**LEADERSHIP IN** **THE** **CAMPAIGN TO FIGHT AIDS IN AFRICA**

George B.N. Ayittey, Ph.D.[^1]

Department of Economics

American University

4400 Mass Avenue, NW

Washington, DC 20016-8029

\(202\) 885-3779

e-mail: <ayittey@american.edu>

Presentation before The Presidential Advisory Council on HIV/AIDS,
Hubert Humphrey Building, United States Congress, Washington, DC July
18, 2003

**Executive Summary**

Africa, the \"cradle of humanity,\" has been buffeted relentlessly by
many crises: senseless civil wars, famine, drought, poverty and brutally
repressive kleptocratic regimes. A new threat, AIDS, now threatens the
very survival of a beleaguered continent. The pandemic has killed at
least 20 million of the more than 60 million people it has infected thus
far, leaving 14 million orphans worldwide.

Today, on the continent of Africa, nearly 30 million people have the
AIDS virus\--including three million children under the age of 15.
Nearly 20 million HIV-infected men, women and children, representing
almost 70 percent of the total number of HIV/AIDS cases in all of Africa
and the Caribbean are concentrated in just 14 countries: Botswana, Cote
d\'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria,
Rwanda, South Africa, Tanzania, Uganda, and Zambia.

To address this crisis, President Bush announced in his January State of
the Union address the Emergency Plan for AIDS Relief, a five-year, \$15
billion initiative to turn the tide in combating the global HIV/AIDS
pandemic. This Plan is intended to help the most afflicted countries in
Africa and the Caribbean wage and win the war against the epidemic. This
Plan can be seen as a magnanimous act of supreme compassion and
foresight, given that AIDS \-- just like SARS \-- respects no
international borders \-- nor boundaries of class, culture and race. The
U.S. therefore helps itself by helping treat AIDS-sufferers in Africa.

However, m any questions still remain to be answered about the plan's
likely effectiveness, which is likely to be influenced by the existence
of a functioning health infrastructure that can safely and efficiently
deliver cheaper drugs. More critical is the leadership or the political
will on the part of African governments to implement programs. Absent
these factors, the noble gesture by President Bush may sink into a
wasteful oblivion.

Unfortunately, leadership or the political will has demonstrably been
weak in the fight against AIDS. When the AIDS epidemic first erupted,
African leaders were in denial. Many were reluctant to talk publicly
about the dreadful disease and its prevention. Only a few African
countries have made serious efforts to confront the AIDS epidemic:
Senegal, Ghana and Uganda. Most disappointing has been the failure of
South Africa to provide effective leadership in the campaign against
AIDS \-- despite its 10 percent infection rate and its first-rate modern
health care systems. It won a landmark court case against the
pharmaceutical industry to provide cheaper versions of patented
anti-retroviral drugs to AIDS sufferers but subsequently refused to
follow up by providing cheaper drugs to AIDS sufferers. Then President
Thabo Mbeki of South Africa added more confusion by claiming in 1999
that HIV does not cause AIDS but rather poverty and other socio-economic
factors -- a position he has since abandoned.

Benchmarks or goal posts may need to be established for African
governments if the campaign against AIDS in Africa is to be effective.

\[T\]o meet a severe and urgent crisis abroad, I propose the Emergency
Plan for AIDS Relief - a work of mercy beyond all current international
efforts to help the people of Africa\...I ask the Congress to commit
\$15 billion over the next five years, including nearly \$10 billion in
new money, to turn the tide against AIDS.\"

> President George W. Bush in his \"State of the Union\" address,
> January 28, 2003

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

A. INTRODUCTION

Africa, the \"cradle of humanity,\" holds many unsavory distinctions.
Economically, it is the least developed region in the Third World and,
according to the Heritage Foundation/Wall Street Journal Index of
Economic Freedom, the least \"economically free.\" Four out of 10
Africans live in absolute poverty and this number is expected to grow.
Politically, Africa is also the most \"un-free\" continent, having more
despots per capita than any other region. Fewer than 15 of the 54
African countries are democratic. Hence, the vast majority of Africans
labor under brutally repressive and corrupt regimes. Further, Africa has
been ravaged by warfare that has devastated agriculture, and collapsed
infrastructure. Famine is widespread. This mix of calamities has sapped
the vitality of the continent, brutalized its skilled manpower, and
sentenced its people to near stone-age existence. Africans lost the 20th
century. And as if these challenges were not enough, a new threat, AIDS,
now threatens the very survival of a beleaguered continent.

The HIV/AIDS pandemic has killed at least 20 million of the more than 60
million people it has infected thus far, leaving 14 million orphans
worldwide. Today, on the continent of Africa, nearly 30 million people
have the AIDS virus\--including three million children under the age of
15. Nearly 20 million HIV-infected men, women and children, representing
almost 70 percent of the total number of HIV/AIDS cases in all of Africa
and the Caribbean are concentrated in just 14 countries: Botswana, Cote
d\'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria,
Rwanda, South Africa, Tanzania, Uganda, and Zambia. In some countries in
Africa, more than one-third of the adult population carries the
infection. Africa has already lost some 12 million people from AIDS --
more than the total number of deaths from all of the wars in Africa
combined -- and 11,000 new cases are diagnosed every day.

The AIDS epidemic has taken a heavy toll on Africa\'s most productive
people \-- those between the ages of 15 and 45 years \-- and undermined
agricultural productivity. Output has suffered dramatically. With the
vitality of the population weakened by AIDS, people\'s ability to
recover from natural and artificial shocks has been impaired. By 2001,
the UN Food and Agriculture Organization (FAO) estimated that 7 million
of Africa\'s agricultural workers already had died of AIDS, and that 20
million more may succumb by 2020 (*Africa Recovery,* May 2003; p.11).
Such deaths severely impacts Africa\'s agricultural labor force and its
ability to grow food or other crops.

A study in a communal area in Zimbabwe has demonstrated that an adult
death from the disease can immediately reduce a household\'s ability to
produce different foods. The declines average 61 per cent for maize, 49
per cent for vegetables, 47 per cent for cotton and 37 per cent for
groundnuts. In Malawi, death rates among employees of the Ministry of
Agriculture and Irrigation have doubled, almost all because of HIV/AIDS.
In Namibia, studies indicate that

agricultural extension workers spend one-tenth of their work time
attending the funerals of people who died of AIDS (*Africa Recovery*,
May 2003, Vol. 17, No.1; p.11).

Malawi, Lesotho, Zimbabwe and Zambia are three African countries that
have been most devastated by the deadly mix of AIDS and famine.
Malawi\'s lush-green countryside is criss-crossed by several rivers.
Further, Africa\'s third-largest lake can be found along its eastern
border. Yet, Malawi is finding increasingly difficult to find people to
work its fertile land. The AIDS epidemic has caused an acute labor
shortage. It has an annual rate of 70,000 deaths from AIDS-related
illnesses (including tuberculosis, malaria and cholera), and life
expectancy has fallen from 46 years to 36 years, according to the UN
Development Program (*Africa Recovery,* May 2003; p.11). Partly as a
result, Malawi has sought emergency food assistance, including donations
of even maize \-- the key staple of East and Southern Africa.

With nearly one-third of working-age adults infected with the virus \--
the world\'s fourth highest HIV infection rate \-- Lesotho was unable to
deal with crop failures, largely due to inclement weather over the
period 2001-2003. In Zimbabwe, some 2.2 million people are infected with
the virus, of whom 600,000 have developed full-blown AIDS. According to
the Ministry of Health, 70 per cent of hospital admissions are
HIV-related and the government expected that the country\'s 2002/2003
agricultural production to fall far short of national needs Lesotho has
the world\'s fourth-highest HIV infection rate, with nearly one-third of
working-age adults infected with the virus. Since Zimbabwe used to be
the breadbasket of the region, the food deficit would have ramifications
on the neighboring countries.

In Zambia, the HIV/AIDS pandemic has not only devastated agricultural
production and depleted the work force, but also affected every other
aspect of life and society. By the end of 2000, between 40,000 and
90,000 people had died of AIDS, most of them men between the ages of 20
and 45 (*Africa Recovery,* May 2003; p.12).

To address this crisis, President Bush announced the Emergency Plan for
AIDS Relief, a five-year, \$15 billion initiative to turn the tide in
combating the global HIV/AIDS pandemic. This commitment of resources,
first set forth in the president's State of the Union address in January
2003, is intended to help the most afflicted countries in Africa and the
Caribbean wage and win the war against HIV/AIDS. President Bush called
for \$2 billion to fund the program in FY04, with spending expected to
rise in subsequent years.

Specifically, the initiative aims to:

-   Prevent 7 million new infections (60 percent of the projected new
    infections in the target countries).

-   Treat 2 million HIV-infected people.

