Haiti struggles to deal with major cholera outbreak

Haiti’s capital Port-au-Prince is bracing itself for an outbreak of cholera as the disease which has killed 200 in the countryside makes itself known in the city. The five confirmed cases in the capital are among more than 2,000 people who were infected in an outbreak mostly centred in the Artibonite region north of Port-au-Prince. At least 208 people have died with that figure likely to rise in the country’s first outbreak of cholera since 1960. The outbreak is the latest disaster to hit the poverty-stricken country still struggling to recover from the devastating 7.0 earthquake which left much of the country in ruins last January. (photo: David Darg)

Medecins San Frontieres sent assessment teams to the Artibonite region including the coastal town of St Marc, 70km north of Port-au-Prince. MSF said St Marc’s hospital was becoming overcrowded and does not have the capacity to handle a cholera epidemic. MSF staff are giving patients an oral rehydration solution to replace fluids lost from diarrhoea and vomiting symptoms of a cholera infection. Patients too sick to drink the ORS are given infusions intravenously. “The most important thing is to isolate the cholera patients there from the rest of the patients, in order to best treat those people who are infected and to prevent further spread of the disease,” the local MSF coordinator said. “This will also enable the hospital to run as normally as possible. We are setting up a separate, isolated cholera treatment centre now."

David Darg, of the US-based Operation Blessing International, drove the two hours from Port-au-Prince to find a “horror scene” at St Marc hospital. Darg said he had to fight his way through the gate through crowds of distressed relatives while others carried dying relatives into the compound. “Some children were screaming and writhing in agony, others were motionless with their eyes rolled back into their heads as doctors and nursing staff searched desperately for a vein to give them an IV,” he said. “The hospital was overwhelmed, apparently caught out suddenly by one of the fastest killers there is.”

Cholera is an acute intestinal infection caused by bacteria carried in human faeces and can be transmitted by water, some foodstuffs and, more rarely, from person to person. The main symptoms are watery diarrhoea and vomiting, which lead to severe dehydration and rapid death if not treated promptly. According to the World Health Organisation, there are an estimated three to five million cholera cases every year causing between 100,000 to 120,000 deaths. The WHO is worried about the emergence of a new and more virulent strain of cholera that now predominates in parts of Africa and Asia, as well as the unpredictable emergence and spread of antibiotic-resistant strains. And because brackish water and estuaries are natural reservoirs of this strain, cholera could increase where there are rising sea levels and increases in water temperatures.

While it is too early to tell what is causing the Haitian outbreak, conditions in the IDP camps remain primitive and conditions were ripe for disease to strike in areas with limited access to clean water. 230,000 people died in the quake. 1.2 million people were displaced as of August 2010 and a further 1.8 million are affected. According to a post-earthquake fact sheet produced by USAID, the majority of IDPs in Artibonite are “residing with host families, straining resources and creating housing space issues for both groups.” It noted deficiencies in disease reporting processes. As well there has been a mass migration of 120,000 people from Artibonite to Port-au-Prince in search of a better life.

So far there has been no reports of cholera in the camps, but if it does a public health crisis could be imminent. "It will be very, very dangerous," Claude Surena, president of the Haitian Medical Association, said. "Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already. Clearly a lot more needs to be done."

Hopes for Tasmanian Devil Deadly Facial Tumour Disease cure

Hopes for a cure of the deadly facial tumour disease (DFTD) in Tasmanian Devils have grown with the breakthrough that scientists have discovered its genetic code. DFTD is a highly contagious mouth cancer unique to Tasmanian devils passed on during sex and fights. The tumour quickly spreads on the face and down to internal organs, killing the devil within nine weeks. The mysterious disease has threatened the species with extinction within 35 years. However the new discovery of the genetic composition allows scientists to develop a diagnostic test for it. The Australian and overseas-based research team hopes to be able to develop not just vaccines, but therapies as well.

