"Decades have been chopped from life expectancy and young child mortality is expected to more than double in the most severely affected countries of Africa. AIDS is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future," he said. The former South African president and African National Congress leader was addressing more than 12,000 delegates from around the world at the July 14 closing session of the conference held in the Indian Ocean port city.

Southern Africa is the epicenter of the AIDS pandemic. According to estimates published by the Joint United Nations Program on AIDS (UNAIDS), 4.2 million people are infected with HIV/AIDS in South Africa alone--the highest number of any country.

The spread of the disease in sub-Saharan Africa is fueled by the horrendous social conditions imposed on hundreds of millions of workers and peasants as a result of imperialist domination and capitalist exploitation, including the oppression of women.

Three developments stood out at the conference: the scope of the social disaster unfolding in Africa as a result of AIDS; the extortion practiced by capitalist pharmaceutical monopolies that manufacture AIDS drugs; and a controversy surrounding the views of South African president Thabo Mbeki on HIV and AIDS.  
 
Pandemic in southern Africa
According to UNAIDS estimates, by the end of last year 34.3 million people were living with HIV/AIDS worldwide, 24.5 million of them in sub-Saharan Africa.

There are now 16 countries on the continent where more than one-tenth of the adult population (aged 15-49) is infected with HIV. In seven countries below the Sahara, at least one adult in five is living with HIV. In Botswana, 35.8 percent of adults are now infected with HIV, while in South Africa, 19.9 percent are infected, up from 12.9 percent just two years ago, says UNAIDS.

By 1998, AIDS-related diseases had killed 11.5 million Africans. One consequence of this scourge is that life expectancy is dropping throughout much of the continent.

Karen Stanecki of the U.S. Census Bureau told the conference that by 2010, life expectancy is projected to fall to 29 years in Botswana, 30 years in Swaziland, and 33 years in Namibia and Zimbabwe. "These are a level of life expectancy that have not been seen since the start of the 20th century," she said.

These estimates, even given a degree of exaggeration, paint a devastating picture. They illustrate the oppressive social relations imposed by the imperialist powers on the nations of Africa.

Finance capital plunders African nations through unequal terms of trade, debt bondage, and every aspect of the normal functioning of capitalism, perpetuating the legacy of underdevelopment established through centuries of colonial pillage. World capitalist economic instability hits the continent with special force.

African nations are saddled with a foreign debt of $315 billion to banks in imperialist countries; their interest payments alone amount to $15 billion a year. As Washington, London, Berlin, Paris, and Tokyo demand budget-slashing measures to ensure payment of this tribute, already minimal services, including health care, simply collapse in growing parts of Africa.

The spread of HIV/AIDS is fostered by these conditions. Poor general health and sanitation--particularly the presence of other sexually transmitted diseases--makes it easier for people to become infected during sexual intercourse, the primary method of HIV transmission in Africa. Many people infected with HIV do not even know it due to lack of basic health care and testing. The second-class status of women makes them especially vulnerable to becoming infected with and transmitting the virus.

Once a person has HIV, their overall health, including nutrition, plays a key role in the rate at which the immune system collapses. Tuberculosis, widespread in South Africa, is one of the "opportunistic" infections that claims the lives of many people with AIDS.

There is insufficient education on HIV/AIDS and how it is transmitted. Until this is reversed, unscientific views and reactionary prejudices feed the spread of the disease. For instance, in some rural areas of South Africa there is a myth that sex with a virgin will cure AIDS in men. Even more widespread is opposition to using condoms.

Steps proposed by some governments in the region reinforce reactionary ideas on AIDS. In July, the parliament of Swaziland, where a quarter of the population is HIV-positive, declared it would ban short skirts for schoolgirls. An education ministry official said "it all starts from there," implying that men were "enticed" by young women's attire. The parliament also began debating a proposal to sterilize all HIV-positive people in the country.

As the AIDS conference opened July 9, thousands of protesters took to the streets of Durban to demand that big pharmaceutical companies make their drugs available for free or at low cost.  
 
Blood profits
In the profit calculus of the capitalist pharmaceutical monopolies, Africa is the place to win "market share" for AIDS drugs, ranging from life-prolonging agents to medications designed to prevent mother-to-child transmission of HIV.

Washington's approach to the AIDS health crisis was exemplified in its announcement in late July that $1 billion in loans would be granted, at a commercial rate of about 7 percent, through the U.S. Export-Import Bank for African governments to purchase U.S.-made AIDS medications--a boon to the drug profiteers.

The New York Times reported July 19 that "the U.S. loans could help American pharmaceutical companies prevent the spread of generic knock-offs of their profitable AIDS drugs to Africa. Even with heavy discounts of up to 80 or 90 percent...some drug makers may still hope to sell their product profitably in Africa."

"Even at 90 percent discounts," the Times article stated, "a typical cocktail of AIDS-suppressing drugs might cost $2,000 a year for a single patient in Africa, more than four times the average per capita income in many of the worst-afflicted countries."

Earlier this year, five big pharmaceutical companies announced they would "offer" HIV/AIDS drugs to African countries at a discount. However, the health-care infrastructure needed to support use of such drugs--including HIV testing, measurement of viral loads in infected individuals, and dealing with the side effects and complications associated with the medications--does not exist in sub-Saharan Africa.