-   Care for 10 million HIV-infected individuals and AIDS orphans.[^2]

The initial focus of President Bush\'s AIDS plan is in Botswana, Cote
d\'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, South
Africa, Tanzania, Uganda, Nigeria, Rwanda, and Zambia.[^3]

The AIDS epidemic is an intensely emotional issue as it involves matters
of life and death for millions of human beings. At first blush, a \$15
billion increase in new funding to combat AIDS in Africa by providing
affordable treatment drugs or cheaper versions of retro-viral anti-AIDS
drugs to poor African sufferers can be seen as a magnanimous act of
supreme compassion and foresight. Given that AIDS respects no
international borders \-- nor boundaries of class, culture and race \--
the U.S. helps itself by helping treat AIDS-sufferers in Africa.
Furthermore, very few people would stand in opposition of a plan to save
lives. However, caution needs to be exercised against excessive
optimism.

B. **GRAND FAILURES IN THE PAST**

In the past decade, various grand initiatives have been crafted by
Western governments, international aid organizations, and African
leaders to tackle problems in Africa: poverty, humanitarian crises,
civil wars or disease. Most of these well-intentioned initiatives, came
to ignominious grief, but not for want of trying.

The most notable was the African Crisis Response Initiative (ACRI),
announced on September 28, 1996 by the Clinton administration to stem
crises on the continent by having Africans keep the peace in Africa. Its
goal was to assist African nations to respond to humanitarian crises and
peacekeeping missions in a timely fashion, by organizing and training an
African peacekeeping team for use on the continent. ACRI sought to
promote peace and stability on the continent and to help African nations
to prevent more of the deadly conflicts which had plagued and continue
to ravage that continent. The Clinton administration, with Congressional
approval, allocated \$35 million for ACRI\'s start up costs.

Since the program\'s inception, more than 8,600 African troops have
completed their initial training at the battalion and brigade
levels.[^4] In fiscal year 2000 Senegal, which received \$2.5 million
and had 645 soldiers trained, was the top recipient of the ACRI program
grant assistance. Cote d\'Ivoire had more with 740 soldiers trained
under the same program in the same fiscal year with \$1.7 million in
funding.[^5] Ironically, Cote d\'Ivoire imploded in October 2000, which
by telling coincidence, happens to be the last date the State Department
posted an update on its ACRI web site.[^6]

Then there was the Africa Growth and Opportunity Act (AGOA), signed into
law by President Bill Clinton on March 12, 2000, and aimed at boosting
U.S.-Africa trade. Although trade has increased, relatively few African
countries have benefited from the program. According to Greg Simpkins of
the Foundation for Democracy in Africa, some of the problems can be
attributed to "a widespread lack of understanding of this trade process.
Some misconceptions are simply caused by a lack of knowledge, but others
are the result of a deliberate attempt to distort AGOA because of a lack
of belief in the benefit of trade for African governments and societies.
" Simpkins contends that "there are still many policymakers and Africa
activists who...believe any trade deal between Africans and foreigners
is inherently unfair to Africans."[^7]

Multi-lateral development agencies have also undertaken grand plans for
Africa. The World Bank, for example, spent more than \$20 billion,
between 1981 and 1991, to restructure various African economies away
from state controlled to market economies. The World Bank in 1994
identified only six "success stories" from a list of 29 "adjusting"
African economies---The Gambia, Ghana, Burkina Faso, Nigeria, Tanzania
and Zimbabwe\--a failure rate of more than 80 percent.[^8] Even then,
the shelf life of the "success stories" was trenchantly ephemeral. As
the United Nations Conference on Trade and Development (UNCTAD) noted,
"Despite many years of policy reform, barely any country in the region
has successfully completed its adjustment program with a return to
sustained growth.\"[^9]

On 15 March 1996, when the United Nations launched a \$25 billion
Special Initiative for Africa to revive development on the continent,
World Bank president James Wolfensohn gushed with enthusiasm.[^10] But
the results were no better than previous initiatives. Surveying the
history of failed international aid efforts, Stephen Thompson, a former
director at the World Bank, noted \"The infusion of cash strengthens
corrupt ruling classes and encourages the continuation of disastrous
socialist policies. Thus, the World Bank becomes, in effect, the partner
of corrupt, oppressive, often brutal regimes.\"[^11]

Over the past two decades, the record of Western aid programs to Africa
has been an abysmal failure. This was the candid conclusion reached in a
report issued in Feb 1989 by the late Alan Woods, Administrator for the
Agency for International Development (AID). Noting that the United
States had provided some \$400 billion in aid to the developing world,
he regretted that no country that had received U.S. aid in the past
twenty years has graduated from less-developed to developed status.
Worse, \"only a handful of countries that started receiving US
assistance in the 1950s and 1960s has ever graduated from dependent
status.\"[^12]

# 

-   
-   
-   
-   

C. FIGHTING HIV/AIDS : WHAT WORKS, WHAT DOESN'T

An effective strategy for fighting HIV/AIDS in Africa must be based on a
clear understanding of the roots of the pandemic. AIDS is a highly
contagious disease contracted through unprotected sex and intravenous
drug use with contaminated needles. A variety of cultural, economic,
social, and political factors contribute to the rapid spread of the
disease in the continent. Because the disease has no known cure, an
intense controversy has erupted over where limited resources and
combative efforts must be focused: on the therapeutic or treatment side
(by providing access to cheaper treatment drugs) or the preventive side
(preventing the spread of the disease and lowering the infection rate).
While the debate rages, AIDS patients continue to suffer. This is the
real tragedy or scandal of the AIDS pandemic in Africa.

The controversy over how best to fight the disease came to a head at the
June 25, 2001 United Nations AIDS Conference in New York. Insisting that
the typical anti-retroviral AIDS drug cocktail cost of \$10,000 to
\$15,000 a year is beyond the reach of poor Africans, AIDS activists and
NGOs have excoriated the pharmaceutical industry for putting profits
ahead of saving human lives. African leaders, for their part, came to
the UN AIDS conference to berate the international community for
negligence, and to badger the West for more funds to fight the disease.
These same African leaders never spoke of their own culpability or
criminal irresponsibility in the spread of the disease.

In fact, cheaper drugs -- or financial assistance to buy expensive drugs
-- are only one set of policy options in a complex menu of strategies
required to combat the disease. Delivering affordable anti-retroviral
drugs to the infected population in Africa is important, but since the
disease has no cure, effective AIDS-education and prevention programs
ought to occupy center stage. Further, health care delivery systems have
collapsed in many African countries -- as has the infrastructure of
roads, electricity, water, communications and other basic requirements
necessary to provide an effective response to the epidemic.

A frustrated Rev. Jesse Jackson captured the nature of the problem in an
interview with *Washington Post* columnist William Raspberry. \"Even if
today you landed a 747 full of free AIDS medicine in every sub-Saharan
country in Africa," Jackson explained, "you might get the plane
unloaded, but there wouldn\'t be sufficient roads and bridges and trucks
to get the medicine where it needs to go." Then, even if you were able
to deliver medications to AIDS sufferers in rural areas, "AIDS treatment
requires 20, 30 or 40 pills a day, and there might not be drinkable
water to take them. Some of the drugs are supposed to be taken so long
before or after a meal, or with milk. But sometimes there is no milk --
and occasionally no meal.\"[^13]

Drug treatment might not be the best place to expend scarce resources,
and a poorly coordinated plan to distribute anti-AIDS medicine could
actually exacerbate the problem. African experts have warned that unless
public health systems are strengthened, the benefits of cheaper AIDS
drugs could be undone by ineffective distribution or misuse, leading to
the development of new strains of drug-resistant viruses. At a meeting
in Kampala, Uganda in 2000, Peter Mugyenyi, director of the Joint
Clinical Research Center in Kampala, cautioned that the sudden promise
of more readily available drugs added urgency to the problem of poor
health care systems. At another African meeting on AIDS in the Nigerian
capital, Abuja, in April 2000, Arthur C.I. Mbanefo, Nigeria\'s
ambassador to the United Nations, warned that, \"Since the drugs we are
talking about are not curative drugs, it is most important that people
continue to focus on preventing the infection.\"[^14]

Mbanefo also said there was great opportunity for corruption in making,
selling or distributing AIDS drugs. Other Nigerian experts say that
studies have found that over-the-counter sales of medications to the
poor are often fraudulent or substandard. Even the South African
government now admits that the health system must be upgraded, before
the drugs -- at lower prices -- can be safely distributed in the public
hospitals. In short, to provide financial assistance without also
addressing underlying problems of infrastructure is a recipe for
disaster.

In addition, the potential for graft and corruption has been extremely
high. As the death toll from AIDS mounts and more money arrives from
overseas to combat the disease, all sorts of shady characters,
unscrupulous and fly-by-night operators have suddenly sprouted to pimp
on the misery. \"Across Africa, fake AIDS charities, which often lack
offices or phones, have sprung up. Experts say the impostors illustrate
that while money is desperately needed to fight AIDS, so are programs to
combat corruption and stimulate African economies\" (*The New York
Times*, July 10, 2003; p.A8).