University of Tasmania researchers earlier last year developed a pre-diagnostic test similar to a Prostate Specific Antigen (PSA) test in the detection of human prostate cancer but has not yet been scientifically validated. A diagnostic test builds on the earlier work and will be more conclusive. Scientist Greg Woods from the Hobart-based Menzies Research Institute said the identification of the nerve-protection called Schwann cells as the likely origin of DFTD was a significant step. "We are now much more confident in understanding what the tumour cell is and this will help in the development of treatments and strategies to combat this disease," he told The Australian.

DFTD is a new disease. Not a single case was found in any animal captured by wildlife biologists up to 1995. It was first diagnosed in 1996 when devils with large facial tumours started appearing. Small lumps around the mouth quickly develop into large tumours on the face and neck making it difficult for the animal to eat. If they don’t die first of starvation, the cancer kills the infected animal within nine weeks. By the end of 2009 DFTD had laid waste to 60 percent of the total devil population. In the north-east region, where signs of the disease were first reported, there has been a 95 percent decline of sightings of the animal in the decade from 1995 to 2005.

Scientists initially thought DFTD was a virus but realised it was a cancer after they compared the DNA from sick and healthy devils. They discovered that a single nerve cell gene from one devil created the disease cells and then spread to many other animals. Analyses of these cell genes and gene activity patterns indicated that the tumor cells most closely matched Schwann cells, a type of cell that forms a waxy sheath called myelin around nerve fibres.

The researchers say a protein called periaxin normally found only in Schwann cells is also present in devil facial tumor cells and might be a good diagnostic marker for the disease, the researchers report. They still don’t know how the cancerous Schwann cells became contagious in the first place. Katherine Belov, a geneticist at the University of Sydney, believes it may simply be a “freak of nature” that allowed the cancer to be stable and transmitted.

Whatever it was, its effects have been catastrophic among devil populations. In May 2009, the Australian Government raised the Tasmanian devil from “Vulnerable” to “Endangered” under national environmental law. Tasmania’s Threatened Species Act 1995 has also listed the devil as “Endangered” since May 2008. By the end of 2008, the disease had been confirmed at 64 locations, covering more than 60 percent of Tasmania. The Tasmanian government has launched a Save the Tasmanian Devil Program aimed at maintaining genetic diversity, maintaining healthy populations in the wild and managing the ecological impacts of reduced populations.

It is usually uncommon for wildlife diseases to lead directly to population extinction in the absence of other severe threats. But ominously, there had not been any evidence of a single recovery from the disease. There are fears that niches left vacant by the large carnivorous marsupial will be taken up by introduced species such as feral cats and foxes. If this occurs there could be a wider impact on Tasmania's unique wildlife. The new scientific findings represent the best hope to save the devil. It may take ten years to produce a vaccine against the disease but that will probably be enough time not only to save the animal from extinction but also avoid tipping the island into a major ecological collapse.

Outbreak of deadly Marburg virus in Uganda

(cc photo by Shek Graham) The World Health Organisation (WHO) has warned people against visiting the bat caves in western Uganda after a tourist suspected to have contracted the Marburg virus died on Friday. The Ugandan Wildlife Authority (UWA) has temporarily stopped visits to the caves in Maramagambo forest while they investigate the link to the deadly virus, which is related to Ebola. Experts are now in the area to confirm that Maramagambo is the source of the Marburg disease which killed the Dutch woman last week.

The unidentified 40 year old women died in Leiden University Medical Centre on Friday. Because the disease is highly infectious, doctors are now monitoring the health on a daily basis of people who were in close contact with the victim. No-one else has shown any symptoms. The women visited two caves during a three-week trip to Uganda and suffered fever and chills four days after her return home. She was admitted to Leiden hospital on 2 July.

The Dutch Government notified WHO after a lab test confirmed a tourist had contracted the virus. The Hamburg based Bernhard Nocht Institute isolated the virus in the women who was in Uganda between 5-28 June and entered caves on two occasions. On her second visit, she went to the popular Maramagambo Forest between Queen Elisabeth Park and Kabale. There she had contact with a fruit bat species known to carry filoviruses. Filoviruses cause two types of viral haemorrhagic fever: Marburg and Ebola.

