National Assembly - 04 October 2000
WEDNESDAY, 4 OCTOBER 2000 __
PROCEEDINGS OF THE NATIONAL ASSEMBLY
____
The House met at 15:01.
The Speaker took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS - see col 000.
QUESTIONS AND REPLIES - see that book.
NOTICES OF MOTION
Dr A S NKOMO: Madam Speaker, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes the statement by the chairperson of the Medical Association of South Africa, Mr Zolile Mlisana, that the President’s comments on the Aids disease created confusion about the causal relationship between HIV and Aids;
(2) believes that Mr Zolile Mlisana’s statement neither adds scientific value to the debate nor contributes positively to the challenges facing South Africans in this regard;
(3) reiterates that the Government has not and does not deny the causal relationship between HIV and Aids; and
(4) calls on the Medical Association of South Africa to join forces with the Government and other civil society organisations to fight the Aids pandemic.
[Applause.]
Mr B G BELL: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the DP: That the House -
(1) notes with dismay that the Mpumalanga government is building a new legislature at a cost of R800 million despite having a budget of only R250 million;
(2) acknowledges that there are areas in Mpumalanga where flood damage has destroyed infrastructure, cut people off from fresh water and electricity, and created health risks for citizens;
(3) expresses its grave disquiet that very little has been done to repair this damage or improve the position of these people by a government which callously spends more than R400 million above its budget on non- essentials to the detriment of the poor; and
(4) censures the ANC Government in this province for its fiscal irresponsibility and its neglect of the people it was elected to serve.
Mr B W DHLAMINI: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the IFP:
That the House -
(1) fully supports the directive by the Minister of Water Affairs and Forestry, Mr Ronnie Kasrils, that Cape Town residents should use water sparingly due to the astronomical cost of building new dams;
(2) notes that such a directive will, in the long run, help the residents themselves to cut down the future cost of water;
(3) acknowledges the moves by the Cape Metropolitan Council to engage in education campaigns on water saving; and
(4) urges all other areas as well to use this natural resource sparingly.
Ms M C LOBE: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes the recent utterances by Morgan Tsvangirai, the leader of the Movement for Democratic Change, that President Robert Mugabe of Zimbabwe must resign or face being removed forcibly;
(2) believes that this statement is inflammatory and irresponsible, and does not assist the people of Zimbabwe in resolving the complex social and economic problems they are experiencing, nor does it strengthen democracy in Zimbabwe;
(3) further believes that it is the will of the people of Zimbabwe which will determine the future of their president in the presidential elections of 2002; and
(4) calls on him to refrain from making subversive statements and to use the MDC’s opposition status in the Zimbabwean parliament to strengthen democracy.
[Applause.]
Mrs S M CAMERER: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move:
That the House -
(1) notes with deep concern that, in spite of the red carpet put out for him on the occasion of his last visit to the NCOP, the President is unwilling to return there to answer questions from NCOP members, and that compliant ANC members of that House have accordingly pushed through a resolution to scrap questions to the President of our country;
(2) deplores this latest development in moves by the President’s Office to further isolate this country’s leader from his people and questions the wisdom of such a move, especially in view of the fact that the impression is being created in the media, both at home and abroad, that the President has lost the confidence of his people; and
(3) appeals to the President to make himself available to answer questions from the democratically elected representatives of the people on a regular basis.
Mr M E MABETA: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the UDM:
That the House -
(1) notes that the Department of Foreign Affairs had, at the inception of the new democratic state in 1994, inherited the apartheid structures of the personnel of the respective foreign affairs departments of the former Republic of South Africa, Transkei, Botswana, Venda, Ciskei and the Department of International Affairs of the African National Congress;
(2) notes that this discrimination positioned the former apartheid structure as the legitimate department and thus retained an untransformed Department of Foreign Affairs;
(3) observes with great satisfaction that the new incumbent director- general of this department has taken visible steps towards the transformation of the Department of Foreign Affairs in such a way that there will be a more representative top and middle management structure at head office and among transferred officials in the external offices in the near future; and
(4) urges …
[Time expired.]
Ms M M SOTYU: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes that -
(a) a member of the vigilante group People Against Gangsterism and
Drugs, Pagad, Ismail Edwards, was sentenced to an effective 25
years in prison yesterday; and
(b) Edwards is also on trial with alleged Pagad hit-man Ebrahim
Jeneker on a charge of murdering Inspector Bennie Lategan; (2) acknowledges that the Government and the judicial system is serious
about putting the perpetrators of violence behind bars; and
(3) calls on the police to expedite and conclude their investigations into the killing of Inspector Lategan and other terrorist activities.
[Applause.]
Mr S N SWART: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ACDP:
That the House -
(1) notes that approximately 100 000 disabled people in the Eastern Cape had their disability grants unilaterally cut by the provincial welfare department;
(2) notes that the Eastern Cape High Court has subsequently given the go- ahead for a class action to be brought on behalf of these disabled people after it was argued, on their behalf, that a class action was the only way to obtain justice for the desperately poor disabled people who could not afford their own legal action;
(3) notes that the presiding judge found that the grants of the individual applicants were unlawfully stopped in violation of their constitutional rights; and
(4) calls on the national Government to urgently intervene in this untenable situation, particularly as a further delay in the reinstatement of these disability grants may be caused by an appeal to the Supreme Court of Appeals by the provincial government.
Mr I S MFUNDISI: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the UCDP:
That the House -
(1) notes the efforts of the University of the Free State and the Pan South African Language Board to promote indigenous languages in South Africa by embarking on a monolingual project on the Sesotho dictionary;
(2) appreciates that the twosome are proceeding with the establishment of a Sesotho lexicographic unit at the university;
(3) congratulates Prof Mohlomi Moleleki, head of the department of African languages, who has been appointed chair of the directorate;
(4) commends the University of the Free State and PanSALB on this progressive move which is the first on the continent; and
(5) expresses its hope that other universities will take a leaf from the book of the University of the Free State in serving the nation.
Mr B A RADEBE: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House - (1) notes the survey conducted by Idasa which indicates that most white South Africans refuse to accept responsibility for apartheid;
(2) recalls that the apartheid government was voted into power for 46 years by an exclusively white electorate;
(3) notes that the report indicates that only 50% of whites - as opposed to 70% of blacks - indicated a willingness to participate in nation- building, and that only 20% of whites think that material compensation for victims is an important part of national reconciliation; and
(4) calls on all South Africans, especially the white community, to face the past with honesty and responsibility, and work together for a united, just, and democratic South Africa.
[Applause.]
Ms M SMUTS: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move: That the House -
(1) notes the opinion of the Chairperson of the SABC Board that we will have either a national broadcaster or a national circus, depending on the quality of the appointees to the posts of Chief Executive Officer, Chief Operations Officer and Chief Financial Officer, all being executive members of the Board;
(2) urges Cabinet to honour such appointments to be made by the Board, in terms of section 14 of the Broadcasting Act;
(3) notes further that the Broadcasting Act of 1998 predates and conflicts with the Public Finance Management Act of 1999 on certain accounting and reporting procedures and that government policy to separate the SABC into public and commercial components was never persuasively argued or justified; and
(4) urges the Government to consult the SABC Board and to commence work on amending the Act.
Mr J H SLABBERT: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the IFP:
That the House -
(1) notes that -
(a) the building and maintenance of our precious network of high
quality roads is a significant infrastructure supporting our
economic growth and progress; and
(b) trucking keeps the wheels of our industries and commerce
rolling, literally and figuratively;
(2) is extremely perturbed by a report written for the Sunday Times of 1 October 2000 by Chris Barron under the heading ``South Africa’s Trucking Industry is in a Mess”;
(3) requests the Minister of Transport to deal with the issues raised here, which cannot and should not be countenanced; and (4) calls on the Minister to make statements to the House indicating what measures he is going to take to deal with the problems.
Mr E P MOGALE: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes that -
(a) an exploratory meeting took place between Agri SA and the
uMkhonto weSizwe Veterans' Association; and
(b) this meeting was the first of its kind between these two
organisations, where ideas were exchanged on land and farming
issues;
(2) believes that meetings of this nature are important in establishing strategic partnerships amongst civil society organisations; and
(3) commends the bold initiatives by these two organisations, and hopes that future engagements will contribute towards the reconstruction and development of our country.
Dr P J RABIE: Mnr die Voorsitter, ek gee hiermee kennis dat ek op die volgende sittingsdag namens die Nuwe NP sal voorstel:
Dat die Huis -
(1) kennis neem van die finansiële oorlewingskrisis wat die landbou in Suid-Afrika beleef en die vernietigende effek daarvan op die ekonomie van Suid-Afrika in die lig daarvan dat -
(a) diesel, een van die grootste insetkostes in die landbou, vandag
met 37 sent per liter styg;
(b) dieselbrandstof die afgelope kalenderjaar met bykans 50% in
koste toegeneem het; en
(c) Standard Bank bereken dat die posisie van 'n tipiese mielieboer
die afgelope 5 jaar voor hierdie styging reeds met 132% verswak
het en dié van 'n koringboer met 61%; en
(2) ‘n beroep op die Minister van Finansies doen om die flagrante diskriminasie teen die landbou in Suid-Afrika te beëindig deur die dieselrabat wat vir ander sektore van die ekonomie geld spoedeisend uit te brei na die vernaamste bron van werkgeleenthede op die platteland. (Translation of Afrikaans notice of motion follows.)