In Kenya, for example, about 800 \"organizations\" received funds to
fight AIDS in 2002. One such organization was the Neema Children\'s
Center, whose work to was help AIDS orphans, who number about 1 million
in Kenya and are mostly abandoned. Neema, which means blessing in
Swahili, won about \$14,000 after a slick grant proposal to the
government. Money to fight AIDS came from a World Bank grant intended to
finance grass-roots work on AIDS. However, the Kenya National AIDS
Control Council, which co-ordinates the governments anti-AIDS campaign,
cut off funds to Neem after its auditors failed to find a single orphan
who had benefited from its work. \"We could not identify any orphan who
received anything,\" said Kassim Mambo, a spokesman for the control
council (*The New York Times*, July 10, 2003; p.A8).\"We couldn\'t find
anyone who worked for Neema either.\"

Though the Kenya\'s AIDS oversight body subsequently stopped financing
three more such groups, none of the organizers were apprehended. Ten
more were placed under investigation and the government suspended
several hundred more nongovernmental organizations that did not properly
document their spending, of which several dozen of the suspended groups
focused on AIDS (*The New York Times*, July 10, 2003; p.A8). But the
irony was, the Kenya National AIDS Control Council, which was supposed
to audit and control the unscrupulous operators, \"was itself accused of
mishandling funds marked for the disease. The anticorruption unit of the
Kenya police investigated the group to determine whether it misspent
\$250,000 during the observance of World AIDS Day in 2001\" (*The New
York Times*, July 10, 2003; p.A8). Wonders never cease in Africa \--
like when despots pompously announce the establishment of a \"peer
review mechanism\" whereby tyrants will stand in judgment of other
tyrants rule and crush their people.

D. CRIMINAL IRRESPONSIBILITY OF AFRICAN GOVERNMENTS

Beyond the practical impediments and potential risks of an ineffective
drug treatment strategy, the nearly exclusive focus on the cost of
anti-AIDS drugs sidesteps the culpability of African leaders and
governments in the spread of the disease. President Bush\'s initiative
will only work if African governments are serious about tackling the
AIDS epidemic, and are willing to undertake their own domestic
initiatives to combat the disease. Absent meaningful reform, the Bush
initiative will induce another cycle of aid dependency.

At a Cairo Forum in May 2001, UNICEF\'s regional director for East and
Southern Africa, Urban Jousson suggested that current African leaders be
made to answer for their failure to adequately address the HIV/ AIDS
pandemic. He expressed fears that most of the \"millions of dollars now
being promised to fight AIDS in Africa would go into the pockets of
leaders and members of national AIDS committees if adequate control
measures were not immediately taken.\"[^15]

When the AIDS epidemic first erupted, African government officials
dismissed AIDS as a racist conspiracy plot, invented by the West. \"For
a long time, we have been in denial." said Mary Kanya, Swaziland\'s
ambassador to the United States. "We looked at AIDS as a foreign
problem, involving white people, foreign people.\"[^16] Then President
Thabo Mbeki of South Africa added more confusion by claiming in 1999
that HIV does not cause AIDS but rather poverty and other socio-economic
factors -- a position he has since abandoned.[^17] Meanwhile some other
African leaders continue to cling to the misguided notion that AIDS is a
disease of the homosexual community, prompting a wave of public attacks
on gays. For example, Sam Nujoma of Namibia has announced that his
government would immediately deport homosexuals who try to enter the
country through Hosea Kutako International Airport.[^18] For his part,
Robert Mugabe of Zimbabwe has also lashed out at the homosexual
community.

**Former President Frederick Chiluba \"denied the reality of AIDS and
threw obstacles in the way of those keen to confront it.\"**[^19]

Only a few African countries have made serious efforts to confront the
AIDS epidemic. Senegal, for example, has managed to hold its infection
rate below 2 percent of the adult population. Senegal\'s success has
been attributed to cultural norms that promote responsible sexual
behavior (pre-marital sex is discouraged), comprehensive strategic
approaches to controlling the epidemic and commitment from Senegalese
authorities. Among the approaches taken by Senegal are the following:

a.  Creation of a safe national blood supply system through systematic
    testing to prevent the transmission of HIV through blood
    transfusion;

b.  Registration and regular medical check-up of commercial sex workers,

c.  Promotion of condom use,

d.  Comprehensive information, education, and communication programs
    through NGOs, as well as mass media campaigns and massive production
    of information material, and

e.  Active involvement of community, political and religious
    leaders.[^20]

Ghana\'s Ministry of Health launched the female condom program in May
2000, ordering a million of them, after extensive strategic planning
with the Joint United Nations Program on HIV/AIDS (UNAIDS), the United
Nations Population Fund (UNFPA), the Ghana Social Marketing Foundation,
the Society for Women and AIDS in Africa (SWAA) and the Female Health
Company. The Ghana Chapter of SWAA has played a particularly important
role in helping to mobilize local women\'s organizations and community
groups to educate Ghanians about the importance of safer sex.

Uganda, through intensive public education, condom distribution,
voluntary testing and counseling services, dramatically cut its
infection rate. Its \"ABCD\" prevention program \-- Abstinence, Be
faithful, and only then, Condoms or Die \-- reduced HIV infection rates
in Uganda from 30 percent in 1990 to 6.1 percent since 2001. Although
Uganda\'s miracle is somewhat exaggerated, President Museveni deserves
credit. He got personally involved in the AIDS awareness campaign. He
spoke endlessly about the dangers of unsafe sex and opened the radio
waves to frank talk about safe sex. Shops were stocked with condoms. In
addition, he introduced the campaign to schools and encouraged religious
leaders to play an active role.

However, despite the alarming spread of the disease, African leaders
continue to spend scarce resources on the procurement of arms to repress
the people and to prosecute senseless civil wars. Each year, African
governments spend more than \$8 billion on the purchase of weapons and
maintenance of the military. At least 14 conflicts currently rage on the
continent. Africa is home to more than half of the world\'s refugee
population, about 12 million people, including those internally
displaced. The refugees, in turn, serve as easy targets for sexual
predators and become fertile breeding grounds for the HIV virus. West
African peacekeeping soldiers fathered some 25,000 children by Liberian
women. These children were then abandoned.[^21]

Even in those countries at peace, government priorities are grotesquely
mis-aligned. South Africa, for example, faces the fastest-growing AIDS
crisis in Africa: 1,600 people contract HIV every day and within five
years more than 6 million of its 40 million people will have the virus.
Morna Cornell of the Johannesburg-based AIDS Consortium, a clearing
house for organizations fighting the epidemic, estimates that in the
next 5 to 10 years, 3.5 million South Africans \-- or 10 percent of the
current population \-- will die of AIDS.[^22]

**E.** **SOUTH AFRICA\'S LACK OF LEADERSHIP**

In the fight against AIDS, South Africa has played a rather perplexing
and confusing role. It is the one country, of all those in sub-Saharan
Africa, which is best equipped to deal with the AIDS crisis. It is
relatively more developed and has the infrastructure and health-care
delivery systems. It is also the country that won a landmark court case
against the pharmaceutical industry to provide cheaper versions of
patented anti-retroviral drugs to AIDS sufferers. Yet its government has
grievously mismanaged the campaign against AIDS and failed to provide
coherent or effective leadership. Its public pronouncements hardly match
its commitment to an AIDS campaign, riven with self-doubt and policy
flip-flops. The governing party, the African National Congress (ANC),
has come under withering criticism from even its own former allies in
the anti-apartheid struggle.

Back in 1997, with its infection rate rising rapidly, South Africa
passed *The Medicines and Related Substances Control Amendment Act 90 of
1997.* The act was aimed at allowing local manufacturing of medications
to avoid dependency upon multinational pharmaceutical companies. The law
was never enforced. During 1997 and 1998, the South African Health
Department argued that Section 15C of the Act was intended purely to
enable the South African Government to "occasionally parallel import" a
product that they believed might be overpriced in South Africa. In
January 1999, speaking at the World Health Organization Executive Board
meeting, the South African delegation announced that Section 15C was
"model legislation designed to allow for compulsory licensing and
parallel trade."[^23] At that meeting the South African representative
also encouraged other developing countries to follow the South African
example to increase access to medicine.

In 1999, South Africa\'s government passed legislation to allow local
drug companies to manufacture or import cheap, generic substitutes for
patented AIDS drugs. Cipla, an Indian manufacturer of generic medicines,
sought permission under the law to sell inexpensive knockoff versions of
8 of the 15 anti-H.I.V. drugs that, in varying combinations, are used in
the cocktails for an AIDS regimen at a cost of \$600 per patient per
year. Believing their intellectual property rights were under assault,
39 foreign drug companies brought a lawsuit in March 2001 to challenge
the constitutionality of South Africa\'s law. AIDS activists sided the
South African government.

The suit alleged that South Africa\'s law gave the health minister power
to arbitrarily ignore patents and violate the drug companies\' legal
rights. The Pharmaceutical Manufacturer's Association (P*h*rma) argued
that any infringement of intellectual property rights, as enshrined in
international trade agreements, would discourage foreign investment, as
well as research and development in new medicines. Further, compulsory
licensing and parallel trade have not proven to be effective tools in
increasing access to medicine and health care in developing countries.
In Africa, for example, most countries have no patent protection. Yet
access to a reliable, sustainable and affordable supply of quality
medicine is abysmal. For these countries -- where pirate medicine,
counterfeits and no-name generics are the order of the day -- the
absence of patent protection has exposed these populations to
substandard medicines while robbing their economies of investment,
technology-transfer and general economic development.