WHO spokesman Gregory Hartl played down the outbreak saying it was an isolated case of “imported Marburg." He advised people should not think about amending their travel plans to Uganda but should not go into caves with bats. His advice was reiterated by the Ugandan Health Ministry. They advised people who have to enter caves in Uganda that they should exercise "maximum precaution not to get into close contact with the bats and non-human primates in the nearby forests".

Marburg is an acute, infectious, hemorrhagic viral fever which affects both human and nonhuman primates. Marburg is a contagious disease that causes sudden bleeding and high fever. Other early symptoms include severe diarrhoea, abdominal pain, nausea and vomiting, severe chest pain, and sometimes sore throat and coughing. The incubation period is 3 to 9 days. Contact with bodily fluids of infected people is the main risk factor for infection. There is no treatment or vaccine. The natural source of the virus remains unknown.

Although endemic to Central and East Africa, the virus is named after the German town in which some of the first cases were described when local workers were exposed to green monkeys imported from Uganda. It is spread through contact with blood, semen or other bodily fluids. The Marburg virus is identical to Ebola in most respects, differing only in that it stimulates the production of different antibodies. Death rates are currently 80 to 90 percent of sufferers. At least 220 people died in the largest ever Marburg epidemic in Angola in 2004 and 2005, which followed an outbreak in the Democratic Republic of Congo which cost 128 lives between 1998 and 2000.

While no cure is yet available, North American scientists have successfully demonstrated an experimental Marburg vaccine in monkeys. Researchers from Maryland's Army Medical Research Institute of Infectious Diseases and Winnipeg's National Microbiology Laboratory injected eight monkeys with an extremely high dose of the virus. After half an hour, five of the eight were given the vaccine. The vaccinated animals all survived for at least 80 days, but the others died within 12 days. The vaccine is not yet ready for human testing but researchers are hopeful it may eventually be possible to immunise researchers infected in laboratory accidents. "Quite honestly, we were astonished," said Dr Thomas Geisbert, a senior US army virologist involved in the test. "We never thought it would work that well for something acute like Marburg, where the infection happens so fast that you don't have time to intervene."

Save the Children report paints shocking picture of child mortality

Save the Children UK have released a new report that says that nearly ten million children die worldwide each year before they reach the age of five. The figures get worse as the children are younger. Four million of these die within the first 28 days of their life. Three million die in the first week and two million die on the day they are born. An incredible 99 per cent of all these deaths occur in developing countries. The report also contains a new 'Wealth and Survival Index' which compares child mortality to national income per person. This shows which nations are squandering their resources and Angola is ranked as the worst offender.

The report (pdf) blames three major causes for child deaths. Firstly, poor access to treatment and prevention means for major diseases such as pneumonia, measles, diarrhoea, malaria, HIV and AIDS. Secondly are infrastructure factors such poor health systems, undernutrition, lack of clean water and female illiteracy. The third factor, says the report, are the outcome of political and policy choices that are the responsibility of governments and other agencies. Bad governance, violent conflict and worsening environmental trends are additional underlying causes that profoundly impact children’s survival prospects.

The countries with the worst child mortality rates are among the world’s poorest and to have experienced war or violent conflict, such as Afghanistan, Angola, Chad, the Democratic Republic of Congo (DRC), Liberia and Sierra Leone. Five countries: India, Nigeria, DRC, Pakistan and China account of half of all deaths of children under five. Sierra Leone has the worst mortality rate, closely followed by Angola. Afghanistan is third worst and the only non-African country in the top ten. But on the Wealth and Survival Index oil-rich Angola is considered the worst offender. Although it now has a per-capita income high enough to put it in the "middle income" category, 20 percent of all Angolans still die before their fifth birthday.

