This month, South African President Thabo Mbeki fired a health official (SABC) widely credited with turning round his government’s previously lamentable performance on HIV/AIDS. Mbeki cited an “inability to work as part of a collective” for the dismissal (Independent SA), but the official retorted that she was fired due to clashes over AIDS treatment. The move triggered international concern for the fate of AIDS treatment in the country with the largest number of infected people in the world. The Financial Times reports that one South African labor official said: “Our biggest fear is that we may now return to the terrible days of ‘denialism.’” In the past, Mbeki upset the health community by dismissing HIV drugs (Independent UK) as a toxic “neo-colonialist conspiracy by Western drug companies.” Though Mbeki’s unorthodox views (Harper's) garner some support, many scientists strongly object. A recent New York Times editorial, summing up these objections, argues that unless Mbeki “starts listening to sensible advice on AIDS, he will leave a tragic legacy of junk science and unnecessary death.”
Cultural and political mistrust in the fight against HIV/AIDS have proven difficult to overcome, and not just in South Africa. In Gambia, President Yahya Jammeh, styling himself a healer, asks patients to cease retroviral treatments and instead use a green herbal paste (AP) he claims is a cure. Northern Nigerian leaders boycotted polio vaccinations (News24) they believed “contaminated” with certain viruses “known to cause HIV and AIDS.” An op-ed in the International Herald Tribune contends that, while the notion of health workers purposely infecting Libyan children with AIDS “seemed to Westerners preposterous,” writing off such fears “means losing an opportunity to understand why a dangerous suspicion of medicine is so widespread in Africa.”
AIDS prevention and treatment efforts have faced an uphill struggle for recognition and funding over the years. MSNBC offers this multimedia look at the devastating demographic swath cut by AIDS throughout sub-Saharan Africa. But a recent report (PDF) by UNAIDS shows infections rates in many parts of the world are leveling off, access to treatment has “dramatically” expanded, and global funding for battling the disease increased from $1 billion in 2000 to nearly $9 billion in 2006. President Bush also has pledged an additional $30 billion in funding for the next five years.
Despite these successes, obstacles remain, especially for experimental treatments in regions with a significant AIDS presence. Earlier this year, a high-profile study in five developing countries on a microbicide (PDF) was halted when women using the drug (LAT) had higher infections rates than those who did not. Although investigators concluded that the gel was not at fault (New Vision), one South African journalist notes that, in his country, some people believed (Business Day) the infections meant “black women had been used and deceived.” This CFR.org transcript discusses the cultural obstacles in Africa for male circumcision, shown to help prevent the spread of HIV.
Other microbicide research (AAP) continues, as does work on an AIDS vaccine (IAVI). Experts say any vaccine produced is unlikely to be 100 percent effective and worry that approval of a partially effective vaccine for use only in African countries with high instances of AIDS could spark outrage. CFR’s Laurie Garrett says targeting high-risk regions in Africa would be as politically controversial as targeting treatment of African-American or gay communities inside the United States. “I think you could see there would be a lot of tension around this,” Garrett says.