P*h*rma further argued that the pharmaceutical industry in South Africa
has always pursued tiered-pricing, offering the South African government
exceptional preferential prices \-- at prices one-tenth of those charged
to the private sector. But despite having access to cheap, high quality
medicines, the South African government loses about 50 percent of all
its stock to theft, fraud and mismanagement at government
facilities.[^24] Pharmaceutical Manufacturers' of South Africa, in a
joint effort with the Department of Health offered well-researched
solutions to curb theft but these proposals were never acted upon by the
Minister of Health.

Nonetheless, under intense public relations pressure, the drug companies
dropped their court challenge on April 19, 2001, to the jubilation of
AIDS activists and the South African government. Subsequently in May,
2001 and at the urging of WHO, Merck and Bristol-Myers Squibb of the
United States; Boehringer Ingelheim of Germany; GlaxoSmithKline of
Britain; and Hoffman-LaRoche of Switzerland --- offered to sell their
AIDS drugs to poor nations at lower prices. The German drug
manufacturer, Boehringer Ingelheim, offered free supplies of nevirapene
to developing countries. Nevirapine is administered to infected pregnant
mothers and their newborns to prevent the spread of HIV to babies during
labor, when much of the HIV transmission could occur. Studies show it
can reduce transmission of HIV by up to 50 percent. But South Africa was
reluctant to take the company up on the offer, insisting on limiting its
use to a handful of public hospitals, and only slowly introducing 18
prenatal pilot projects. The ambivalence was particularly perplexing,
coming so soon after the government had ostensibly \"defeated\" the
pharmaceutical firms in a celebrated court case presumed to strengthen
poor nations\' capacity to make cheap, generic versions of patented AIDS
medicines.

In December 2001, a high court judge ruled that South Africa must begin
a nationwide nevirapine program, making the drug immediately available
at health institutions with the capacity to administer it. But the
government appealed the ruling, saying the drug should be tested before
it is distributed beyond the government\'s pilot programs. Nevirapine is
still prescribed legally in the United States but officials at South
Africa\'s Food and Drug Administration raised questions about
\"procedural\" problems with the data from the drug trial in Uganda,
which was completed in 1999.

On April 4, 2002, South Africa\'s Constitutional Court upheld the
December ruling, forcing the government to make the drug immediately
available. Even then, the government cautioned that the drug would not
be made universally available. \"The order of the court specifically
points out that government is not required to undertake \'the whole
extension\' of the nevirapine program,\" Health Minister Manto
Tshabalala-Msimang said in a statement. \"What we are expected to do is
to enable the drug to be prescribed to HIV-positive pregnant women and
their babies.\"[^25]

The South African government\'s often-confusing approach to the AIDS
crisis and doubts about the safety and effectiveness of anti-retroviral
drugs constitute serious impediments in the fight against the deadly
disease. Rather than look to the government for leadership, companies
are initiating their own anti-AIDS programs. Anglo-American, South
Africa\'s largest mining company, estimates that one quarter of its
work-force is HIV-positive. It made an expensive commitment to provide
free anti-retroviral drugs to those workers with AIDS-related diseases.
Brian Brink, the director of Anglo-American\'s AIDS policy, describes
the initial responses to the offer as encouraging, with patients now
willing to talk about AIDS, instead of hiding it away. \"It\'s a
complete transformation in attitude,\" he said.[^26] It may be noted
that when Anglo-American first started this program, South African
Minister of Health Dr. Manto Tshabalala-Msimang objected, saying that
the wives of many employees lived in inaccessible villages, and many
\"do not understand the importance of completing a course of drug
therapy. People don\'t have watches.\"[^27]

In 1998, despite a rapidly rising infection rate, South Africa\'s
government allocated a miserly \$13 million to AIDS-related education
and care programs over the five year period (1999-2004). Only after
intense pressure from domestic AIDS activists and provincial
governments, did the South African government allocate about \$100
million in new spending on conventional AIDS programs in 2002. For
2003-04, government set aside R1.952billion (\$253.76 million) for
HIV/AIDS, but the funds are persistently under-spent. For example, about
R1.1billion (\$143 million) is channeled to provinces to be spent at the
provinces\' discretion; the remaining R666 million (\$86.58 million) is
allocated to the provinces in the form of conditional grants \-- used
only for the purpose specified in the grant. But research by the
democracy lobby, Idasa, into spending on HIV/AIDS conditional grants for
2001-02 showed that 23 percent of the budget had not been spent. The
unspent funds were not rolled over into the next year\'s budget. Idasa
researcher Nhlanhla Ndlovu said provincial officials gave conflicting
explanations for the under-spending. Provincial treasury staff said the
problem was lack of management skills in provincial health, education
and social welfare departments. But department officials said it was the
rigidity of the conditional grants themselves that made spending
difficult.[^28] Even then, much of the government's new spending comes
too late to save the hundreds of thousands who have already died, or who
have already contracted the disease.

More problematic was the government\'s system of national priorities. In
November 1999, the ANC government announced plans to buy \$5.5 billion
worth of warships, fighter planes and other weapons. Critics raised
questions about the wisdom of such a large expenditure when more than a
third of the work force is jobless, and the white-minority government
left behind dysfunctional schools, an inadequate health care
infrastructure, understaffed police departments, and little public
transportation. Allegations of criminal wrongdoing in the award of the
defense contracts -- of bribes offered and paid, and of government
ministers and negotiators funneling contracts to companies in which they
had an interest -- surfaced when an opposition lawmaker, Patricia de
Lille, claimed she had evidence that some ANC politicians had taken
bribes from defense contractors. That was followed by media reports that
the government\'s chief negotiator, Shamin Shaik, and former defense
minister Joe Modise had funneled contracts to companies in which they
had interests or were owned by relatives.[^29]

President Thabo Mbeki not only rejected an independent audit but also
fired the judge, Judge William Heath, who headed the commission
responsible for such investigations. Subsequently, the head of a
parliamentary watchdog committee was removed when one of its members,
Andrew Feinstein, challenged the ANC to refrain from meddling in the
probe. All these raised still more questions about the South African
government's misplaced priorities.[^30]

To make matters worse, South African government officials issued
confusing statements about the provision of drugs to AIDS sufferers. The
confusion started in 2000 when South Africa\'s president, Thabo Mbeki,
as noted earlier, began questioning, in speeches and letters, the
efficacy of anti-retroviral drugs and the causal link between HIV and
AIDS. He emphasized the role of poverty in the spread of HIV. In 2001,
he assembled a research panel of international experts including
\"dissident\" scientists who contend that AIDS is not caused by a virus,
but a host of other factors including immune systems weakened by
substandard living conditions that are prevalent in sub-Saharan Africa.

In March 2002, Peter Mokaba, the former deputy minister of tourism, and
a senior official in the ruling ANC governing party, created a storm of
controversy by arguing that H.I.V. does not exist and cannot be spread
through sexual intercourse. "\"H.I.V.? It doesn\'t exist." Mokaba
stated, "The kind of stories that they tell that people are dying in
droves? It\'s not true. It\'s not borne out by any facts. Where the
science has not proved anything, we cannot allow our people to be guinea
pigs.\" When asked about the AIDS drugs commonly used in the West,
Mokaba replied: \"Anti-retrovirals, they\'re quite dangerous. They\'re
poison actually.\" He also asserted that the epidemic itself is a
fiction created by multinational drug companies hoping to boost their
profits by forcing poor countries to buy AIDS drugs and by financing
researchers to terrorize the public with lies about AIDS.[^31]

Apparently, the ANC\'s reservations are partly driven by deep racial
suspicions and party by concerns over the economy. During the apartheid
era, blacks were often exposed to chemical weapons and black women were
the targets of sterilization campaigns. Suspicions surfaced in 2000 when
a government spokesman accused a Cape Town relief agency that provided
anti-retrovirals to poor HIV patients of treating blacks as \"guinea
pigs\" and an ANC spokesman described the same effort as \"reminiscent
of the biological warfare of the apartheid era.\"[^32]

Although the WTO agreement on Trade Related Aspects of Intellectual
Property Rights (TRIPS) allows developing countries to suspend relevant
patents in the case of a national emergency, President Mbeki has refused
to enact the provision, which would have allowed the production of cheap
generic versions of patented anti-AIDS drugs. Business executives and
political analysts surmise that Mbeki\'s resistance stems from ANC
concerns that the emergency declaration would scare away investors and
that the resulting opportunity to purchase drugs \-- however cheaply \--
would siphon away scarce public funds.[^33] Rather than rely on the WTO
provisions for securing generic drugs, South Africa passed a law in 1997
that would allow importing them in the event of a public health crisis
\-- the law that was the subject of the March 2001 lawsuit.

Government sensitivity to offending business interests notwithstanding,
South Africa has not been able to attract much foreign investment. Since
the country\'s first democratic elections in 1994, foreign investment in
South Africa has equaled roughly \$32 per person, less than a third of
what Brazil has had over the same period; meanwhile, unemployment has
climbed to about 36 percent of the workforce.[^34] South Africa\'s
inability to attract investment is due to a wide variety of factors that
are largely legacies of apartheid, including crime, trade union
militancy and unskilled workers, as well as investors\' negative
impressions of sub-Saharan Africa as a whole, and the impact of AIDS on
the workforce.