Angola is still recovering from a 27 year civil war which ended in 2002. The former Portuguese colony was supported by the Soviet Union after independence in 1975. However they faced a long and debilitating war against Unita rebels backed by the US and apartheid-regime South Africa. After several broken ceasefires, it took the death of Unita leader Jonas Savimbi to bring the rebels to the table. However a separate struggle still remains in the enclave of Cabinda where 60 per cent of Angola’s oil resides. There have also been strong allegations that oil revenues have been squandered through corruption and mismanagement. Most Angolan still live in desperate poverty on less than $1US a day. The Index shows that Angola’s child mortality is strongly related to grossly unequal distribution of wealth.

Angola’s problems are not unique in sub-Saharan Africa. A child’s risk of dying on their first day of life is about 500 times greater than their risk of dying when they are one month old. The first few hours of a baby’s life are therefore critical, but far too often basic steps that could save the life of a child are not taken. A 2007 study in Ghana showed that 16 percent of neonatal deaths could be prevented by breastfeeding infants from birth. That figure rises to 22 percent, if breastfeeding begins within one hour of birth.

With two million victims annually, pneumonia is the largest single killer of children under five and is responsible for more deaths than AIDS, malaria and measles combined. However the underlying cause is malnutrition. Children without food do not have a strong immune system, and are unable to defend themselves against diseases. Pneumonia can be treated through community diagnosis and the use of antibiotics. However many poor countries do not have access to such successful antibiotics as Cotrimoxazole and Amoxicillin. In the 1990s, just one in five children who developed pneumonia was treated with antibiotics. Costs have dropped all over the world but the price is still beyond the means of most poor people.

Save the Children’s director of policy David Mepham concludes that a child's chance of making it to its fifth birthday depends on where it is born. But he disputes this is beyond human control. While poverty and inequality are consistent underlying causes of child deaths, all countries, even the poorest, can cut child mortality if they pursue the right policies and prioritise their poorest families,” he said. “Good government choices save children's lives but bad ones are a death sentence.”

World Health Organisation backs use of DDT against malaria

The World Health Organisation (WHO) has endorsed the use of banned insecticide DDT in a new approach to controlling malaria in West Africa. Stephan Tohon, WHO’s focal point on malaria in West Africa, told a malaria evaluation meeting in the Burkina Faso capital Ouagadougou that the organisation no longer recommended the use of mosquito nets. Instead he cited the positive results of southern African countries with indoor house spraying using the partially banned insecticide DDT.

The endorsement of DDT (Dichloro-Diphenyl-Trichloroethane) will be particularly controversial. The pesticide was used in World War II to control malaria with apparent great success. DDT is toxic and kills by opening sodium ion channels in insect neurons, causing the neuron to fire spontaneously. The Swiss chemist Paul Müller won the Nobel Prize for medicine in 1948 for demonstrating DDT killed the Colorado potato beetle, a pest that was ravaging the potato crops in the developed world.

DDT contributed to the final eradication of malaria in Europe and North America and WHO’s program to combat malaria worldwide was based on the success of the drug. DDT was less successful in the tropics. Because farmers used it as a crop spray, insect populations began to develop resistance. It all began to unravel for DDT in 1962 when Rachel Carson published the hugely influential “Silent Spring” which showed the chemical resulted in reproductive problems and death in humans. The US eventually banned DDT in 1972.

With the failure of DDT, experts focussed their attentions on bednets impregnated with other insecticides. However the Stockholm Convention of 2001 which outlawed a dozen persistent organic pollutants left the door open for continued use of DDT as a vector control. Vector control works by reducing the levels of transmission and its method varies widely depending on local conditions.

Arata Kochi, head of the WHO's antimalarial campaign, is leading the charge to bring back DDT. In November 2006 he called on environmental groups to support the change. “We are asking these environmental groups to join the fight to save the lives of babies in Africa," Kochi said. "This is our call to them." Kochi is supported a group called Africa Fighting Malaria, who say that while there may be lab studies showing DDT could potentially cause cancer, no large studies show an actual increase in cancer in people.