[Dr P J Rabie: Mr Chairperson, I hereby give notice that on the next sitting day I shall move on behalf of the New NP:
That the House -
(1) notes the financial survival crisis which South African agriculture is presently experiencing, and its destructive effect on the economy of South Africa, in the light of the following -
(a) the price of diesel, one of the biggest input costs in
agriculture, is set to rise by 37 cents per litre today;
(b) the price of diesel fuel has increased by almost 50% during the
past calendar year; and
(c) Standard Bank estimates that even before this increase the
position of a typical maize farmer had already deteriorated by
132% over the past 5 years, and that of a wheat farmer by 61%;
and
(2) appeals to the Minister of Finance to end the flagrant discrimination against agriculture in South Africa by urgently extending the diesel rebate that applies to other sectors of the economy to the most important source of employment opportunities in the rural areas.]
Mr S ABRAM: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the UDM:
That the House -
(1) notes the election of Mr Walter Ntuli, a KwaZulu-Natal sugar cane farmer, as President of the KwaZulu-Natal Agricultural Union; (2) congratulates the agricultural fraternity of KwaZulu-Natal for placing their trust in Mr Ntuli; and
(3) wishes Mr Ntuli a fruitful term and expresses the hope that transformation in this sector and the interests of agriculture generally will be vigorously promoted.
Ms N V CINDI: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes that -
(a) six people have been killed and at least seven others injured in
taxi-related violence in the Eastern Cape; and
(b) since the weekend, taxi violence in this province has been
escalating;
(2) expresses its sincerest condolences to the families, friends and loved ones of the deceased; and
(3) calls on the police to expedite and conclude their investigations into taxi violence to ensure that the perpetrators of violence are put behind bars.
[Applause.]
Mrs M A A NJOBE: Mr Chairperson, I hereby give notice that on the next sitting day of the House I shall move on behalf of the ANC:
That the House -
(1) notes that the Minister for Agriculture and Land Affairs will sign a R11 million settlement agreement for the Chatha community in the Keiskammahoek area in the Eastern Cape;
(2) believes that this is yet another indication of the commitment by the Government to work towards a better life for rural communities; and
(3) welcomes the initiatives by the Ministry and the department to resolve land claims in rural areas.
[Applause.]
SCHEDULING OF DEBATES
(Draft Resolution)
The CHIEF WHIP OF THE MAJORITY PARTY: Madam Speaker, I move the draft resolution printed in my name on the Order Paper as follows: That, notwithstanding Rule 253, the debates on the following Bills be conducted on Thursday, 5 October 2000, and Friday, 6 October 2000:
(a) Local Government: Municipal Structures Amendment Bill [B 51B -
2000] (National Assembly - sec 75);
(b) Home Loan and Mortgage Disclosure Bill [B 53 - 2000] (National
Assembly - sec 75); and
(c) African Renaissance and International Co-operation Fund Bill [B
65 - 2000] (National Assembly - sec 75).
Agreed to.
ADJUSTMENTS APPROPRIATION BILL
(First Reading debate)
Order disposed of without debate.
Bill read a first time.
Votes and Schedule agreed to.
ADJUSTMENTS APPROPRIATION BILL
(Second Reading debate)
Mnr T D LEE: Mnr die Voorsitter, dit is jammer dat die Pretoriase stadsraad in gebreke gebly het om die beloofde skenking te maak ten bate van die Urban 21 - Afrika Streek Voorbereidende Konferensie wat in Junie vanjaar gehou is. Die Departement van Behuising moet geloof word vir die spoed waarmee hulle tot die redding van die situasie gekom het en R206 000 geskenk het om ons land ‘n groot verleentheid te spaar.
Wat ek egter betreur, is dat dieselfde departement nie met dieselfde spoed, ywer en drif hulle primêre taak uitvoer en tot die redding van die miljoene haweloses kom nie. Ek is seker dat, soos ek hier staan, mev C M Bono van Lower Crossroads nog altyd sonder dienste is, en dat mev D Smith nog altyd in ‘n ou lykswa bly, alhoewel ek hulle lot reeds sedert Mei vanjaar bekla.
As ek die bedrag R206 000 sien, sien ek amper 16 mense voor my wat elkeen ‘n R15 000-subsidie vir ‘n huis kon ontvang het. Dit is eintlik skandalig dat, terwyl die behuisingsbegroting tot slegs 1% van die nasionale Begroting besnoei is en die behuisingswaglyste ál langer word, ‘n deel hiervan op kletssessies bestee word. Is dit nie maar tipies van hierdie ANC- regering nie? Hier word ge-``workshop’’, daar word ‘n seminaar gehou en êrens anders ‘n kongres.
Hulle ly in der waarheid aan ‘n kletssindroom, maar of dit nou deur ‘n virus veroorsaak word of nie, sal ek my nou nie oor uitspreek nie. Ek sal dit liewer oorlaat aan baie hogere mense wat deskundiges is op die gebied van virusse en sindrome!
Daar word gepraat oor geweld, maar daagliks sterf onskuldige mense as gevolg van geweld. Daar word gepraat oor armoede, maar die armoediges word afgeskeep, want toelaes en pensioene word nie uitbetaal nie, om nie eens van die Lotto-debakel te praat nie. Daar word gepraat oor vigs, maar HIV/vigs het reeds pandemiese afmetings aangeneem. Daar word gepraat oor behuising, maar die waglyste vir behuising word by die dag al hoe langer. Hierdie pratery baar selde enige vrugte, want die posisie vererger daagliks. Dit is soos hulle in Engels sê, ``Talk is cheap, but money buys the whisky’’.
Die tyd het aangebreek om oor te gaan tot aksie. Iets moet gedoen word sodat al die mense van Suid-Afrika in veiligheid, vrede en voorspoed en met ‘n dak oor hulle kop kan lewe.
Die DP steun hierdie wetsontwerp. (Translation of Afrikaans speech follows.)
[Mr T D LEE: Mr Chairperson, it is a pity that the Pretoria City Council failed to make the promised donation in favour of the Urban 21 - Africa Region Preparatory Conference that was held in June this year. The Department of Housing must be praised for the speed at which they came to the rescue and donated R206 000 to spare our country major embarrassment.
What I regret, however, is that the same department does not perform its primary task with the same speed, zeal and passion and come to the aid of the millions of homeless people. I am certain that, as I am standing here, Mrs C M Bono of Lower Crossroads is still without services, and that Mrs D Smith is still living in an old hearse, although I have been lamenting their plight since May this year.
When I see the amount of R206 000, I see almost 16 people before me who could each have received a R15 000 subsidy for a house. It is really disgraceful, while the housing budget has been cut to only 1% of the national Budget, and the waiting lists for housing are growing longer and longer, that a part of this is spent on chat sessions. Is this not typical of this ANC Government? Here a workshop, there a seminar and elsewhere a congress is held.
They are in fact suffering from a chat syndrome, but whether it is caused by a virus or not I cannot say. I would rather leave that to much higher-up people who are experts in the field of viruses and syndromes!
There is talk about violence, but innocent people are dying daily because of violence. Poverty is talked about, but the poor are neglected, because allowances and pensions are not paid out, not to mention the Lotto debacle. Aids is talked about, but HIV/Aids has already reached pandemic proportions. Housing is talked about, but waiting lists for housing are growing by the day. This talking rarely bears any fruit, because the position is worsening daily. It is as they say: Talk is cheap, but money buys the whisky.
The time has come for action. Something must be done so that all the people in South Africa can live in safety, peace and prosperity and with a roof over their heads.
The DP supports this Bill.]
Dr G G WOODS: Chair, we can contrive to exploit this debate on the Adjustments Appropriation Bill to go in many different directions unrelated arguments, but the real issues in the Bill remain non-issues. Why? Firstly, the three adjustments are purely of a technical nature; secondly, they do not call for any additional funds; thirdly, they do not amount to any loss of value-for-money for the state; fourthly, they do not translate into any loss of delivery by the state; and, finally, they do not imply any instance of financial mismanagement.
In the given circumstances, these adjustments are necessary and make good sense, and all that is left for me to say is that we support the Bill. [Applause.]
Mrs S M CAMERER: Chairperson, the New NP and the DA support this Bill because we believe that it is most important for the Finance department …
The MINISTER OF FINANCE: Deputy Chairperson, on a point of order: I thought the Speaker said earlier on that there was no DA in this House. Now, why are they supporting this Bill? [Interjections.]
Mrs S M CAMERER: Deputy Chairman, we wear our colours on our sleeves.
It is important for the Finance department to get its house in order, particularly with reference to the amount of R107 million for legal aid. This amount was included in the adjustments estimate for 1999-2000 as an additional appropriation, and first appeared before this House nearly a year ago in November 1999. I wish to say to the Minister of Finance that we are talking about the reappearance of items.
As the Minister of Justice and Constitutional Development told this House at the time, the amount was for the payment, by the Legal Aid Board, of debts owed to legal practitioners. The amount was again before this House when the Minister of Finance presented his Budget in February this year. The Minister included the amount in the increase, which he claimed had been allocated to the Justice department. Now it is before the House for the third time for a technical reason, it seems, namely that it was included in the wrong column in the original 1999 Act. The purpose of its inclusion here is to shift it into the right column, namely, from column one to column two. It boggles the mind how this sort of thing can go wrong time and time again in the Finance department. Anyway, let us hope that this amount has at last been placed in the right column, since it was all spent ages ago.