Nonetheless, the dithering on the part of South African officials
provoked a blistering editorial from the *New York Times.* It noted that
in the global fight to provide third-world AIDS sufferers with
affordable medicine, South Africa was the staging area for many
important battles. Therefore, \"It is dismaying," the *Times* editors
complained, "to see that South Africa is still not planning to use the
effective AIDS drugs called antiretrovirals. While the health minister
has told global bodies that South Africa is open to their use, at home
she has said there are \"no plans\" for their widespread use in the
public sector. \"[^35]

AIDS activists were enraged when the Health Minister Manto
Tshabalala-Msimang advised the HIV/AIDS population to eat onions, garlic
and virgin olive oil because \"these things are affordable for South
Africans (unlike) things like (antiretrovirals) ARVs which are
not.\"[^36] Furious at the government\'s persistent refusal to provide
ARVs to all HIV-positive South Africans, AIDS activists mounted a civil
disobedience campaign on March 25, 2003. Blowing whistles, waving red
\"wanted\" posters and shouting \"Murderer\" and \"Manto go to jail\",
some 100 members of the Treatment Action Campaign (TAC) shouted down
Health Minister Tshabalala-Msimang as she tried to address a public
health conference in Cape Town.[^37] TAC accused Tshabalala-Msimang and
Minister of Trade and Industry Alec Erwin of \"culpable homicide\" over
what it claimed were 600 AIDS-related deaths in the country every day.
\"Our patience with the government is exhausted after four years of
lobbying, but we will continue this assault until the government commits
itself to a treatment plan for all,\" TAC National Manager Nathan Geffen
said.[^38] But the government still maintains that the cost of
anti-retroviral drugs remains high and the cost of essential tests to
monitor those on therapy is also considerable.

As officials dither, desperate people infected with the virus resort to
violent remedies, including child rape. In recent years, South Africa
has had one of the highest per capita rates of rape and sexual assault
in the world. About 40 percent of the more than 52,000 rape cases in
2000 involved victims under 18, and in the first six months of 2001, 20
percent of the victims were under 11. The rape explosion is fueled by a
popular myth that sex with a virgin cures AIDS.[^39]

According to one United Nations estimate, \$200 billion or 90 percent of
the sub-Saharan part of the continent\'s gross domestic product, was
shipped to foreign banks in 1991 alone.[^40] Cash-strapped Lesotho,
buffeted by an HIV/AIDS epidemic and poverty, found the resources to
purchase luxurious Mercedes Benz E Class 240 sedans to be used by
cabinet members as official vehicles. As columnist Thabo Thakalekoala
complained:

> \"The purchase of the vehicles comes at a time when the country is
> faced with unprecedented famine, poverty, unemployment and a high
> prevalence of HIV/AIDS pandemic which need a lot of money if they are
> to be contained and controlled. Is Lesotho copying the trend of King
> Mswati III of Swaziland who wants to buy a luxurious and expensive jet
> for himself when throngs of his subjects are dying of hunger and
> HIV/AIDS?\"[^41]

This gross abuse of public trust has attracted the attention, and scorn,
of the international community. U.N. Secretary-General Kofi Annan
complained at a press conference in London in May 2000 \"Billions of
dollars of public funds continue to be stashed away by some African
leaders -- even while roads are crumbling, health systems have failed,
school children have neither books nor desks nor teachers and phones do
not work.\"[^42]

When it comes to finding money to fight disease or alleviate poverty,
African leaders are seldom willing to touch the billions of dollars they
have siphoned out of their countries and stashed in foreign bank
accounts. In a June 2002 speech before representatives of African civic
groups meeting in Addis Ababa, Ethiopia, Nigeria\'s President Olusegun
Obasanjo said \"corrupt African leaders have stolen at least \$140
billion from their people in the decades since independence.\"[^43]
Would these leaders put up a mere \$15 billion of their loot to fight
AIDS, as President Bush has promised to do?

# F. A BETTER WAY TO ADDRESS THE CRISIS

Experts recognize that huge sums of money will have little impact on
stemming the AIDS epidemic until African nations build up their public
health systems to administer the drugs, monitor the health of those
receiving them, and mount an effective prevention campaign through the
media. Today the formal public health care system reaches only 10 to 20
percent of the people in Africa.[^44]

Public health infrastructure is the responsibility of ministries of
public health, but despite billions of donor funds pumped into these
ministries over the past decades, the infrastructure is in shambles. The
WHO Report 2000 described these ministries as having \"a reputation for
being the most bureaucratic and least efficiently managed institutions
in the public sector. They are often fragmented by many vertical
programs which run as virtual fiefdoms.\"[^45] Rehabilitation of the
public system often assumes there was an infrastructure to begin with
\-- an assumption that is unwarranted, given that formal health care has
increasingly fallen on private and church-related providers.

Treatment of AIDS patients falls into the category of chronic disease
care and management, which requires a clinical mix of skills ranging
from pulmonary medicine, radiology, endocrinology, virology to
pharmacology, and everything in between. These skills are woefully
lacking in African public health systems. Some of these skills can be
found within the ministries of higher education, medical schools,
teaching hospitals, the professional medical societies and private
providers. Unfortunately, these institutions receive little or no donor
funding. Until they do, the global war on AIDS will make little progress
in Africa.

Also largely ignored are the traditional healers who provide primary
health care for nearly 80 percent of Africa\'s population. These men and
women live in the communities where help is most needed, and they treat
many patients with HIV/AIDS-related diseases. A World Bank report found
that the majority of Ethiopians \"depend on medicinal plants as their
only source of health care.\"[^46] In Uganda, about 80 percent of the
population rely on traditional medicine. The World Health Organization
pointed out that \"western-trained medical personnel are limited or not
really accepted by the community"; most Ugandans are more comfortable
consulting with traditional healers who live in the same
community.\"[^47] There is at least one traditional healer for nearly
290 Ugandans compared to one Western-trained medical practitioner for
every 10,000 people in the urban areas, and one for every 50,000 people
in the rural areas.[^48] Similar ratios prevail in other African
countries. Zambia, where an estimated 20-25 percent of the population of
10 million is HIV-positive, has only 900 Western-trained doctors (600 of
whom are foreign) but has 40,000 registered traditional healers. Ghana
has 1,200 Western-educated doctors, but an estimated 50,000 traditional
healers, for a population of 20 million, 5 percent of whom are
HIV-positive.[^49] Consequently, a World Bank study published in 2001
concluded \"given the central cultural role of traditional healers in
African communities, they provide one of the best hopes for treating and
stemming the spread of AIDS.\"[^50]

While traditional medicine is yet to be scientifically validated, its
critical role in the war on HIV/AIDS is now being recognized. A separate
World Bank study published in 2001 notes: \"Some healers have already
been successful in extending the lives of patients with HIV/AIDS using
medicines they produce from locally grown medicinal plants.\"[^51]
Contrary to Western misconceptions, traditional healers are not
predatory, operating on an \"outcome-contingent contract\" whereby they
\"receive the bulk of they payment only if the patient is cured.\"[^52]
However, they face enormous difficulties, least of which is acceptance
and recognition by modern medical practitioners.

The notion of traditional healers as \"witch doctors\" practicing quack
medicine remains pervasive, despite the fact that many pharmaceutical
products are derived from plants. Other impediments cited for the
failure to incorporate traditional medicine in the treatment of HIV/AIDS
include poor documentation, lack of standardization, and the absence of
regulatory mechanisms. Further, traditional healers rely on medicinal
plants, whose supply has been decreasing due to deforestation,
overgrazing, and droughts. In the long run, however, the health
infrastructure provided by the traditional healers and their
organizations could provide the distribution network for AIDS medicines.
Simple economics suggests that upgrading the knowledge of traditional
healers would be less expensive than expanding the formal public health
care system, and would likely be more sustainable over the long
term.[^53] Furthermore, the stark reality of the high cost and scarcity
of essential drugs, including anti-retroviral drugs, means that most
Africans with HIV/AIDS would seek traditional herbal treatments for
HIV-related conditions including opportunistic infections. As such,
there is an urgent need for more research into the efficacy and safety
of the traditional medicines being used by the majority of Africans, and
how these medicines can be improved and developed. As the WHO noted,
\"traditional medicine has a central role to play in combating new and
re-emerging diseases. The AIDS crisis has led an increasing number of
countries to question their priorities in health expenditures. There is
an emerging awareness that traditional health practitioners (THPs) can
play an important role in delivering an AIDS prevention message and the
literature is rapidly expanding.[^54] Recognition is also growing that
some THPs can offer treatment for opportunistic infections (OIs).\"[^55]
Since there are, at the same time, concerns about unsafe practices and a
growth in claims of traditional cures for AIDS, the WHO recommends
partnerships between the modern and traditional health sectors as a
cornerstone for building a comprehensive strategy to manage the AIDS
crisis. Nigeria has taken an important step towards addressing the
research needs in this field. The Nigerian health minister Hon. Tim
Menakaya announced on 30 March 2000 that \"the government has
significantly increased its budget for verifying HIV/AIDS cure claims,
after a recommendation by the World Bank and UNAIDS.\"[^56]

-   
-   
-   

Collaborative AIDS programs have been established in many African
countries, including Malawi, Mozambique, Uganda, Senegal, South Africa,
Swaziland, Tanzania, Zambia, and Zimbabwe. Preliminary results have been
promising.