While the jury remains out on DDT, there is no denying that malaria is one of the world’s greatest health problems. Approximately 40 percent of the world’s population, mostly in the poorest countries, are at risk of contracting malaria. Its intensity depends on local factors such as rainfall patterns, proximity of mosquito breeding sites and mosquito species. Every year, an astonishing 500 million people (one person in every twelve) become seriously ill with one of the four different types of the disease.

Malaria has serious economic impacts in Africa, slowing growth and development as well as perpetuating a vicious cycle of poverty. It mainly afflicts the poor who tend to live in malaria-prone rural areas in poorly-constructed houses with few barriers against mosquitoes. Malaria disease affects sub-Saharan Africa harder than anywhere else in the world and kills about 800,000 children younger than 5 each year. The disease also contributes greatly to anaemia among children, a major cause of poor growth and development. Malaria infection during pregnancy is associated with severe anaemia and other illness in the mother and contributes to low birth weight among newborn infants.

The cause of malaria is a parasite called Plasmodium, transmitted through bites from infected mosquitoes. In the human body, the parasites multiply in the liver, and infect red blood cells. Symptoms include fever, headache, and vomiting, usually about 10 to 15 days after the mosquito bite. If untreated, Malaria can kill by disrupting the blood supply to vital organs. The parasites have developed resistance to a number of malaria medicines and the field of malaria control has historically been dogged by problems with resistance. Each time scientists find a way to fight the parasite, the parasite finds a way to fight back. WHO says resistance can be limited if DDT is used carefully, and only where it's likely to be effective.

new Ebola outbreak in Congo

UN officials are desperately rushing in supplies and doctors to south-central Congo to contain a new outbreak of the deadly Ebola virus. More than 150 people have died so far in Kasai province and the World Health Organisation (WHO) is aware of another 372 cases. Congolese ministers are going on radio and television to educate villagers about the crisis. “We are extremely concerned,” said Dr. Benoit Kebela Ilunga, secretary general of the Congo Health Ministry. “But we also have experience dealing with this.”

Makwenge Kaput, Congo’s health minister, said the outbreak of the Ebola virus occurred at Mweka, a village outside the Western Kasai provincial capital of Kananga. The WHO regional office is supporting the Kinshasa health ministry in the field at the location of the outbreak. However the presence of dysentery in blood and urine samples is complicating diagnosis and treatment.

The WHO has confirmed the presence of Ebola virus in samples taken from cases associated with the outbreak after laboratory analysis at the Centre International de Recherches Médicales de Franceville (CIRMF), Gabon, and at the Centres for Disease Control and Prevention (CDC) in Atlanta. They are now sending Personal Protective Equipment (PPE) to the area and Médecins Sans Frontières (Belgium) has deployed clinicians, water and sanitation experts and logisticians to set up quarantine facilities.

Following the announcement of the outbreak, the Health Ministry of neighbouring Uganda has issued a red alert to all border posts. Although Kasai is 2,000kms away, medical experts say the threat of the virus spreading is serious. "We are always concerned that is why we have issued a directive to all border posts to be vigilant," said Dr Sam Okware, the Ugandan commissioner for health and chairperson for the Ebola Task Force. The last outbreak in Uganda in 2000 killed 160 people.

Ebola haemorrhagic fever (EMF) is one of the deadliest pathogens affecting primates, killing up to 90 percent of infected people. The virus is endemic to Africa and the Philippines. There is no known cure. In severe cases, victims haemorrhage and bleed from body orifices before dying. There are four identified subtypes (pdf) of Ebola virus. Three of the four have caused disease in humans: Ebola-Zaire, Ebola-Sudan, and Ebola-Ivory Coast. The fourth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans.

Ebola is an animal-borne highly contagious virus that causes high fevers, diarrhoea, vomiting and often severe internal bleeding, has killed hundreds of people in Africa, where diets include primates. The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Transmission of EHF has also occurred by handling ill or dead infected chimpanzees.