I am informed by the Legal Aid Board that the funds were paid out to it last December to help defray the huge amount of accumulated arrears owed to legal practitioners at that time. In fact, during the period from 1 January this year to 30 September this year, approximately 134 000 payments were made to legal practitioners at a total cost of approximately R205 million. These payments would not have been possible without the additional R107 million received in December 1999.
Indeed, it had a salutary effect so that, today, the outstanding debts on accounts that have already been accepted by the board amount to only R50 million. This deal has also substantially helped reduce the board’s contingency liabilities which, in August 1999, amounted to a whopping R600 million. They were heading for R1 billion, based on instructions received by the board.
At the time, the amount of R107 million was voted in November 1999. The Legal Aid Board also acted to reduce the fees payable by the board to legal practitioners. This, apparently, was a quid pro quo to the Treasury for getting the bail-out funding. The result of this has been that the current contingent liabilities of the Legal Aid Board have been reduced to an estimated R300 million. The board hopes to have reduced this to R150 million by the end of the year.
In other words the deal that was done a year ago around this bail-out of R107 million has had a good knock-on effect on the management of the Legal Aid Board’s finances, which is also a persuasive reason for supporting this Bill. It is a story with a reasonably happy ending. What is quite clear is that the new constitutional rights of the accused and rights to legal representation have placed an impossible burden on the resources available for legal aid from the Department of Justice and something had to be done about it.
Our constitutional rights owe a great deal to the Canadian constitution. But, historically, South Africa has spent only one-sixtieth of what a country like Canada spends per capita of the population on legal aid. Given the scope and volume of the Legal Aid Board’s operations, they anticipate that they will - at least for the foreseeable future - always have approximately 5 000 accounts on hand, representing work in progress, in their finance department. There also have been problems around the drastically reduced fees for legal practitioners and many lawyers have been unwilling to take on Legal Aid Board work, particularly in the rural areas, although this is settling down, to a degree.
Another silver lining is the fact that last month the Treasury apparently authorised the creation of some 900 new posts at the new Justice centres which are to be established and managed by the Legal Aid Board and will eventually replace the judice system of using lawyers in private practice for legal aid. The deal around this R107 million, therefore, seems to have been a trigger for the implementation of an idea that has been around for some time.
The previous Minister of Justice spent five years talking about introducing a new, cheaper system of legal aid, but did nothing about it. The Justice centres are an attempt to offer cheaper legal aid, but it will be a modest start on the prospective 900 posts; apparently only just over 200 will be filled in the current financial year at some seven Justice centres. In the meantime the legal aid system must continue to rely heavily on lawyers in private practice. So the Legal Aid Board will apparently again be asking for additional funding amounting to R140 million above their annual baseline figure of R270 million for the next financial year. They hope to get, at least, R100 million extra. This is in order to pay the legal practitioners who in good faith did work for the Legal Aid Board within a reasonable time. This Government has a moral obligation to ensure that these lawyers who in good faith did the work get paid in time. [Time expired.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! The hon the Minister raised a point of order. I do not want to rule on that, but I want to observe that we are dealing with adjustments. Some members may take adjustments to mean a much broader term than that which is on the Order Paper, and may choose to see themselves in a somewhat different way. But the presiding officers are not compelled, by the same logic, to recognise how they wish to see themselves. So we do allow them that liberty.
An HON MEMBER: Just tell them it is not seeking injustice!
Dr G W KOORNHOF: Mr Chairperson, the Bill before us is crystal clear and represents no increase in the expenditure of Government. It addresses requests from certain departments to the national Treasury …
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! I am not sure whether you are being heard. Would you speak into the microphone?
I think, while we are on this subject, I would appreciate it if the Whips of the various parties could ascertain from their members what difficulties are being experienced with the handset that is on the table. If some of these are defective, then I think we would like to know how many are defective in order that something could be done about it.
Mr J H MOMBERG: The whole DP is defective!
Dr G W KOORNHOF: Mr Chairperson, the Bill addresses requests from certain departments to the national Treasury mainly to move amounts from column 1 to column 2. I will, therefore, not waste the time of the members of this House by speaking at length about this Bill.
I will conclude by making two remarks. Firstly, it is of vital importance that the Legal Aid Board addresses its financial problems seriously in order that disadvantaged people in particular should have access to legal services where they need them and where they apply for such assistance.
Secondly, the National Skills Fund must utilise its resources in such a manner as to develop skills that are needed for the 21st century economy. In this regard, the disadvantaged people must be empowered on a scale never seen before in our country with skills that will provide them with jobs.
The UDM supports the Bill. [Applause.]
Mr L M GREEN: Mr Chairperson, hon Ministers and members, it is the responsibility of the Department of Finance to explain whether it is good financial practice to operate on assumptions in financial matters. Good financial practice would have ensured that the City Council of Pretoria stuck to its commitment to contribute to the conference on housing. However, because the contract was based on an incorrect assumption, the department has been forced to correct the situation to the tune of R206 000.
With reference to the Legal Aid Board, we hope that the Minister aims to provide continual assistance to this struggling sector. The constitutional right to legal aid becomes meaningless if the funding is lacking. It has been mentioned that the legal aid crisis affects the poor the hardest, as lawyers struggle to provide legal assistance to indigent people.
It is estimated that the board is struggling with a debt of about R280 million. Law firms are reluctant to take on cases from the Legal Aid Board because of the controversy surrounding the payment of fees. If we allow the situation to continue, this will lead to the undermining of justice, as less experienced public defenders are used to defend complex cases. We must avoid the situation at all costs, where legal aid either ceases to operate or, if it does continue to operate, its services are of a very poor quality.
We note, further, that an amount of almost R4 million was used for technical support in the Department of Labour. A clearer statement on the breakdown of how this money has been allocated would have been very useful.
With these few words, the ACDP supports this Bill.
Miss S RAJBALLY: Mr Chairperson, the Adjustments Appropriation Bill is structured in a transparent, rolling budget format which supports effective planning to meet the policy priorities of national and subnational government.
One cannot deny that efforts have been made to implement the priorities within the country’s financial resources. In a sense, the national Budget facilitates a process in which expenditure responsibility complements revenue. All the needs have been thoroughly considered and determined accordingly, because resources are scarce.
Furthermore, not all goals can be met immediately and simultaneously. Therefore, trade-offs and prioritising are required to meet certain objectives that are outlined by the policy goals. The budget plan has managed to place emphasis on social service, which can act as a catalyst to strengthen the economy’s ability to grow.
The reform of the budgetary process has, to a certain degree, successfully met the objectives of the economy, and satisfied certain basic psychological needs of the electorate. Evidence of this exists in the distribution of the child support grant, the intensive campaign against HIV/Aids, housing projects and new local government structures.
The economy is dynamic, therefore, the budget policy framework is also dynamic. However, the MF is confident that, from year to year, the creative budget process will be implemented to circumvent difficulties that affect the economy.
The MF supports the Bill.
Prof B TUROK: Mr Chairperson, I would like to start off by commenting on what was said about the procedures in discussing this Bill. It seems to me there has been a bit of abuse of the Rules and Procedures of this House. When the Bill came to the Portfolio Committee on Finance, there was some discussion as to whether we should have a debate at all.
We all want lots of debate in this House, we are all political animals, we all wish to air our views, but we have to be appropriate in the way we behave in the House. The feeling in the ANC in the Portfolio Committee on Finance was that we did not need to debate this Bill. It is a technical Bill, it is an administrative Bill, and we thought that it should pass on the nod.
However, the hon Andrew from the DP made a big point about wanting the Bill
to be discussed. He said that he wanted to make two or three points in this
debate on behalf of the DP and therefore we agreed to the Bill being
discussed. We now find that the hon Lee is the spokesperson for the DP. He
is not a member of the Portfolio Committee on Finance, nor does he know
anything about finance. [Laughter.] I have observed, over some time, that
the hon Lee is not a yes man''. When the leader of his party saysno’’,
he says ``no’’. [Laughter.] Clearly, this is what happened on this
occasion. [Interjections.]
As for the hon Camerer, she is also not a member of the Portfolio Committee on Finance. I think she would claim some knowledge on finance, but she has never dealt with the issues which are before us today. So I think what is happening here is that there is a politicisation of a purely administrative process and, if it was not so late in the evening, I would have quite a lot to say on this matter.
What did strike me about the speech by the hon Lee, is that he was attacking the Government on three critical delivery issues. Although this is a technical Bill, he took the opportunity to deal with three critical issues facing this Government, namely housing, law and labour and, to my astonishment, he managed to bring in yet again the question of Aids. [Interjections.]
I do want to appeal to the hon Lee that we have had more than our fair share of comments on the Aids crisis and the Aids problem. To use the discussion of a technical finance Bill to broach, yet again, for the hundredth time, this issue, is really unfair to the House. In my opinion the Chair might perhaps have ruled him out of order. [Interjections.]
I also want to make a point about the question of the housing conference. Clearly Pretoria failed to pay its share, and the lesson the House must learn is that if the conference had been held in Cape Town, the money would have been paid without any problem. Maybe the department should take note of that.
Just to comment very briefly on the contents of the Bill, an African regional conference is a matter of major importance. Clearly we need to co- ordinate across the continent, we need to co-ordinate in the region, and anyone who raises any objection to that kind of issue perhaps ought not to be in the House.
Secondly, concerning the Legal Aid Board, the Portfolio Committee on Finance had long hearings and discussions on the Legal Aid board. It is vital to get that board on its feet and therefore this money must be allocated right away.