In South Africa, for example, information sharing and educational
programs have resulted in THPs providing correct HIV/AIDS advice as well
as demonstrations of condom use. One such program trained 1,510 THPs and
it was calculated that during the first ten months of the program, some
845,600 of their clients may have been reached with AIDS/STD prevention
messages. In similar programs in Mozambique, traditional healers learned
that AIDS is transmitted by sexual contact, by blood and un-sterile
razor blades used in traditional practice. In a follow-up evaluation,
81% of those trained reported that they had promoted condom use with at
least their STD patients.[^57]

The Uganda AIDS Commission and the Joint Clinical Research Centre in
Kampala have worked with traditional healers\' in evaluating several
traditional treatments used locally for opportunistic infections (Ois).
The research has found traditional medicine to be \"better suited to the
treatment of some AIDS symptoms such as herpes zoster (HZ), chronic
diarrhea, shingles and weight loss.\"[^58] THETA has conducted
controlled clinical trials on a Ugandan herbal treatment for herpes
zoster. Comparing subjects with herbal treatments with controls using
acyclovir, the conventional treatment for HZ, both groups were found to
experience similar rates of resolution of HZ attacks. The traditional
medicine group had less super-infection and showed less keloid formation
than did subjects on acyclovir. HZ pain resolved significantly faster in
the herbal group. The investigators concluded that herbal treatment is
an important local and affordable alternative in managing HZ in HIV
infected patients in Uganda.[^59]

In Tanzania, the work of the Tanga AIDS Working Group (TAWG) has
successfully bridged the gap between ancient and modern medicine, and
has been recognized for its innovative work with traditional healers by
the British charity, OXFAM, the World Bank, and USAID. TAWG evolved from
meetings that a German physician and his Tanzanian colleagues initiated
with traditional healers near Tanga in 1990. Participants discussed how
to treat various ailments, when to refer a patient to the hospital,
public health issues, and how to cooperate with biomedical personnel. As
David Scheinman of the Tanga AIDS Working Group (TAWG) in Tanga,
Tanzania, reported:

> \"One day the subject was HIV/AIDS. When Waziri Mrisho, a 84-year-old
> healer, asked if he could try treating HIV/AIDS in-patients, the group
> agreed and Waziri treated a few confirmed HIV-positive patients with
> three plants TAWG still uses today.
>
> Biomedical personnel soon observed that patients treated with
> Waziri\'s three plants generally had improved appetites, gained
> weight, suffered from fewer and less severe opportunistic infections,
> and enjoyed improved health and well-being. The plant remedies soon
> became the hospital\'s standard HIV/AIDS treatment for patients who
> preferred herbal medicine. TAWG eventually developed a home care
> service to deliver the plant remedies to HIV/AIDS patients and their
> families.[^60]

In 1994, TAWG was officially registered with the Ministry of Home
Affairs. In February 2002, TAWG reported that its medicines had
successfully treated a number of HIV/AIDS symptoms.[^61]

Similar work with medicinal plants is showing promising results in South
Africa. A South African indigenous medicinal helps relieve the symptoms
of AIDS. The plant, *Sutherlandia Frutescens*, grows wild in the Western
Cape and in the hills of Zululand. A particular variety of the plant has
been used for centuries as a potent medicine by South Africa\'s
indigenous San people who call it \"*Insisa*\" - the one that dispels
darkness. It is used as an energy booster and a powerful
anti-depressant. Zulu *sangomas* or traditional healers know it as
\"*Unwele*\", the great medicine that was used to ward off the effects
of the devastating 1918 influenza pandemic which claimed 20 million
lives worldwide. The Tswana people know it as \"*Mukakana*\" for its
power in treating gonorrhea and syphilis, while the Afrikaners call it
the \"*Kankerbossie*\" or cancer bush, because of its properties in
treating people suffering with internal cancers and wasting.

A local company specializing in the development of indigenous plant
medicines, Phyto Nova, first started researching the bio-chemical
properties of *Sutherlandia* in 1999. A multi-disciplinary team headed
by Dr Nigel Gericke, a botanist, medical doctor and indigenous plant
specialist, found that *Sutherlandia* contained a powerful combination
of molecules which have been identified and used in the treatment of
patients with cancer, tuberculosis, diabetes, schizophrenia and clinical
depression and as an anti-retroviral agent. [^62] Phyto Nova has been
manufacturing high quality *Sutherlandia* tablets, gel and powder.

At the same time as Phyto Nova was conducting its research, one of the
country\'s most venerated traditional healers, Dr Credo Mutwa, 80, was
using *Sutherlandia* to treat Aids patients. \"I have treated people who
were told by the doctors at the hospital to \'go home and die\' and they
are still alive today, three years after they should have died. This
plant is near-miraculous, I can say that with certainty,\" he says.[^63]

Anne Hutchings, an ethno-botanist and lecturer at the University of
Zululand has been using *Sutherlandia,* together with a range of other
indigenous plant medicines, to treat Aids patients who attend the weekly
Aids clinic at Ngwelezane Hospital. She has 176 patients who all testify
that Sutherlandia has helped them to live a fuller, healthier and more
productive life. In the Northern Cape town of Kuruman, nurse and
*sangoma*, Virginia Rathele is using *Sutherlandia* at her clinic to
treat more than 300 Aids patients.

At present, one month\'s supply of Phyto Nova tablets costs a little
under \$2.50 and two months\' supply of the powder form of the
medication can be bought for under 50 cents. Phyto Nova has approached
the South African Government in a bid to persuade them to grow the plant
on a massive scale for use in public health treatment. So far they have
had no response.

A focus by African governments to improve traditional medicine would
make the health system less dependent on external sources, such as
multinational companies, and international aid institutions. Most
importantly, and in sharp contrast to the legacy of corruption, denial,
and negligence on the part of governmental leaders in Africa, various
African civic and church organizations are actively involved in AIDS
prevention and awareness programs. At a workshop, held in Nyanga and
entitled \"Responsible Reporting on HIV and AIDS\", participants
complained that the Zimbabwean government has not yet fully committed
itself to the war against HIV/Aids despite well-documented evidence of
the devastating effects of the killer disease. Isabella Matambanadzo,
the director of Zimbabwe's Women Resources Center and Network, observed
that, \"the lack of political commitment has badly exacerbated the
effects of Aids on our society.\"[^64]

Accordingly, Christians in Bulawayo have stepped up their campaign to
increase HIV/AIDS awareness among the people. For example, the Methodist
Church in Zimbabwe, in collaboration with Nhimbe Trust, a
theatre-oriented non-governmental organization has produced a stage play
called \"The Premier of Gethsemane,\" which is an interactive piece,
preaching tolerance and the de-stigmatisation of people living with
HIV/AIDS.[^65]

Similarly in Kenya, churches and other religious organizations have
stepped up campaigns against AIDS. The Methodist Church urged monogamy
to curb the HIV/Aids spread and warned of stern disciplinary action
against any church member with more than one spouse. Presiding Bishop
Stephen Kanyaru called on individuals to change their sexual behavior,
and implored the community to take care of orphans and HIV/AIDS
sufferers. While the Catholic Church called for chastity among unmarried
people and faithfulness in married couples, the Anglican Church said it
would develop a syllabus for the education institutions it sponsors to
incorporate HIV/AIDS.[^66]

In Ghana, the Centre for Moral Education (CEMED), seeks to form 60
virgins and drug-free clubs in the Ashanti Region to \"instill moral
values and discipline in the youth.\" Mr. Opoku-Agyemang Prempeh,
Executive President of the CEMED said already 20 of the clubs have been
formed in the region.[^67] In South Africa, over 150 faith leaders from
various beliefs gathered in Johannesburg on March 31, 2003 to further a
national faith-sector initiative in the fight against HIV/AIDS - \"Faith
in Action - a united response to HIV and AIDS.\" Over the past year,
HIV/AIDS consultative workshops have been held across South Africa\'s
nine provinces in order to support and strengthen the role of provincial
faith-based leaders. The faith sector can reach millions of South
Africans within their own communities and in a manner that provides
appropriate and relevant care and support services in times of crisis -
such as the current HIV/AIDS epidemic.[^68]

Led by the Lutheran Church, religious organizations in Namibia have
taken a holistic approach to fighting the AIDS pandemic. \"I am urging
every Lutheran congregation in Namibia

to form its own HIV/AIDS committee during the year 2003," said Bishop Dr
Zephania Kameeta of the Evangelical Lutheran Church in the Republic of
Namibia (ELCRN), "This is the only way we can implement our programme to
combat the AIDS pandemic.\" The call was directed at more than 880,000
members of the Lutheran Church, who make up almost 50 percent of the
country\'s population. With an HIV prevalence rate of 22.3 percent among
its population, and with over 80,000 orphaned children, Namibia is one
of the countries in southern Africa most affected by the AIDS pandemic,
alongside Botswana, Swaziland and Zimbabwe.