Although the disease is named after a river in the Congo, it was first recognised in a western equatorial province of Sudan in 1976. There it affected 284 people over half of whom died. A few months later, there was a second outbreak in Yambuku in Congo (then known as Zaire). 318 people were affected in the Congo and a staggering 88 per cent of those who contracted the virus died. There have been sporadic outbreaks, mostly in Africa, since that time.

The latest outbreak is the worst the world has seen for several years and is likely to have serious repercussions. It started three months ago when people started falling sick from a mystery virus in several villages around Kananga. Although several villages remain under quarantine, the WHO is saying there no need for any restrictions on travel or trade with the Democratic Republic of the Congo for now. That could change quickly with WHO warning of a “possible concurrent outbreak of another etiology [cause]".

Chikungunya reunion

Malaria remains a scourge of much of the developing world. It kills somewhere between one and five million people a year. Only pneumonia and AIDS kill more people outside the Western World. The World Health Organisation believes that 300 million are infected annually. Closer to the ground, the Kenyan Medical Research Institute says there are actually 515 million cases a year of the deadliest form of malaria alone.

But now some of malaria’s lesser known cousins are now starting to share the limelight. One of the most virulent at the moment is from a bite by Aedes aegypti. Better known in English as the Yellow Fever Mosquito, Aedes aegypti is a tolerable host to a number of fevers that are dangerous to humans. As well as the yellow fever itself, it is home to dengue fever and a new, previously non-fatal disease that is now killing people in the South. It is called chikungunya (“chicken gunya”) Chikungunya is Makonde (a Tanzanian language similar to Swahili) for ‘that which bends up.’ People struck by the disease end up with a hunched back and intense pain.

Chikungunya was never considered fatal, until recently. Acute chikungunya fever typically lasts a few days to a couple of weeks, but similar to other fevers, it can have prolonged fatigue lasting several weeks. One million people a year are infected with chikungunya which is minute compared to malaria. But its recent change of behaviour is cause for alarm. Now it is starting to kill.

On the island of Reunion, an outre-mer department of France in the Indian Ocean chikungunya has killed 315 people since it broke out in March 2005. The French occupied the island in the 17th century and the name Reunion commemorates the union of French revolutionaries from Marseille with the National Guard in Paris in 1792. It is now a busy country with 775,000 people crammed into its two and half thousand square kilometres. It is the 4th densest department of France and only Paris, Martinique and Calais have more feet per foot. Chikungunya was first noticed on Reunion in February 2005. Barely one year later, 50,000 people on the island were infected.

Now over ten percent of the population has Chikungunya. There is a twenty four hour mission every day to spray insecticide with the French Army involved by day and volunteers by night. In the country they are looking for mosquito larvae anywhere they can find standing water. But chikungunya is winning the battle. By March, a local French newspaper reported there was 186,000 cases - a quarter of the island.

Chikungunya started to crop up in other Indian Ocean islands. It moved around from Madagascar and the Comoros, to Mayotte and the Seychelles. Across the islands chikungunya has infected more than 1.3 million people in the last 20 months. By 24 November, half a dozen US states have reported cases of travellers from Asia and East Africa returning to the States with the virus.

One day later, a Sri Lanka health official confirmed the epidemic arrived in the country. Dr Nihal Abeysinghe, director of the state epidemiology department, says it has infected 5 000 people in the island's Tamil controlled far north. The people of Tamil capital Jaffna residents are living on rations shipped in by sea. Medicines and food are in short supply. Local residents said doctors had recommended paracetamol as a fever preventive, but most shops had run out. On the same day, Taiwan reported its first ever case.

No vaccine or specific antiviral treatment for chikungunya fever is available. Unconfirmed reports have stated the US military has a vaccine as of March 2006. But if they have it, they aren’t sharing. The last known trials were in 2000 but were discontinued due to lack of funding. Meanwhile on Reunion, the pain goes on. Islander Louise Maillot has been suffering from intense pain in her legs and depression since chikungunya struck. I'm waiting to die," she told Al Jazeera. "I'm praying for the good Lord to take me."