Regarding the labour issue, the issue of job creation and the presidential Jobs Summit is something that the whole House must support. People have talked about it a great deal and therefore this Bill is of great importance.
I have no hesitation in saying that the ANC supports the Bill and we regret, a little bit, that people have tried to make nonsense of what is a technical Bill and actually misrepresented the situation in the Portfolio Committee on Finance. [Applause.]
The MINISTER OF FINANCE: Chairperson, there is an old bit of economics which says ``talk is cheap because supply always exceeds demand’’. The 39 minutes of debate that we have had on this technical Bill, that nobody has had any disagreement with, merely confirms that old truism. It confirms the price of talk.
I would like to thank all the parties for their support for the Adjustments Appropriation Bill. [Applause.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Hon Minister, yes, indeed, in respect of time it appears that supply has exceeded demand, or rather demand has been much less than the supply here. That being the situation, that concludes the debate on this Bill.
Debate concluded.
Bill read a second time.
The House adjourned at 18:12.
__________
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- The Speaker and the Chairperson:
(1) The Joint Tagging Mechanism (JTM) on 4 October 2000 in terms of
Joint Rule 160(3), classified the following Bills as section 75
Bills:
(i) South African Reserve Bank Amendment Bill [B 62 - 2000]
(National Assembly - sec 75) - (Portfolio Committee on
Finance - National Assembly).
(ii) Judicial Matters Amendment Bill [B 63 - 2000] (National
Assembly - sec 75) - (Portfolio Committee on Justice and
Constitutional Development - National Assembly).
(iii) South African Rail Commuter Corporation Limited Financial
Arrangements Bill [B 64 - 2000] (National Assembly - sec
75) - (Portfolio Committee on Transport - National
Assembly).
(iv) African Renaissance and International Co-operation Fund
Bill [B 65 - 2000] (National Assembly - sec 75) -
(Portfolio Committee on Foreign Affairs - National
Assembly).
(2) The Joint Tagging Mechanism (JTM) on 4 October 2000 in terms of
Joint Rule 160(4), classified the following Bill as a section 76
Bill:
(i) Chiropractors, Homeopaths and Allied Health Service
Professions Second Amendment Bill [B 66 - 2000] (National
Council of Provinces - sec 76) - (Select Committee on Social
Services - National Council of Provinces).
- The Speaker and the Chairperson:
The following papers were tabled on 2 October 2000 and are now referred
to the Portfolio Committee on Education:
(1) Government Notice No 777 published in the Government Gazette No
21444 dated 11 August 2000, The date on which TEFSA ceases its
functions made in terms of the National Student Financial Aid
Scheme Act, 1999 (Act No 56 of 1999).
(2) Government Notice No 789 published in the Government Gazette No
21438 dated 11 August 2000, Approval that the pilot project Travel
and Tourism Standard Grade, Grade 10 - 12 becomes a fully fledged
instructional offering, made in terms of the National Education
Policy Act, 1996 (Act No 27 of 1996).
(3) Government Notice No R.848 published in the Government Gazette
No 21501 dated 1 September 2000, Correction notice to Government
Gazette No 21192 dated 18 May 2000, made in terms of the National
Education Policy Act, 1996 (Act No 27 of 1996).
(4) Government Notice No 3102 published in the Government Gazette No
21539 dated 6 September 2000, Call for public comment on draft
document - The National Policy Framework on Whole-school
Evaluation, made in terms of the National Education Policy Act,
1996 (Act No 27 of 1996).
National Assembly:
- The Speaker:
The following correspondence has been submitted to the Speaker of the
National Assembly by the Ministry of Provincial and Local Government:
Dear Dr FN Ginwala
National Assembly
P O Box 15
CAPE TOWN
8000
(021) 461 9462
GOVERNMENT'S RESPONSE TO THE SUBMISSIONS BY TRADITIONAL LEADERS ON
THEIR ROLE, POWERS AND FUNCTIONS
By direction of the Minister for Provincial and Local Government, I
forward herewith a copy of a letter signed by the President relating to
this matter for your information.
Yours sincerely
HEAD: MINISTERIAL SERVICES
PRESIDENT REPUBLIC OF SOUTH AFRICA
28 August 2000
GOVERNMENT'S RESPONSE TO THE SUBMISSIONS BY TRADITIONAL LEADERS ON
THEIR ROLE, POWERS AND FUNCTIONS
1 Your memorandum presented to me and dated 16 May 2000, your response
to the Discussion Document towards a White Paper on Traditional
Leadership and Institutions dated 29 June 2000, and our discussion
on 23 August 2000, have reference.
You will recall that we met on 23 August 2000 so that I could
present to you the Government's response to your submissions. You
then requested that Government's response be presented in writing.
At the conclusion of the meeting we then agreed as follows:
- That I would transmit the written response to you early this week;
- A copy of the letter would also be given to the other stakeholders
who have provided us with comments on the Discussion Document; and
- That nothing will be said publicly about what was discussed in our
meeting of the 23rd of August until this letter has been
dispatched.
I now hereby respond formally in line with the decision taken on 23
August 2000. In formulating this response, Government had recourse
to the memoranda of 16 May and 29 June 2000 referred to above.
2 Proposals by Government
1 Traditional leaders will, in line with the Constitution and the
relevant law, continue to discharge the authority currently vested
in them.
2 Government will process an amendment to the Municipal Structures Act
during the September 2000 session of Parliament and increase the
representation of traditional leaders in the municipal councils
from 10% to 20%. The increased representation relates not only to
local municipalities, but also to the relevant metropolitan and
district councils.
3 Government will review the role of traditional leaders in matters of
governance and ensure that they are accorded an appropriate role
within the intergovernmental relations structures. This review
will occur simultaneously with the current review of our
intergovernmental system. The principles of co-operative
governance will continue to guide us in this process.
4 Government will take steps to ensure that Provincial Houses of
Traditional Leaders and the National House are properly resourced
so that they may carry out their functions more effectively.
5 Where traditional authority areas have been subdivided as a result of
the demarcation process, the Municipal Demarcation Board will
reassess the situation. It must also be said that, ultimately, the
Board will have the final say on the matter, as it is an
independent body. The Chairperson of the Demarcation Board has
already been approached in this regard and will hold meetings with
the various Houses of Traditional Leaders and the respective
Premiers within the next ten days.
6 The national and provincial spheres of government administer laws
having a bearing on traditional leadership. With a view to
identifying which additional responsibilities may be assigned to
traditional leaders, various national departments and the affected
provinces have been asked to identify areas which may be so
assigned. The work relating to this has started already, and the
list of additional responsibilities produced thus far indicates
clearly that traditional leadership does indeed have a place in
matters of governance in our country.
7 The National departments involved in this process are:
- Agriculture;
- Arts, Culture, Science and Technology;
- Environmental Affairs and Tourism;
- Health;
- Home Affairs;
- Justice and Constitutional Development;
- Land Affairs;
- Minerals and Energy;
- Safety and Security;
- Water Affairs and Forestry; and
- Welfare, Population and Development.
8 The White Paper on Traditional Leadership, which will be finalised in
March 2001, will lead to the enactment of national framework
legislation in July 2001. This legislation will effectively
rationalise approximately 1500 pieces of existing laws relating to
traditional leadership.
9 The role of the various Houses will be reviewed with a view to
strengthening their participation in the national and provincial
legislative processes.
10 MEC's for Local Government will be advised to consider applying
Section 81(4)(b) of the Municipal Structures Act in their
respective provinces. This section empowers an MEC for local
government in a province, after consulting the relevant House of
Traditional Leaders, by notice in the Provincial Gazette, to
prescribe a role for traditional leaders in the affairs of a
municipality. Such a role will be consistent with the Constitution
and will bring traditional leaders and municipalities closer
together.
11 We will continue to conduct discussions with yourselves on all
outstanding issues. We will also continue to update you on
progress being made with the work that is currently underway.
3. Rural Local Government Model
1 Is is clear from the memoranda dated 16 May and 29 June 2000 that a
new model of local government in rural areas is being proposed. I
am familiar with the arguments being put forward in favour of the
proposed model, as these have been under consideration for a
number of years. It must be recorded that the existing model, as
provided for in the Constitution, was approved by the
Constitutional Assembly after an extensive and inclusive
consultation process.
2 It must be pointed out that during the colonial and apartheid eras,
the institution of traditional leadership was distorted in a
number of ways. These distortions included allocating to
traditional leaders functions that traditionally did not belong to
them. As a result of these distortions, this country has ended up
with a system that is not in line with the basic framework of our
Constitution. Most of these functions will now be performed by
local government structures, in terms of the Constitution.
3 The existing constitutional framework provides for a dual system
which provides for the retention of traditional leadership, while
at the same time allowing local communities to elect their public
representatives. This system was ushered in, in a phased manner
through amendments made to the Local Government Transition Act -
hence the election of rural councillors in 1995/1996.
4 In addition to your submissions, government has also analysed many
other submissions by other organisations and South Africans on the
Discussion Document towards a White Paper on Traditional
Leadership and Institutions. I am given to understand that the
general tenor of these submissions is known to you as these were
referred to constantly at the rounding up conference on the
Discussion Document which you attended on the 17-18 August 2000.
It is clear from these submissions that many South Africans
support the rural local government model provided for in the
Constitution.
5 The Government does not support the alteration of the existing local
government model. The proposal to disenfranchise a section of our
people negates the aspirations of millions, including some
traditional leaders, who fought for democracy.