A major goal of the programs of the Lutheran Church in 2003 is to build
a network of village AIDS committees, among the 165 congregations in the
country. Using a holistic approach, the AIDS groups will work in three
areas, namely, home-based care, youth education, and practical and
spiritual care for the increasing number of orphaned children.

Success is possible when government works with civil society groups, or
at least does not get in the way. A significant factor in the success of
AIDS work is also ecumenical co-operation. Lutheran churches in Namibia
are founding members of the Church Alliance for Orphans (CAFO), launched
in November 2002, which unites 11 church organizations in promoting
practical care and trauma healing for orphaned children. Namibia\'s
Minister for Health and Social Welfare Dr. Libertine Amathila, speaking
in December 2002, pointed out that the rate of new infections had
stabilized or even decreased in some regions. Six of the larger towns in
Namibia reported decreases by 3 to 4 percent for the last 12 months.
According to Amathila, this had been made possible by combined education
campaigns carried out in towns by the government and civil society
groups in the past few years. Along with schools, the minister
considered churches the most important actors in the civil society since
more than 90 percent of Namibians are church members. \"Even in the most
remote parts of the country, you can find a church and worship services.
So we take our work seriously and work together at all levels,\" the
minister said.[^69]

Conclusions

The AIDS epidemic is a scourge that threatens Africa\'s future and
President Bush\'s \$15 billion Emergency AIDS Relief Plan should be
welcomed as a noble humanitarian measure. But, as with all
"humanitarian" measures financed by American taxpayers, the president is
operating under dubious Constitutional authority. The responsibility for
dealing with the pandemic falls with African leaders. Unfortunately,
Africa\'s experience with grand schemes in the past urges caution, and
suggests that well-intentioned efforts by non-Africans to solve African
problems have actually exacerbated problems in the continent.

One should be doubly cautious in placing too much faith in an initiative
to cure an epidemic as complex as AIDS. Since there is no known cure for
the disease, emotionally-wrenching decisions must be made in terms of
where to spend scarce resources: on either treatment or prevention.
Treatment requires rehabilitation of a collapsed public health care
infrastructure, which is utilized by only 20 percent Africa\'s
population. Building up the institutional capacity of public health
systems in Africa to handle chronic disease care and management is a
daunting task. Initiatives at the grass roots level offer much better
hope of providing the AIDS prevention education that can save millions
of lives across Africa.

On the vital task of slowing and then stopping the spread of AIDS, most
African governments have shamefully abdicated their
responsibility\--even the government of South Africa, which has the
capacity and the infrastructure to provide leadership in the campaign
against AIDS.

To make the campaign against AIDS more effective in Africa, the
following recommendations may be advanced:

1.  African leaders need to become more involved in the campaign by
    speaking out more publicly. The readiness with which President Bush
    spoke publicly about AIDS during his July 7-12, 2003 trip to Africa
    should prompt African leaders to do the same.

2.  Funds to fight AIDS are fungible and may need to be separated from
    general expenditures on health to prevent "disappearance,"

3.  Benchmarks may need to be established to ensure that certain
    percentages of AIDS budgets are actually spent.

4.  Civil society groups and traditional authorities need to be
    recruited. For example, traditional African chiefs, the guardians of
    indigenous cultures, need to be involved in the battle against AIDS
    especially if certain cultural practices and sexual behaviors need
    to be modified.

5.  A way has to be found to involve traditional healers since more than
    80 percent of Africans -- and AIDS sufferers -- still rely on them.
    Even if traditional medicine can be dismissed as "quackery,"
    traditional healers still need to be involved since they can greatly
    complicate the fights against AIDS. For example, the notion that
    having sex with a virgin that led to the rape of even baby girls in
    South Africa, came from the country's *sangomas* or traditional
    healers.

> Thank you.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[^1]: ^\*^ *The author, a native of Ghana, is a Distinguished Economist
    at American University and President of The Free Africa Foundation,
    both in Washington, DC. He is the author of several books on Africa
    including,* Africa Unchained: The Blueprint For Africa\'s Economic
    Development *(Palgrave, New York, 2003).*

[^2]: White House web site:
    http://www.whitehouse.gov/news/releases/2003/01/20030128-14.html -
    35.6KB)

[^3]: \"Presidential Emergency Plan for AIDS Relief,\" *USAID In
    Africa,* Spring 2003; p.12.

[^4]: United States, Department of State, Foreign Military Training and
    DoD Engagement Activities of Interest: Joint Report to Congress in
    Fiscal years 2000 and 2001, Bureau of Political-Military Affairs,
    (Washington, D.C. March, 2001)

[^5]: United States, Department of State, Department of Defense, Foreign
    Military Training and DoD

    Engagement Activities of Interest: Joint Report to Congress in
    Fiscal years 2000 and 2001, Bureau of Political-Military Affairs,
    Volume I (Washington: March 2001)
    \<http://www.state.gov/t/pm/rls/rpt/fmtrpt/2001/3121.htm\>.

[^6]: See <http://usinfo.state.gov/regional/af/acri/>

[^7]: See Gregory Simpkins, "Myths Continue to Stymie AGOA
    Implementation," posted on the web site of the Foundation for
    Democracy in Africa at <http://democracy-africa.org/7myths.htm>

[^8]: The World Bank, *Adjustment in Africa: Reforms, Results and the
    Road Ahead*. New York: Oxford

    University Press; 1994.

[^9]: UNCTAD (1998). Trade and Development Report, 1998: Financial
    Instability and Growth In Africa. New York: The United Nations,
    1998.

[^10]: UN Announces New Initiative For Africa, *African Recovery,* May
    1996; p. 13.

[^11]: Letter to the Editor, *Washington Times,* 20 June 1995, p. A18.

[^12]: Alan Woods (1989). *Development and the National Interest: US
    Economic Assistance into the 21^st^ Century*. Report by the
    Administrator, Agency for International Development, Washington, DC,
    p.112.

[^13]: \"Overreach On AIDS\" by William Raspberry in *The Washington
    Post*, March 26, 2001; p. A25

[^14]: \"AIDS Obstacles Overwhelm a Small South African Town,\" *The New
    York Times,* March 29, 2001.

[^15]: \"UNICEF official warns African leaders to address AIDS\" by Al
    Ebokem Fomenky, Panafrican News Agency, May 30, 2001.

[^16]: \"AIDS and the African,\" by Kurt Shillinger, *The Boston Globe*,
    October 10, 1999.

[^17]: \"The politics of AIDS in South Africa: beyond the
    controversies\" by Didier Fassin and Helen Schneider at
    http://bmj.com/cgi/content/full/326/7387/495?eaf

[^18]: \"Homosexuals Barred From Entering Namibia\" in *The Namibian*,
    April 6, 2001.

[^19]: When finally forced to confront reality, many African leaders
    were reluctant to talk about the disease. Initial public education
    initiatives in the early stages were half-hearted. Few governments
    enforced even existing AIDS-related laws. On the whole, prevention
    campaigns continue to lag because of the stigma attached to the
    disease. At a summit conference in 2002 of twelve African leaders in
    Dar es Salaam, Zimbabwe\'s Mugabe admitted that he found it
    difficult at first to talk publicly about condoms and sex, so he
    delegated one of his ministers to speak openly about the illness.
    Kenyan President Daniel arap Moi agonized over whether by giving
    away condoms he would be \"encouraging adultery.\"[^70] John Nyamu,
    \"Famine and AIDS: A Lethal Mixture,\" *Africa Recovery,* May 2003;
    p.12.

[^20]: \"HIV/AIDS In Senegal: A USAID BRIEF\" at
    http://www.synergyaids.com/documents.

[^21]: See, *Pan African News Agency*, 21 September 1998.

[^22]: \"AIDS and the African,\" by Kurt Shillinger, *The Boston Globe*,
    October 11, 1999.

[^23]: \"Beyond Blame: Why the Drug Companies Aren\'t Responsible for
    Africa\'s AIDS Epidemic, \" by Taylor Baines,
    [http://www.e-venthorizon.net](http://www.e-venthorizon.net/).

[^24]: \"Beyond Blame: Why the Drug Companies Aren\'t Responsible for
    Africa\'s AIDS Epidemic, \" by Taylor Baines,
    http://www.e-venthorizon.net.

[^25]: \"Court Forces Distribution of HIV Drug in SA\" by Ravi Nessman
    in *The Washington Times*, April 5, 2002; p.A12.

[^26]: \"Get On With It,\" *The Economist,* April 19, 2003; p.41).

[^27]: See *Newsday*, June 17, 2001.

[^28]: \"Lack of Skills Not Money Dogs Aids\" by Tamar Kahn in *Business
    Day* (Johannesburg). Posted to the web March 27, 2003.

[^29]: \"S. African Arms Probe Raises Political, Racial Tensions\" by
    Jon Jeter in *The Washington Post*, Feb 6, 2001; p.A13.

