela, may soon succeed where virtually unanimous international disapproval has failed.

However, even if this happens, unless the government openly acknowledges a change of heart, rather than appearing to give way to political pressure, a significant danger will remain. This is the threat that Mbeki?s anti-scientific stance will not only damage his political authority, but also undermine a fundamental premise of health and development policy: the idea that any such policy will only succeed if it draws on sound scientific and technical knowledge.

This year, that message is even more important than usual. It will be one of the main themes of the forthcoming World Summit on Sustainable Development, which opens in the South African city of Johannesburg in August (See Putting science in the frame for Johannesburg). There are many who hope that, as host of the meeting, South Africa will fully endorse this message. Continued public equivocation on the AIDS issue could weaken public confidence in its commitment to knowledge-based policies more generally.

There are grounds for optimism that the equivocation may come to an end. Some of this comes from growing evidence of dissatisfaction with the government?s stance from within the ANC. In particular, the heads of two important provinces — first East Cape and subsequently Gauteng — have decided to stand up to Pretoria by introducing plans to allow the anti-retroviral drug Nevirapine to be issued to pregnant mothers, a treatment that has been generally found to reduce the mother-to-child transmission of HIV by up to 50 per cent.

The move has not gone down well with the federal government. Minister of Health Manto Tshabalala-Msimang has accused both premiers of breaking a previous agreement that the anti-retroviral drug would not be issued until the completion of further studies into its effectiveness and its potential side-effects. If there were a genuine cause for concern, such caution and calls for further research would be justified. In the circumstances, given that both issues have already been extensively covered elsewhere, it appears to be little more than further evidence of the government?s — and Mbeki?s — continued procrastination.

Those who are becoming increasingly frustrated with this stance include Mandela. Since handing over the reins to Mbeki three years ago, Mandela has expressed relatively little criticism of his successor?s policies. Just over a week ago, however, he shifted gear significantly in an interview with the South African Sunday Times. Echoing criticism from scientists, AIDS activists, and the country?s trade union movement, he called for an end to the debate ? which Mbeki seems intent on keeping alive — on whether HIV causes AIDS. "This is a war," he declared. "We must not continue to be debating, to be arguing, when people are dying".

AIDS will not, as such, be the top item on the agenda when the WSSD opens in Johannesburg (even though it will not be far behind). But the need for action to alleviate poverty and health across the world will be. Hopefully, the meeting will endorse a commitment to the idea that sound science is required to ensure that this action is effective. Hopefully South Africa, as the host nation, will readily sign up to a consensus on this point. And hopefully, it will have shifted its position on AIDS by then with sufficient conviction to demonstrate that it, too, believes in its own words.

© SciDev.Net 2003

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