4. Conclusion
1 The challenge we are faced with at this moment in time is to find a
way of stabilizing our system of governance in the rural areas by
creating a climate within which the institution of traditional
leadership and elected institutions of government can co-exist.
This is a challenging task, but it is achievable.
2 In tackling the enormous challenges facing us, Government,
traditional leaders and other stakeholders must jointly promote
the common ideal of nation building in our country. Government is
committed to promoting development throughout South Africa. We
will, together with you, continue to work out mechanisms, which
will ensure the attainment of these ideals.
Regards
T M MBEKI
Khosi F P Kutama
Northern Province House of Traditional Leaders
Private Bag X9503
Pietersburg, 0700
- The Speaker:
The following correspondence between the President of the Republic and
the Leader of the Official Opposition relating to the use of AZT in
rape cases and to other matters has been submitted to the Speaker of
the National Assembly by the Parliamentary Counsellor of the President
at the request of the President:
13 September 2000 Dear Madam Speaker
You may remember that on June 13 this year, the National Assembly discussed the budget vote of the Presidency.
During the debate, an exchange took place between the President and the Hon Mr Tony Leon relating to the use of the drug AZT in rape cases.
Subsequent to this debate, Mr Leon wrote to the President further to clarify his position on this matter. This led to an exchange of letters discussing this and other matters.
The President and Mr Leon then agreed that this correspondence should be made available to Members of Parliament, given both the nature of the issues discussed and the fact that the discussion began in Parliament.
Accordingly, I would, hereby, like to submit the relevant documents with a request that they should be made available to all Members of Parliament.
These documents are:
-
A transcript of the relevant exchange between Mr Leon and President Mbeki in the National Assembly on 13 June 2000. (Annexure A)
-
A letter from Mr Leon to the President dated 19 June 2000. (Annexure B)
-
A letter from Mr Leon to the President dated 27 June 2000. (Annexure C)
-
A letter from Mr John P Kearney, CEO of Glaxo Wellcome South Africa to Mr Leon dated 21 June 2000. (Annexure D)
-
A letter from President Mbeki to Mr Leon dated 1 July 2000. (Annexure E)
- A letter from Mr Ryan Coetzee to Mr Parks Mankahlana dated 7 July
- (Annexure F)
-
A letter from Mr Leon to President Mbeki dated 7 July 2000. (Annexure G)
-
A letter to the Editor written by Mr Kearney of Glaxo Wellcome published in the Sunday Times edition of 16 July 2000. (Annexure H)
-
A letter from President Mbeki to Mr Leon dated 17 July 2000. (Annexure I)
-
A letter from Mr Leon to President Mbeki dated 28 July 2000. (Annexure J)
-
A letter from Mr Leon to President Mbeki dated 5 August 2000. (Annexure K)
-
A letter from Mr Leon to President Mbeki dated 24 August 2000. (Annexure L)
- A letter from President Mbeki to Mr Leon dated 1 September 2000. (Annexure M)
I stand ready to meet the Hon Speaker at your convenience, to discuss any matters you may wish to raise in connection with the request contained in this letter. Your sincerely
Charles Nqakula Parliamentary Counsellor of the President cc The Hon Chairperson of the NCOP ANC Chief Whip Cape Town
ANNEXURE A:
EXCERPTS FROM THE DEBATE ON THE PRESIDENT’S BUDGET VOTE NATIONAL ASSEMBLY, 13 JUNE 2000
The LEADER OF THE OPPOSITION (Mr A J Leon):
We move to the second paradox of this Government, to which the President drew close attention this morning, and that is that it represents poor people globally, but neglects them locally. The President has taken on, as he told us this morning, the mantle of representing poorer nations on the world stage. For that, he deserves our acclamation and congratulations, and we are not stinting in giving them to him. But, paradoxically, and that for which the Presidency deserves the widest condemnation, the poorest people here at home have seen and heard little of their President this year. [Interjections.]
Those without jobs, those in dire poverty, and those living with HIV/Aids, have been left wondering what the future holds for them under this Government. The President’s questions about the causes of HIV/Aids have failed to reach their ears. And let me say, if that is the case, then perhaps they are less confused and, in one real sense, better off than if they had heard the mixed messages emanating from him and his office on this crucial issue.
I think the Aids debate is an acute one. I quote the words uttered on 10 May this year by Charlene Smith, who herself survived a horrific rape ordeal. Let us listen to what she said about the Government’s and the President’s stance:
If, instead of spending vast amounts of money on recreating the wheel, President Mbeki had taken up the GlaxoWellcome offer - the lowest in the world at R200 for 28 days’ supply of AZT - and made it available to rape survivors to prevent HIV, 10 000 rape survivors in South Africa would have got the drug. Eighty percent of them would not have sero-converted and become HIV-positive if raped by an HIV-positive person.
As the Americans would say, whom he met recently: Case closed.
The PRESIDENT OF THE REPUBLIC (Mr T M Mbeki):
The hon Tony Leon raises the matter of the use of AZT in instances where women have been raped. It is illogical. I do not know if the manufacturing company here, that manufactures AZT, is in fact selling AZT for that particular purpose or is giving it out to patients who are in those circumstances, because if they are doing that, I am not sure that it will be legal. The reason for that is that AZT is not licensed in this country for that particular purpose. Indeed, it is not licensed in any country in the world for that particular purpose. The reason for this is that the manufacturing company says that AZT is not a vaccine. Therefore, one cannot use it in this instance where somebody gets raped, possibly by somebody who is HIV-positive, and if one gives that person AZT, it will stop an infection. The manufacturing company itself says that AZT is not a vaccine and therefore it cannot work in the circumstances, which is why they have never applied for the licensing of AZT for that purpose in any country.
An HON MEMBER: What about the offer that they made you?
The PRESIDENT OF THE REPUBLIC: Glaxo Wellcome would not have made an offer to the Government for AZT to be used in this way. [Interjections]
The LEADER OF THE OPPOSITION: But they made an offer!
The PRESIDENT OF THE REPUBLIC: No, Tony, they did not. You should give me the evidence of the offer. We have discussed this matter with them. We have discussed this matter with them and have said that there is this demand which is strange, because they have not applied to the MCC for this purpose. There is not a single clinical study anywhere in the world which deals with this. The manufacturing company said that, of course, they would not apply for this particular application because it is illogical. It is absurd, because if it worked, then there would be no need to work further on a vaccine because this would be a vaccine.
It is very easy to check this one. We just need to telephone Glaxo Wellcome tomorrow. [Laughter.] It is quite easy to check that out. That member should try to speak to them again and tell them what I said about this. I say that it is not licensed in this country for that purpose. It is not licensed anywhere in the world for this purpose, because that company has not applied, for the reasons that I have indicated.
ANNEXURE B:
19 June 2000
Mr T M Mbeki President Republic of South Africa Private Bag X1000 PRETORIA 0001
Dear President Mbeki
I enjoyed participating in the debate on your Budget Vote and look forward to future encounters of this or a similar kind. Perhaps we could take the discussion further in a less adversarial forum.
I would, however, like to answer your challenge on the issue of HIV/Aids and the proposals concerning AZT and your response thereto. My statement to Parliament was along the following lines:
I think the AIDS issue is an acute one. I quote the words uttered on 1O May this year by Charlene Smith, who herself survived a horrific rape ordeal - she said about the Government’s and the President’s stance:
If, instead of spending vast amounts of money on recreating the wheel,
President Mbeki had taken up the GlaxoWellcome offer - the lowest in
the world at R200 for 28 days' supply of AZT - and made it available to
rape survivors to prevent HIV, 10 000 rape survivors in South Africa
would have got the drug. Eighty per cent of them would not have sero-
converted and become HIV-positive if raped by an HIV-positive person.
Obviously what I said is generally the view of rape and anti-AIDS victim Charlene Smith. Of necessity my remarks were somewhat elliptical because of the wide number of topics I had to cover in the very limited time available to me in your debate.
However, with respect to your response, I believe that my central contention is valid. You, of course, are correct to indicate that AZT is not a vaccine, which I did not suggest it was. It is, however, an anti- retroviral medication which will prevent sero-conversion in rape victims who are raped by an HIV- positive person.
I accept the accuracy of your statement that AZT is not registered with the relevant authority. But surely this is irrelevant? After all, Misoprostal, used in clinics by the Government’s own Department of Health to induce abortions, is also not registered by the MCC for that specific purpose. As I understand it, a 28 day course of AZT will boost the immunity of a woman raped by an HIV-positive person, thereby allowing her to fight the virus and increase her chances of not converting positive.
Kindest regards Yours sincerely A J LEON MP Leader of the Opposition
ANNEXURE C
27 June 2000
Mr T M Mbeki President Republic of South Africa Private Bag X1000 PRETORIA 0001
Fax: 012 342 1938 Dear President Mbeki Further to my letter to you of 19 June 2000 on the issue you raised in Parliament in response to my remarks about the so-called Aids vaccine, may I draw to your attention the enclosed response I received from the Chief Executive of Glaxo Wellcome.
Kindest regards Yours sincerely
AJ LEON MP Leader of the Opposition cc Dr M E Tshabalala-Msimang, Minister of Health
ANNEXURE D
GlaxoWellcome J.P. Kearney Chief Executive
21 June 2000
Mr A Leon MP Parliament of the Republic of South Africa P.0. Box 15 Cape Town 8000
Dear Mr Leon Thank you for your letter of 20 June 2000 and the copy of your written response to President Mbeki regarding the AZT drug issue raised in Parliament on 13 June 2000.