[^30]: On October 3, 2001, Tony Yengeni, chief parliamentary whip of the
    African National Congress (ANC) and chairman of the Parliament\'s
    committee on defense, was arrested and charged with public
    corruption, fraud, perjury and forgery. The indictment centered on
    Yengeni\'s purchase of a luxury sport utility vehicle at a steep
    discount by a defense contractor. The contractor, European
    Aeronautic Defense and Space Co., eventually won a contract to build
    radar systems as part of a \$6 billion package of weapons purchases
    made by the South African government in 2001 (*The Washington Post,*
    October 4, 2001; p.A26).

[^31]: Rachel L. Swarns, \"An AIDS Skeptic in South Africa Feeds
    Simmering Doubts\" *New York Times*, March 31, 2002, p.WK4.

[^32]: \"Political Resistance in S. Africa Blocks Wide Use of HIV Drugs
    Leaders Ambivalent About Distribution of Antiretrovirals\" by Jon
    Jeter in *The Washington Post*, October 1, 2001; p. A18.

[^33]: \"Global Issues Dog S. Africa on AIDS, Way Is Cleared for Cheaper
    Drugs But Market-Medicine Conflict Remains\" by Jon Jeter in *The
    Washington Post,* April 20, 2001; p.A1.

[^34]: ^?^ *Ibid,* \"Global Issues Dog S. Africa on AIDS, Way Is Cleared
    for Cheaper Drugs But Market-Medicine Conflict Remains\" by Jon
    Jeter in *The Washington Post,* April 20, 2001; p.A1.

[^35]: \" South Africa\'s Failure on AIDS,\"*The New York Times* , June
    21, 2001, page A24.

[^36]: \"Add Pinch of Salt to State Advert On Its Aids Policy,\" by Tim
    Trengove Jones, *Business Day*

    (Johannesburg). Posted to the web April 1, 2003.

[^37]: \"Aids Activists Shout Down Health Minister\" UN Integrated
    Regional Information Networks (IRIN). Posted to the web March 25,
    2003.

[^38]: ^?^ \"Aids Activists Shout Down Health Minister\" UN Integrated
    Regional Information Networks (IRIN). Posted to the web March 25,
    2003.

[^39]: In November 2001, a 9-month old baby girl was gang-raped and
    sodomized by six men, between 24 and 66 years old, in the small
    northern township of Louisville (*The New York Times*, Nov 16, 2001;
    p.A3).

[^40]: See *The New York Times* (4 February 1996, page 4.

[^41]: \"Government Buys Luxurious Mercedes Benz Cars for Cabinet
    Members!\" Mopheme/The Survivor (Maseru) March 26, 2003.

[^42]: \"Annan Lashes Out at African Leaders,\" *The African-American
    Observer*, April 25 -- May 1, 2000; p.10.

[^43]: \"Africa\'s leaders \'stole \$140bn\" by Basildon Peta in Addis
    Ababa, *The London Independent,* 14 June 2002.

[^44]: \"HIV/AIDS: Traditional Healers, Community Self-Assessment and
    Empowerment,\" *IK Notes*, No.37, October 2001; p.2. A publication
    of the World Bank Africa Region\'s Knowledge and Learning Center in
    partnership with communities, NGOs, development institutions and
    multilateral organizations.

[^45]: See, http://www.un/who.org.

[^46]: \"Ethiopia: Traditional Medicine and the Bridge to Better
    Health,\" *Indigenous Knowledge (IK) Notes,* No.35, August 2001;
    p.1. (A World Bank publication).

[^47]: Bannerman, R.H. Burton J & Chien Wen-Chieh (1993). *Traditional
    Medicine and Health Care Coverage.* Geneva: World Health
    Organization.

[^48]: Green, E.C. (1997). \"The participation of African traditional
    healers in AIDS/STD prevention programs,\" in *Tropical Doctor* 27:
    Supplement 1, 56-59.

[^49]: \"Indigenous Knowledge and HIV/AIDS: Ghana and Zambia,\"
    *Indigenous Knowledge (IK) Notes,* No.30, March 2001;p.2. (A World
    Bank publication).

[^50]: \"Indigenous Knowledge and HIV/AIDS: Ghana and Zambia,\"
    *Indigenous Knowledge (IK) Notes,* No.30, March 2001;p.1. (A World
    Bank publication).

[^51]: \"HIV/AIDS: Traditional Healers, Community Self-Assessment and
    Empowerment,\" *Indigenous Knowledge (IK) Notes,* No.37, March 2001;
    p.1. (A World Bank publication).

[^52]: \"African Traditional Healers: The Economics of Healing,\"
    *Indigenous Knowledge (IK) Notes,* No.32, May 2001;.p.3. (A World
    Bank publication).

[^53]: David Scheinman, \"Traditional Medicine in Tanga Today,\"
    *Indigenous Knowledge (IK) Notes,* No.51, December 2002; p.2. (A
    World Bank publication); \"Traditional Medicine and AIDS,\"
    *Indigenous Knowledge (IK) Notes,* No.26, November 2000; p.2. (A
    World Bank publication); \"HIV/AIDS: Traditional Healers, Community
    Self-Assessment and Empowerment,\" *Indigenous Knowledge (IK)
    Notes,* No.37, March 2001; p.2. (A World Bank publication).

[^54]: The following may be noted: Bodeker G (1999). Traditional (i.e.
    indigenous) and complementary medicine in the Commonwealth: new
    partnerships planned with the formal health sector. *Journal of
    Alternative & Complementary Medicine* 5 (1), 97-101; Green EC, Zokwe
    B, Dupree JD (1995). The experience of an AIDS prevention program
    focused on South African traditional healers. *Social Science and
    Medicine* 40(4), 503-515; Hewson MG (1998). Traditional healers in
    southern Africa. *Annals of Internal* *Medicine* 128(12 Pt 1),
    1029-1034; Kale R (1995). Traditional healers in South Africa: a
    parallel health care system. *British Medical Journal* 310:
    1182-1185; King R, Homsy J (1997). Involving traditional healers in
    AIDS education and counseling in sub-Saharan Africa: a review.
    *AIDS* 11 Suppl. A: S217-225; and Ndubani P, Hojer B (1999).
    Traditional healers as a source of information and advice for people
    with sexually transmitted diseases in rural Zambia. *Tropical
    Doctor* 29(1), 36-38.

[^55]: See <http://www.who.or.jp/tm/research/bkg/6_disease.html>

[^56]: WHO, \" Priority disease areas: HIV/AIDs and Malaria,\"
    <http://www.who.or.jp/tm/research/bkg/6_disease.html>

[^57]: Green, E.C. (1997). \"The participation of African traditional
    healers in AIDS/STD prevention programs,\" in *Tropical Doctor* 27:
    Supplement 1, 56-59.

[^58]: WHO, \" Priority disease areas: HIV/AIDs and Malaria,\"
    <http://www.who.or.jp/tm/research/bkg/6_disease.html>

[^59]: Bodeker G, Kabatesi D, Homsy J, King R. \"A Regional Task Force
    on Traditional Medicine and AIDS in East and Southern Africa.\" *The
    Lancet*, April 8, 2000, 355(9211):1284.

[^60]: David Scheinman, \"The Ancient and Modern Worlds Unite to Fight
    HIV/AIDS in Tanga, Tanzania,\"
    <http://www.scienceinafrica.co.za/2002/september/tanga.htm>

[^61]: David Scheinman, \"Traditional Medicine in Tanga Today,\"
    *Indigenous Knowledge (IK) Notes,* No.51, December 2002; p.4. (A
    World Bank publication).

[^62]: \"Not just a pretty plant, Medicinal plant \'fights\' Aids\" by
    Carolyn Dempster. *BBC World Service* 30 November, 2001.
    <http://news.bbc.co.uk/1/hi/world/africa/1683259.stm>.

[^63]: *Ibid,* \"Not just a pretty plant, Medicinal plant \'fights\'
    Aids\" by Carolyn Dempster. *BBC World Service* 30 November, 2001.
    <http://news.bbc.co.uk/1/hi/world/africa/1683259.stm>.

[^64]: \"Government Lacks Political Will to Fight Aids Scourge\" in *The
    Zimbabwe Standard,* (Harare). Posted to the web March 31, 2003.

[^65]: \"Play Preaches Tolerance\" by Florence Ndhlovu. *The Daily News*
    (Harare). Posted to the web April 4, 2003.

[^66]: \"Monogamy Stressed in Fight Against HIV/AIDS\" by Julius Bosire.
    *The Nation (Nairobi).* Posted to the web March 27, 2003.

[^67]: \"60 Virgin Clubs for Ashanti,\" *Accra Mail* (Accra) Posted to
    the web April 1, 2003. The virgins clubs are made of young girls who
    have not as yet broken their virginity and also opened to those who
    have engaged in sex before but have now denounced the practice and
    have decided to stay away from it until marriage. The drug-free
    clubs on the other hand, are composed of young people who were hard
    in drugs before and those who have never tasted them and now decided
    to devote their time to educating people on the dangers of hard
    drugs.

[^68]: \"Faith Leaders Gather to Coordinate HIV/Aids Activities\" by
    Veronica Mohapeloa in *BuaNews* (Pretoria). Posted to the web April
    1, 2003.

[^69]: \"Influence of the Church in Bringing About Change\" by Erika Von
    Wietersheim. *African Church*

    *Information Service.* Posted to the web March 25, 2003.