South Africa criticised for its AIDS policies

The South African government was criticised for its handling of the HIV crisis by speakers at the 16th international conference on Aids in Canada. The conference was held from 13 to 18 August in Toronto, Canada. Stephen Lewis, the UN special envoy on Aids, told the closing session: "It is the only country in Africa, amongst all the countries I have traversed in the last five years, whose government is still obtuse, dilatory and negligent about rolling out treatment." The country has the single biggest HIV-positive population in the world, estimated at five million or 11% of its population. About 70,000 children in South Africa are born with HIV each year. According to the Joint UN Programme on HIV/AIDS (UNAIDS), by the start of 2006 there were an estimated 39 million AIDS sufferers worldwide. Most of these people live in developing countries. In the last 12 months alone, 4.1 million people were infected and 2.8 million died of AIDS related illnesses.

The concluding report from the conference with a call for a quickening of the pace of HIV prevention measures and care and treatment programs in resource-strapped environments. The theme echoed the sense of hope tempered with growing impatience at government inaction. Of 7 million sufferers in the lowest GDP countries in need of antiretroviral medication, barely a quarter of these people have access to the drugs. The treatment access gap is even worse for children under 15. Approximately 90% of the 800,000 children in need have access to the treatment. In total, barely 1 in 5 people of high risk of infection have access to effective prevention. The new President of the International AIDS society, Dr Pedro Cahn, called for political action. “All the knowledge, innovative research and new tools will not be effective without the political leadership that is essential to halting the disease,” he said on the final day of the conference.

Thabo Mbeki's government was openly criticised by many speakers at the conference for denying that the human immunodeficiency virus is a cause of Aids and for its resistance to offering HIV drugs to its people. Dr Manto Tshabalala-Msimang, the Soviet-educated South African health minister prefers to promote traditional cures such as garlic, beetroot and lemon while also referring to possible toxicities of AIDS medicines. Stephen Lewis told the conference "It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state."

The South African government denies the charges and issued a statement that said "The ANC reaffirms its support for government's comprehensive plan for management, care and treatment of HIV and Aids, and for an approach that aims to combat HIV and Aids in an all-embracing and integrated manner.". Nelson Mandela has weighed in on the argument and criticised the government for not making drugs freely available across the country. Several South African provinces announced that they would ignore the government policy and start distributing a key anti-retroviral drug, nevirapine.

Many believe that Tshabalala-Msimang is merely carrying out the pseudo-scientific wishes of President Thabo Mbeki. In 2002, Mbeki, convened an international panel to consider the causes of and appropriate solutions to AIDS in the African context. The panel included representatives from the so-called AIDS dissident community. The willingness of the President to entertain, if not unequivocally endorse, dissident science created an international stir. Although the conference’s outcome, known as the Durban Declaration, supported the orthodox view of AIDS, Mbeki continued to stall the pilot of antiviral drugs.

The question is why South Africa’s leadership is so obdurate on this question? The answer probably lies in the speed and force of the AIDS epidemic in South Africa. There are neither clear reasons nor simple solutions for the spread of AIDS and its complexity has made it extremely difficult to assimilate. And so, in a denial of reality, leaders proclaim that the presence of AIDS is not true. President Mbeki publicly questioned the importance of HIV in causing AIDS, controversially suggesting that the main cause was "poverty." The appearance of AIDS as an everlasting affliction precisely at the point when the end of apartheid should have brought a better life for all has also rankled with the ANC government. As one South African journalist put it “how is it possible that, at the very moment we assume our victorious place as the leaders of a democracy we struggled for decades to bring about, we are presented with a dying populace, with a plague to which we have no answers?” And so while the South African government argues that the drugs are too expensive, they ignore the high costs of not preventing the further spread of the world’s worst killer virus.