It is very kind of you to keep us informed of these developments and I am pleased to confirm that your reply to the President is essentially accurate on the scientific aspects of using AZT as post-exposure prophylaxis in individuals who have been raped.
Together with you and your Party, we look forward to the day when all individuals who have been subjected to the horrific crime of rape will have the opportunity to access anti-retroviral prophylaxis.
Glaxo Wellcome is committed to working together with the South African Department of Health and all relevant role players to improve access to drugs for HIV-positive individuals. Kind regards John P Kearney Chief Executive
ANNEXURE E
July 1, 2000 Dear Tony
Thank you for your letters of June 19 and 27, 2000 relating to the AIDS issue. Thank you also for the copy of the letter of the South African CEO of GlaxoWellcome, Mr J.P. Kearney.
As you are aware, during the last few months, I have tried to familiarise myself with all elements relating to the HIV-AIDS matter.
Necessarily, this has also meant studying as much literature as possible on the question of anti-HIV retroviral drugs.
What I said in Parliament was based on the information I had managed to garner on the issue you raised. As you correctly indicate, this related to the efficacy of AZT in stopping HIV infection in cases of rape.
Your statement, that 80% of women raped by HIV-positive men would not become HIV-positive if they are given AZT, has no scientific basis whatsoever.
In this regard, I suggest that, among others, you obtain a copy of the publication of the US CDC, MMWR September 25, 1998/47 (RR17). Among other things, the CDC says:
``no data exist regarding the efficacy of (anti-retroviral drugs) for persons with nonoccupational HIV exposure’’ (As you must be aware, `nonoccupational exposure’ includes rape.)
``Some physicians believe that anti-retroviral agents are indicated for persons with possible sexual, injecting-drug-use, or other nonoccupational HIV exposure. However PHS (the US Public Health Service) cannot definitely recommend for or against anti-retroviral agents in these situations because of the lack of efficacy data on the use of anti-retroviral agents in preventing HIV transmission after possible nonoccupational exposure. Efficacy and effectiveness data and additional epidemiologic information is needed …’’ and,
``Research is needed to establish if and under what circumstances anti- retroviral therapy following nonoccupational HIV exposure is effective.’’
The CDC makes this equally important statement:
``Postexposure anti-retroviral therapy should never be administered routinely or solely at the request of a patient. It is a complicated medical therapy, not a form of primary HIV prevention. It is not a `morning after pill’ …’’ (My emphasis).
In the same report, the CDC says that:
``The risk for HIV transmission … per episode of receptive vaginal exposure is estimated at 0.1%-0.2%.’’
In this regard, you might care to consider what it is that distinguishes Africa from the United States, as a consequence of which millions in sub- Saharan Africa allegedly become HIV positive as a result of heterosexual sexual intercourse, while, to all intents and purposes, there is a zero possibility of this happening in the US.
In your letter to me of June 19, you make the extraordinary statement that AZT boosts the immune system.
Not even the manufacturer of this drug makes this profoundly unscientific claim. The reality is the precise opposite of what you say, this being that AZT is immuno-suppressive.
Contrary to the claims you make in promotion of AZT, all responsible medical authorities repeatedly issue serious warnings about the toxicity of anti-retroviral drugs, which include AZT.
For example, in its Report, MMWR May 15, 1998/Vo. 47/No. RR-7, the CDC says:
``The selection of a drug regimen for HIV PEP (post-exposure prophylaxis) must strive to balance the risk for infection against the potential toxicity of the agent(s) used. Because PEP is potentially toxic, its use is not justified for exposures that pose a negligible risk of transmission.’’
In this context, please bear in mind the 0.1%-0.2% risk of transmission indicated by the CDC with regard to receptive vaginal exposure.
The matter is not in dispute between us that AZT is not licensed by the South African MCC for use in rape cases. Further to this, GlaxoWellcome has not applied to the MCC for such a licence.
Indeed, the approved package insert for AZT makes no claim about the efficacy of AZT with regard to rape cases.
I would presume that the reason that GlaxoWellcome has not applied for a licence is precisely because it knows that there is no scientific evidence it could produce to justify this application.
It is very strange that you have proven scientific information which GlaxoWellcome, the CDC, the MCC and every responsible medical authority does not have, that 80% of rape victims in our country would not have become HIV positive if they had been given AZT.
It may be that I underestimate the scientific expertise of which your Party disposes.
Accordingly, I am ready to change my views on this matter, to pay due tribute to such expertise, if it is demonstrated that you do, indeed, have such expertise.
If it is necessary, I can present the argument about the obvious logical absurdity of the claim that viral infection can be stopped by the use of drugs provided that the virus was communicated in circumstances of forced heterosexual sexual intercourse.
It is in this context, apart from extant scientific information, that the issue I raised in the National Assembly about AZT not being a vaccine assumes its relevance. The PEP argument about AZT (and other anti- retrovirals) cannot be sustained unless vaccine-like efficacy is attributed to these anti-retroviral drugs.
Accordingly, the statement you make in your 19 June letter that I am ``correct to indicate that AZT is not a vaccine, which I (you) did not suggest it was’’, is inconsistent with your argument that AZT should be used as though it were a vaccine.
I am very disturbed at Mr Kearney’s statement that your incorrect statements about AZT and rape are ``essentially accurate on the scientific aspects of using AZT as post-exposure prophylaxis in individuals who have been raped.’’
I imagine that all manufacturers of anti-retroviral drugs pay great attention to the very false figures about the incidence of rape in our country, that are regularly peddled by those who seem so determined to project a negative image of our country.
What makes this matter especially problematic is that there is a considerable number of people in our country who believe and are convinced that most black (African) men carry the HI virus.
In addition to this, reflecting a view among these about rape in our country, Charlene Smith was sufficiently brave, or blinded by racist rage, publicly to make the deeply offensive statement that rape is an endemic feature of African society.
This is what she wrote recently in the US Washington Post: ``Here, (in South Africa), HIV is spread primarily by heterosexual sex - spurred by men’s attitude towards women. We won’t end this epidemic until we understand the role of tradition and religion - and of a culture in which rape is endemic and has become a prime means of transmitting the disease, to young women as well as children.’’
The hysterical estimates of the incidence of HIV in our country and sub- Saharan Africa made by some international organisations, coupled with the earlier wild and insulting claims about the African and Haitian origins of HIV, powerfully reinforce these dangerous and firmly-entrenched prejudices.
None of this bodes well for a rational discussion of HIV-AIDS and an effective response to this matter, including the use of anti-retroviral drugs.
Whatever his obligations as the Chief Executive of the company that manufactures AZT, I think it is grossly unethical that Mr Kearney should seek to increase the sales of AZT, and therefore GlaxoWellcome’s profits, by exploiting the justified health concerns of our people.
I consider it deeply offensive and comtemptuous of our people, our country and its laws that, as you and Charlene Smith say, GlaxoWellcome should promote the sales of AZT by selling `cut-price’ AZT in our country for use by rape victims, knowing very well that this is in violation of the law and that no scientific evidence exists proving the efficacy of this drug in cases of rape.
I have noted the fact that Mr Kearney seeks to achieve his commercial purposes ``together with you and your Party.’’
It is amazing and completely unacceptable that you, the Leader of the Official Opposition, should consider all of this, including blatant disrespect for the rule of law, as ``irrelevant’’, the word you use in your letter to me.
You will remember that during the debate around the legislation we introduced enabling the parallel import of drugs and medicines, to make these affordable for our population that is deeply mired in poverty, your party was correctly and needlessly very vocal about the necessity to ensure that all pharmaceutical products available to our people should be subject to approval by the MCC.
Why is a double standard now being applied with regard to AZT, making the need for the certification of drugs by the MCC ``irrelevant’’?
Only recently, your party has been very strident in demanding respect for the rule of law in Zimbabwe.
Why is a double standard now being applied with regard to AZT, making the requirement for observance of the rule of law ``irrelevant’’?
In his letter to you, Mr Kearney says his company is committed ``to improve access to drugs for HIV-positive individuals’’.
In more direct and plain language, this means that, consistent with its normal and understandable commercial objectives, GlaxoWellcome is committed to increase the sales of AZT in our country, in competition with anti- retroviral drugs manufactured by other companies.
If Mr Kearney did not pursue this objective as vigorously as possible, his company would be entitled to terminate his contract.
You and I, as public representatives of our people, pursue, or should pursue, a different objective. With regard to the matter under discussion, our objective must surely be to improve the health of all our people.
I think that it is dangerous that any of our public representatives and political parties should allow themselves to be used as marketing agents of particular products and companies, including drugs, medicines and pharmaceutical companies.
I accept that it is perfectly within their right for private individuals, such as Charlene Smith, to play this role, as it would be for you, in your private capacity.
In the controversy that has attended the questions our government has raised about various matters relating to HIV-AIDS, much has been said about us, in a sustained effort to force us uncritically to accept a so-called orthodox view. We have resisted this pressure and will continue to do so, because of the decisive importance of an accurate understanding of AIDS and its specifics in our own country. I trust that our discussion about AZT and rape will convince you that despite the fervent reiteration of various assertions, supported by many scientists, medical people and NGO’s, about the existence of some unchallengeable and immutable truths about HIV-AIDS, as public representatives we have no right to be proponents and blind defenders of dogma.
Whatever the intensity of the campaign to oblige us to think and act differently on the HIV-AIDS issue, the instinctive human desire in the face of such a barrage, to obtain social approval by succumbing to massive and orchestrated pressure, will not lead us to become proponents and blind defenders of dogma.