An article in the July 8 New York Times reported that a study in Tanzania, Uganda, and South Africa had dashed initial hopes that newborns could avoid HIV infection with several tested drugs. "The new study, which involved 1,797 people and was the largest ever performed on the transmission of AIDS from mothers to children, followed children who were born to these mothers and found that by 18 months the initial benefit was completely lost as the infants who had been spared infection at birth later became infected through breast-feeding," the article stated.  
 
'Poverty is world's biggest killer'
At the AIDS conference, the views of South African president Mbeki became a subject of controversy.

In recent months, Mbeki has come under attack on two fronts. First, the pharmaceutical monopolies are angry that Pretoria has, for now, decided to not distribute AIDS medications such as AZT at state hospitals. The South African government has questioned the efficacy of such drugs and denounced the high price at which they are sold. Legislation passed by the ANC government also aims to allow the purchase or manufacture of generic medications, undercutting patents and profits.

Second, Mbeki has allegedly questioned the link beween HIV and AIDS. The main source of this assertion in the big-business press was the fact that he had invited a number of scientists who reject the view that HIV leads to AIDS to participate in an advisory panel discussing ways to combat the disease.

South African health minister Manto Tshabalala-Msimang emphasized during a press briefing at the Durban conference that "the president of this country has never denied either the existence of AIDS nor the causal connection between HIV and AIDS."

Opening the conference, Mbeki told delegates that "the world's biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty."

He stated, "Some in our common world consider the questions I and the rest of our government have raised around the HIV/AIDS issue...as akin to grave criminal and genocidal misconduct. What I hear being said repeatedly, stridently, angrily, is--do not ask any questions!"

Mbeki said there was a generalized health crisis on the continent. "One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defense against attack by many viruses and bacteria. As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus."

While the government waited for the advisory panel's conclusions, he said, it would continue to expand its anti-AIDS program.

Mbeki's speech failed to satisfy many delegates. Few had an argument with the connection between wretched social conditions and AIDS. But many expressed concern that a lack of clarity and focus would undercut popular understanding of the spread of HIV and AIDS in a country where the infection rate is estimated by UNAIDS to be one of the fastest in the world.

Phil Wilson of the African-American AIDS Initiative was quoted by Reuters as saying, "The house is on fire and Mbeki is sitting around trying to decide whether it was started by a lighter or a match. He talks about a plan. He doesn't talk about action. This should have been a call to action."

Conference chairperson Hoosen Coovadia, a South African doctor, said, "What I'm sensing from people is an absolute sense of disappointment. Many people believe that the president would use the occasion to try and quell some of the disquiet around government's position on HIV/AIDS."

It is hard to tell, however, where such criticisms begin to meld with the campaign led by pharmaceutical companies against South Africa's stance on AIDS drugs. The drug monopolies themselves were among the principal sponsors of the conference. The Washington Post, which has campaigned against the South African government's AIDS stance, gave an internet story the tendentious headline "Hundreds walk out on Mbeki."  
 
Mandela: 'People want action'
By the end of the conference, as the controversy over Mbeki's speech reached almost fever pitch, Nelson Mandela stepped in with a clear, forceful message.

"It is never my custom to use words lightly," he said. "If 27 years in prison have done anything to us, it was to use the silence of solitude to make us understand how precious words are and how real speech is in its impact upon the way people live and die.

"If by way of introduction I stress the importance of the way we speak, it is also because so much unnecessary attention around this conference has been directed towards a dispute that is unintentionally distracting from the real life-and-death issues we are confronted with," Mandela stated.

"I do not know nearly enough about science and its methodologies or about the politics of science and scientific practice to even wish to start contributing to the debate that has been raging on the perimeters of this conference. I am, however, old enough and have gone through sufficient conflicts and disputes in my lifetime to know that in all disputes a point is arrived at which no party, no matter how right or wrong it might have been at the start of that dispute, will any longer be totally in the right or totally in the wrong. Such a point, I believe, has been reached in this debate....

"Now, however, the ordinary people of the continent and the world--and particularly the poor who on our continent will again carry a disproportionate burden of this scourge--would, if anybody cared to ask their opinion, wish that the dispute about the primacy of politics or science be put on the back burner and that we proceed to address the needs and concerns of those suffering and dying."

The South African leader insisted, "We have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now.... Something must be done as a matter of the greatest urgency. And with nearly two decades of dealing with the epidemic, we now do have some experience of what works.

"The experience in a number of countries has taught that HIV infection can be prevented through investing in information and life-skills development for young people. Promoting abstinence, safe sex, and the use of condoms and ensuring the early treatment of sexually transmitted diseases are some of the steps needed and about which there can be no dispute.

"Ensuring that people, especially the young, have access to voluntary and confidential HIV counseling and testing services and introducing measures to reduce mother-to-child transmission have been proven to be essential in the fight against AIDS. We have recognized the importance of addressing the stigmatization and discrimination, and of providing safe and supportive environments for people affected by HIV/AIDS," Mandela said.