Mbeki further argued that imposing a Western solution to the "uniquely African catastrophe" of fast-spreading heterosexually based AIDS transmission infection would be absurd. "Such a proceeding would constitute a criminal betrayal of our responsibility to our own people." His spokesman subsequently said that Mbeki sent the letter "to explain his position because the reports that have been in the media have either been misleading or inaccurate."
 
Clearly, this is not an issue that can be discussed meaningfully by laypersons lacking the scientific background. What is interesting, however, is the reaction in the international media, which is presumably as ignorant as most of us are. These reactions have ranged from ridicule to vilification, and are so extreme as to suggest that there may be more to this than just a simple scientific dispute.
 
A significant issue in all of this of course is that of drug provision. Medicine is at the heart of the problem for South Africa, as for all developing nations. In the wealthy nations of the West, "cocktails" of anti-retroviral drugs have made it possible - at a cost per patient exceeding $10,000 a year - to live indefinitely with HIV-AIDS. Obviously such cocktails are simply not affordable wither by most South Africans, or by the public health system which at the moment is having difficulty even ensuring the provision of relatively cheap drugs to treat tuberculosis.
 
And one of the more significant aspects of the controversy relates to certain drugs. There has been growing pressure on Mbeki to provide AZT or Nevirapine, two drugs that have been found to be effective in preventing mother-to-child transmission, through the public health system. AZT in particular is among the cheaper of anti-HIV drugs, but it would still impose a heavy burden on South Africa's fragile public health system. Some activists have argued that Mbeki is trying to save money by questioning its usefulness.
 
But there are also genuine debates about the effectiveness of the drug. It basically reduces the risk of foetal transmission, but it does not treat the actual patient, who may still die quite soon leaving behind an orphan. There is growing fear about its level of toxicity, especially among malnourished women (which is the norm among female sufferers in South Africa). And some like Dr. Duesberg have argued that it is actually one of the causes of AIDS transmission among adults, rather than a prevention. However, the lobby of the pharmaceutical giant that makes the drug is a strong one.
 
There have been other problems related to drugs that treat some of the "opportunistic illnesses" that typcially afflict AIDS sufferers and are the proximate cause of death in most case. A common one in South Africa is cryptococcal meningitis. It can be treated, but one of the key drugs - fluconazole, which also works well against thrush, an extremely common ailment among HIV patients - costs the equivalent of about $7.50 for a standard dose. Pharmaceutical giant Pfizer holds the patent for fluconazole and sets the price in almost every country.
 
In Thailand, the government (through a system of compulsory licensing) permits local companies to make a generic form of the drug fluconazole. As a result, the price for the same dose is only about 70 cents. In South Africa, however, a similar strategy has been beset by difficulties. most significantly pressure from MNC drug companies and their home governments, to avoid such practices.
 
Thus, despite the legality of compulsory licensing and parallel imports, and despite the public health emergency enveloping much of the developing world, the US has actively opposed developing country efforts to implement compulsory licensing, parallel imports, or other measures to make life-saving HIV/AIDS drugs more affordable and available in their countries.
 
A report from the State Department says, "All relevant agencies of the U.S. government-the Department of State together with the Department of Commerce, its US Patent and Trademark Office, the Office of the United States Trade Representative, the National Security Council and the Office of the Vice President-have been engaged in an assiduous, concerted campaign to persuade the government of South Africa to withdraw or modify" the Medicines Act provisions that give the government the authority to pursue compulsory licensing and parallel import policies. The State Department report explains how "US government agencies have been engaged in a full court press with South African officials from the departments of Trade and Industry, Foreign Affairs, and Health" to pressure them to change the law. US Vice President Gore has raised the issue repeatedly Thabo Mbeki.
 
The United States has even withheld certain trade benefits from South Africa and has threatened trade sanctions (by putting South Africa on the "Special 301 Watch List" of countries receiving heightened US scrutiny regarding trading practices) as punishment for Pretoria's refusal to repeal those provisions of its Medicines Act that offend the multinational drug companies. Washington has also enlisted the French, Swiss, and German presidents to raise the issue with top South African officials.
 
It is interesting that hardly any mainstream public health specialists made any noise about this appalling attempt to prevent the South African government from making what they see as life-saving anti-HIV drugs affordable to a highly vulnerable population. In the circumstance, it is difficult to accept, without a fairly liberal pinch of salt, that the current outcry against the South African government is born entirely as a result of international concern for the AIDS victims in that country, and is not an orchestration by those who have a direct pecuniary interest in there being no questioning of the way in which AIDS is currently being handled.