The cost of AIDS in human lives is too high to allow that we become blind defenders of the faith.
Unless you have evidence to demonstrate that what I have said about AZT and rape is wrong, I would expect that you make a public statement distancing yourself from the false claims so regularly propagated in this country, concerning the efficacy of AZT as post-exposure prophylaxis in cases of rape, propaganda in which you joined.
Not only is this the only honourable thing to do, but, as a high-level public representative, I believe you have an obligation to correct the misleading impression on the matter we are discussing that you and your Party have conveyed on more than one occasion, in Parliament and elsewhere.
Needless to say, to uphold the rule of law and to fulfil the government’s obligations with regard to the health of our people, we will follow up on the matters you have brought to our attention, concerning the disturbing behaviour of Glaxo Wellcome.
Given that the matters about which you have written to me were discussed openly in the National Assembly, during which debate I suggested that you convey my views to Glaxo Wellcome, I believe that it would be correct that we make the correspondence between us available both to the National Assembly and the general public.
Once again, I would like to suggest that you inform yourself as extensively as possible about the AIDS epidemic. Again, for this purpose, I would like to recommend that you access the Internet.
On the various websites, you will find an enormous volume of literature, including CDC, WHO and UNAIDS documents, editions of various highly respected science journals as well as ``dissident’’ articles.
As you know, many frightening statements are made with great regularity about the incidence of HIV-AIDS in our country and continent and the threat this poses to our very survival as a country, a continent and as Africans.
I believe that it is imperative that all our public representatives should base whatever they say and do on the HIV-AIDS matter, on the truth and not necessarily on the comfort of fitting themselves into the framework of whatever might be considered to be `established majority scientific opinion’.
Yours sincerely THABO MBEKI The Hon A.J. Leon, MP Leader of the Official Opposition National Assembly CAPE TOWN
ANNEXURE F
7 July 2000 Mr Parks Mankahlana Spokesperson for the Presidency Per fax: 012 342 1938
Dear Mr Mankahlana
In his letter of July 1 to Mr Leon on the subject of making AZT available to rape survivors, President Mbeki said that he believed it correct to ``make the correspondence between us available both to the National Assembly and the general public’’.
In his response this morning, Mr Leon agreed.
Consequently, I have made the correspondence available to Ray Hartley of the Sunday Times. Please feel free to contact me in this regard. My cell number is 083 448 2693.
Yours sincerely Ryan Coetzee DP Executive Director for Political Management
ANNEXURE G
7 July 2000 Mr T M Mbeki President Republic of South Africa Private Bag X1000 Pretoria 0001
Fax: 012 342 1938
Dear President Mbeki
Thank you for your letter of the 1st of July. I appreciate the great time and effort that you have obviously put into your response, although I find much of the tone and content unhelpful in promoting rational debate on this important matter.
If I understand your letter correctly, you argue against the provision of AZT to rape victims on two grounds:
Firstly, you argue that there is ``no scientific evidence’’ to support the argument that the provision of AZT could prevent the transmission of the HIV virus to rape victims.
Secondly, you claim that the risks of potential transmission are so low that they do not warrant the use of AZT, which as you correctly point out can have severe side effects.
You base your argument on numerous quotes from the publication of the Centre for Disease Control in America, Morbidity and Mortality Weekly Report, September 25, 1998/ Vol 47/ No. RR-17. I do not believe that when read as a whole, the document supports your arguments. I will deal with each argument in turn.
The evidence from the CDC report which you provide to support your first
argument is a quote from the CDC which says no data exist regarding the
efficacy of (anti-retroviral drugs) for persons with nonoccupational HIV
exposure ... ''; the fact that the US Public Health Servicecannot
definitely recommend for or against anti-retroviral agents in these
situations because of the lack of efficacy data’’; and that further
research is needed ``to establish if and under what circumstances’’ such
therapy would be effective.
The CDC report is extremely even-handed. It scrupulously weighs up the evidence both for and against the provision of anti-retroviral drugs following non-occupational HIV exposure. You have unfortunately only quoted the arguments against. A point that must be made at the beginning is that the CDC does allow the provision of anti-retroviral drugs by physicians to rape victims. The document is an attempt to highlight the ``potential benefits and risks’’ and so provide a guide to physicians on whether or not to pursue such a course of treatment. The CDC has published formal guidelines for physicians should they choose to use AZT.
The reason for the lack of ``efficacy data’’ is that there have been no prospective trials conducted to measure the effectiveness of AZT for non- occupational exposure. It is simply impossible to conduct such trials because one would need to establish beyond doubt the HIV status of both the rape suspect and the rape survivor before and after the rape. While this in itself is almost impossible, the fact that it is illegal to test for HIV against a person’s will makes such research harder still. The best that can be done is to conduct a retrospective case control study. One is currently being conducted by the CDC.
It is for this reason that the CDC is unable to recommend either for or against anti-retroviral drugs for rape victims. This does not mean that there is ``no scientific basis whatsoever’’ for my statement that the provision of AZT would reduce HIV transmission to rape survivors.
In fact, the CDC report evaluates data from various trials, which could
have a bearing on the potential efficacy of anti-retroviral PEPs. It makes
reference to various trials conducted on animals, but I will deal only with
its references to studies on humans. Two are of significance: Firstly, the
CDC quotes the study (which I referred to in my letter) from a 1995 survey
where investigators used case control surveillance data from health care
workers'' in Europe and America to document that AZT usewas associated
with an 81% decrease in the risk for HIV infection after percutaneous
exposure to HIV-infected blood’’. According to the CDC this study
``demonstrated anti-retroviral effectiveness’’ following needle stick
injuries.
The CDC also refers to the study where there was a 67% reduction in
transmission of HIV from mother to child when AZT was administered during
pregnancy, labour, and for six weeks after birth. The CDC states that there
was evidence that a prophylactic effect'' on the foetus before, during or
after birthcould account for some reduction in perinatal transmission’’.
Although the CDC report acknowledges that these studies might not be
directly relevant to non-occupational exposure'' they dosuggest that
anti-retroviral agents are potentially valuable for treating HIV exposures
in these settings’’.
These trials are obviously not conclusive for they have to be extrapolated to non-occupational settings. However, they do suggest that anti-retroviral agents can act as a postexposure prophylaxis and reduce a person’s risk of acquiring HIV infection after exposure. The CDC report states ``it can take several days for infection to become established in the lymphoid and other tissues. During this time, interventions to interrupt viral replication could represent an opportunity to prevent an exposure from becoming an established infection.’’
Thus, if providing AZT to rape victims can prevent an exposure to HIV from becoming an established infection (and there is substantial evidence to suggest it can) the benefit is massive, if not priceless. The victim is literally saved from a death sentence.
Which brings me to your second argument, which is that the chances of HIV transmission from rape are so small, and the side-effects of AZT are so large, that providing such treatment to rape victims is not really worth the candle.
You quote the CDC as saying that in selecting a drug regime for post-
exposure prophylaxis the physician should balance the risk for infection
against the potential toxicity of the agent(s) used. Because PEP is
potentially toxic, its use is not justified for exposures that pose a
negligible risk of transmission.'' You then state,in this context,
please bear in mind the 0.1% - 0.2% risk of transmission indicated by the
CDC with regard to receptive vaginal exposure.’’ You seem to be implying
that receptive vaginal exposure'' constitutes anegligible risk of
transmission’’ and that consequently it is not worth providing rape
survivors with AZT with potentially toxic side effects.
This is disengenous for two reasons: Firstly, the risk of HIV transmission
following rape (particularly in South Africa) is not negligible'' at all.
Rape does not constitutereceptive’’ sex and as such is likely to lead to
trauma and consequently a far greater risk of HIV transmission. The risk is
compounded in South Africa by the high levels of HIV in the population as
well as the prevalence of Sexually Transmitted Diseases, which greatly
increase the possibility of HIV transmission. Secondly, the CDC is not
referring to rape or consensual sex when it states that PEPs are not
justified for exposures that pose a negligible risk of transmission''.
Rather, it is referring to contact between infected body fluid and intact
skin. This would be clear had you quoted the whole sentence from the CDC
report, which reads,Because PEP is potentially toxic, its use is not
justified for exposures that pose a negligible risk of transmission (e.g.
potentially infected body fluid on intact skin).’’ (My emphasis.)
This is just one example of where you have pruned quotes to make them fit
your argument. Elsewhere you quote the CDC report as saying Postexposure
anti-retroviral therapy should never be administered routinely or solely at
the request of a patient. It is a complicated medical therapy, not a form
of primary HIV prevention. It is not a `morning-after pill ...' (your
emphasis)''. Yet you omit to mention that the report continues (from
precisely the point where you left off)but, if proven effective, can
constitute a last effort to prevent HIV infection in patients for whom
primary prevention has failed to protect them from possible exposure.’’ (My
emphasis.)
Reading through your letter I had the strong feeling that you have reached your conclusions already. You then selectively choose quotes to support your argument, and ignored others that didn’t. If the quotes do not quite fit your purposes you lop off the awkward parts.
What is most disturbing about your letter is the way you impute sinister motivations on the bona fide actions of others. You seem to believe that the request by my Party, Charlene Smith and others for the government to provide AZT to rape victims, and the offer by Glaxo Wellcome to provide it at greatly reduced prices, is all part of a giant conspiracy. You imply that this conspiracy is the result of some unholy alliance between a civil society motivated by racism and an international pharmaceutical industry driven by greed.
