Her Ideas on AIDS Are Called Bad Medicine

The United Nations special envoy for AIDS has likened her to the “lunatic fringe,” while a well-known comedian derides her as the “angel of death.”

She is South Africa’s top health official and one of the most important front-line fighters against AIDS in a country beset by an epidemic. But Health Minister Manto Tshabalala-Msimang has been widely criticized for questioning the effectiveness of antiretroviral drugs to combat AIDS, advocating instead a treatment using beets, lemons, garlic and sweet potatoes.

Activists had to take legal action to force the government to provide medication to pregnant women and prisoners.

She has been criticized in international forums, and dozens of global health experts recently called for her to be fired. But South African President Thabo Mbeki has remained steadfast. Some analysts suggest he is being loyal to a longtime political ally, others say he is satisfied with her performance because her views are similar to his own.

In the late 1990s, Mbeki warned of the toxicity and harmful side effects of antiretroviral treatments, and in 2000 he questioned the link between the human immunodeficiency virus and AIDS. He has never publicly disavowed those views, although government spokesman Themba Maseko said this month that the government thought HIV caused AIDS.

“I don’t think he understands how much it has damaged his presidency,” said William Gumede, the author of a biography critical of Mbeki. “Even his closest allies, if you speak to them, don’t see it.”

Other observers think that the more pressure from activists and international experts, the less likely Mbeki is to dismiss Tshabalala-Msimang because he finds it difficult to admit he was wrong about AIDS.

“I think there’s a certain degree of vanity here,” said political analyst Tom Lodge, a former political science professor at the University of the Witwatersrand in Johannesburg. “He’s like a lot of politicians: He really finds it difficult to say, ‘Look guys, I made a mistake.’ ”

This month, Mbeki ignored a call for Tshabalala-Msimang’s dismissal from 81 international AIDS experts, including David Baltimore, who won a Nobel Prize, and Robert Gallo, who developed the first blood test for HIV and identified the virus as the cause of AIDS.

In a letter to Mbeki, they called for an end to South Africa’s “disastrous, pseudoscientific policies,” saying the health minister was an embarrassment.

At the International AIDS Conference in Toronto last month, U.N. envoy Stephen Lewis described the South African government’s approach as “wrong, immoral, indefensible.”

“It is the only country in Africa,” he said, “whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

With 600 to 800 people dying of AIDS in South Africa daily, Lewis said the government had much to atone for, but added, “I’m of the opinion that they can never achieve redemption.”

Cape Town comedian Peter-Dirk Uys, known for his scathing stage show, “Foreign AIDS,” has gone even further, calling his country’s antiretroviral program “the new apartheid” because so many poor people are dying of acquired immune deficiency syndrome from a lack of drugs.

In South Africa, 5.5 million people are infected with HIV, second only to India. The government estimates it treats 140,000 South Africans with antiretroviral medicines. Of those, 40,000 are funded through the President’s Emergency Plan for AIDS Relief, an initiative started by President Bush.

Gumede said Mbeki did not want to fire Tshabalala-Msimang under pressure, but noted that her power had been curbed when the government set up a committee of ministers this month to oversee the AIDS treatment plan.

“Mbeki is very sensitive,” he said. “If he feels one of his loyal supporters or loyal allies is under siege, it’s real unlikely that he will fire such a person.”

Mbeki and Tshabalala-Msimang have been friends since the early 1960s, when they and other students went into exile. Mbeki is also close to the health minister’s husband, Mendi Msimang, treasurer of the ruling African National Congress and the ANC’s London representative when Mbeki was in exile in Britain during apartheid.

Mark Gevisser, author of a forthcoming biography on Mbeki, said the president had been asked why he appointed Tshabalala-Msimang health minister. Mbeki reportedly pointed to a photo of himself, Tshabalala-Msimang and other young exiles and said: “She’s been with us from the start, and she’s a doctor. She could have gone into private practice; she could have left the movement, but she has stayed with us.”

Gevisser said trust was a key factor.

“It’s history that the two of them as youngsters went into exile together, and that’s significant, but not as significant as the fact that he feels that she’s someone that he can completely trust,” he said. “I would imagine that there’s a deep, enduring bond and a sense of loyalty, and a sense of, ‘We were with each other in the trenches, so I can trust this person absolutely.’ That becomes a measure, as much as a minister’s competency in a portfolio.”

Political analyst Lodge said Tshabalala-Msimang held conventional views on HIV and AIDS before she was named health minister, but she had since echoed Mbeki’s opinions, adding her spin about garlic, lemons and beets as a treatment for AIDS.

“In the case of the president, who likes to think independently of experts and who often is in quite an isolated position intellectually, it is possible to see -- and it’s also possible to regret -- where he has ended up,” Lodge said.

“It’s in some ways all the more unforgivable in her case because, unlike the president, she has a conventional medical training. She is going against the conventions and the professional protocols of her own background.”

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robyn.dixon@latimes.com