It seems that underlying your letter is a belief that civil society is once again being driven by an overriding desire to reaffirm ``its belief that its racist stereotype of Africans [is] correct.’’ (ANC statement to HRC on racism in media)
Out of a determination'' to project anegative image’’ of South Africa
unnamed forces peddle what you describe as very false figures'' on the
incidence of rape in this country. You claim that the AIDS debate in South
Africa is being driven (and distorted) by peoplewho are convinced that
most black (African) men carry the HIV virus’’. Among their number you name
Charlene Smith who you claim was ``blinded by racist rage’’ when she wrote
that rape was endemic in South African society.
You proceed to complain that by publishing hysterical estimates'' (your
emphasis) and by makingwild and insulting claims’’ about the African
origins of HIV, the international community is (whether out of accident or
design) acting to ``reinforce these dangerous and firmly-entrenched
prejudices’’.
You then claim that the international pharmaceutical companies are driven
by even more sinister motivations. You suggest that the sole and overriding
desire of the pharmaceutical companies is to maximise their profits by
exploiting every available opportunity to flog their drugs to South Africa,
regardless of their efficacy or toxicity thereof. You claim that having had
their interest pricked by the high incidence of rape in this country, Glaxo
Wellcome set out to cynically exploit the justified health concerns of
our people'' in order to (once again)increase the sales of AZT’’. To top
this giant-racial-capitalist-conspiracy off you accuse Charlene Smith and I
of being ``marketing agents’’ of the pharmaceutical companies.
(For the record: Neither I nor the Democratic Party have received any financial assistance of any nature from Glaxo Wellcome.)
What concerns me about your letter is the tendency to turn questions of fact into questions of motive. This method of propaganda may be useful means of silencing (or isolating) your critics without responding to their arguments, but is not particularly conducive to rational debate.
It is somewhat hypocritical to accuse overseas opinion of intolerance and
then to try to shut down dissent domestically by labelling people
racists'' orpawns of the pharmaceutical industry’’. Your statement
that the government will take steps against the ``disturbing behaviour of
GlaxoWellcome’’ is frankly sinister.
Your determination to resist the imposition of what you call the ``dogma’’ of scientific opinion seems to be matched only by a desire to impose your own.
Yet what is most worrying for South Africa is that it seems your party has actually started to believe its own propaganda. Instead of identifying, confronting, and then dealing with the immense problems facing our country, the ANC is perpetually chasing shadows. You seem more concerned with the possibility that high rape and AIDS figures might confirm the prejudices of some, than with the massive human tragedy in our country which those figures are merely an indication of. In consequence, your obsession with the motives of others has begun to harm the interests of the very people you claim to represent.
As the earlier part of my letter has indicated, there are strong scientific grounds for providing post-exposure prophylaxis to victims of rape. I cannot see how the offer by GlaxoWellcome to provide AZT to rape survivors at reduced prices can be described as ``grossly unethical’’.
Similarly, I cannot see how you can equate the provision of AZT to rape survivors with the state sponsored campaign of terror and intimidation in Zimbabwe It is a nonsensical comparison.
I, like you, am a layman on these matters. You are entitled to your personal opinion on whether AZT is effective in reducing HIV transmission, and indeed, whether HIV even causes AIDS. However, it is wrong for you to use your current position (which was gained on the basis of political rather than medical talent) to block the provision by your government of such treatment.
It is perfectly consistent with the CDC report (which you quote!) for our government to make available AZT for prescription to rape victims. Obviously, our doctors must weigh up the risks and benefits of prescribing such treatment. They must act both with the informed consent of the patient, and according to proper guidelines such as the CDC provides. The point is that the physician and the patient must be left to make that decision. By denying rape victims AZT you are denying them the choice. With all due respect, you lack both the moral right and the medical expertise to make such a life and death decision.
I agree that this correspondence should be made available to the National Assembly and the general public.
Yours sincerely A J LEON MP Leader of the Opposition (Signed in Mr Leon’s absence.)
ANNEXURE H
Putting the AZT record straight (Sunday Times: 16/07/2000) GLAXO Wellcome is concerned that it has become a subject of last week’s correspondence between President Thabo Mbeki and the Leader of the Opposition, Tony Leon, as reported in ``AIDS: Mbeki versus Leon’’ (July 9), when South Africa and the world battle with a serious AIDS crisis.
This should be a time for stakeholders to come together to find common ground rather than a time to polarise the debate.
There were a number of misconceptions and errors contained in the two letters printed in your newspaper, and thus, to correct the misunderstanding and make a meaningful contribution to the discussion, Glaxo Wellcome wishes to put on record the following points:
- Glaxo Wellcome first offered preferential pricing of its two anti- retroviral products, AZT and 3TC, to the South African government for use in the public sector in 1997, and this pricing has since been put into practice through the State Tendering Authority.
The exchange between the President and Mr Leon implied that this
pricing was also offered for use following rape - causing concern at
Glaxo Wellcome because AZT is not registered for this purpose. All our
offers of preferential pricing in South Africa have been for the use of
AZT in prevention of mother-to-child transmission of HIV.
The company has not engaged in any price or supply negotiations to
provide AZT for use in rape survivors, nor does the company promote the
product, for that indication. Mr Leon has therefore misinterpreted the
company's offer.
- President Mbeki is correct in pointing out that Glaxo Wellcome’s package insert for AZT does not mention the medicine’s use in rape situations. For the reasons spelled out in Mr Leon’s letter, it has not thus far been possible to carry out clinical studies relating to the use of anti-retrovirals in rape survivors.
However, the medical profession's discretion to administer AZT to rape
survivors is supported by the recommendation of the Centres for Disease
Control in Atlanta, US, the worldwide authority on communicable
diseases. Furthermore, the CDC and other researchers are analysing the
issues surrounding rape and anti-retrovirals in an attempt to devise
appropriate clinical studies to test the effectiveness of medication in
preventing transmission in such circumstances.
- Glaxo Wellcome is proud of the highest ethical standards of its operation in South Africa and worldwide. Glaxo Wellcome SA does not engage in any direct or indirect support for political parties, as it believes that healthcare needs to transcend political discussion - although the company does provide information and assistance on its products when these are requested by a legitimate source.
Glaxo Wellcome's excellent track record was this year once again
confirmed when 151 general practitioners and 35 managed healthcare
leaders in South Africa voted Glaxo Wellcome as South Africa's most
ethical pharmaceutical ompany. We trust this clarifies the issue. - John Kearney, CEO, Glaxo Wellcome South Africa, Johannesburg.
ANNEXURE I
July 17, 2000
Dear Tony,
Thank you for your letter of 7 July 2000 which discusses various matters related to HIV-Aids. Unfortunately because of pressing engagements inside and outside the country, I could not reply to your letter earlier.
As you will remember, there was the exchange between us in the National Assembly related to the issue of the provision of AZT to rape victims. Accordingly, your own letters to me dated June 19 and 27 also discuss this particular matter. Your latest letter goes beyond this. For instance, you refer to such matters as needle-stick injuries and mother-to-child transmission, neither of which was under discussion between us.
Let me therefore return to the matter of AZT and rape and the matter of statements made by representatives of Glaxo Wellcome.
As you know, in his letter to you, the CEO of Glaxo Wellcome South Africa, Mr Kearney, said that your incorrect statements about AZT and rape were ``essentially accurate on the scientific aspects of using AZT as post- exposure prophylaxis in individuals who have been raped’’.
Yet, Dr Peter Moore, Medical Director of Glaxo Wellcome South Africa, had said on the television programme, Carte Blanche, on 7 November 1999:
I have to state emphatically that AZT is not registered and we do not recommend it for use after rape.’’ (My emphases.)
A rule of simple logic states that two diametrically opposed statements about the same thing cannot both be correct.
It was not possible that both Mr Kearney and Dr Moore, both of Glaxo Wellcome South Africa, could both be correct.
I am pleased to see that the CEO of Glaxo Wellcome has now repudiated what he said about your comments being ``essentially accurate on the scientific aspects … etc’’. As you will have seen in the Sunday Times edition of July 16, 2000, this is what Mr Kearney now says:
``The company has not engaged in any price or supply negotiations to provide AZT for use in rape survivors, nor does the company promote the product for that indication. Mr Leon has therefore misinterpreted the company’s offer.
``President Mbeki is correct in pointing out that Glaxo Wellcome’s package insert for AZT does not mention the medicine’s use in rape situations. For the reasons spelled out in Mr Leon’s letter, it has not thus far been possible to carry out clinical studies relating to the use of anti-retrovirals in rape survivors.’’
I trust you will also note that whereas Mr Kearney says his company does not promote AZT for use by rape survivors, Dr Moore says they do not recommend it for use after rape.
Given the gravity of the matter under discussion, this is not simply a matter of semantics. Perhaps Glaxo Wellcome will have an opportunity to clarify this matter in future.
As I said to you and the rest of the National Assembly, AZT is not registered in this country for use by rape victims. Neither has its efficacy for such situations been demonstrated scientifically.
Obviously, you did not believe what I said then and continued to communicate things I am convinced were clearly wrong.
You sought to convince us that there was proven efficacy of AZT in cases of rape and that Glaxo Wellcome had offered this drug at reduced prices for use in such circumstances.
You even went so far as to suggest that the fact that AZT was not registered or suggested for this indication was ``irrelevant’’.
I remain firmly of the view that had AZT been promoted and offered at reduced prices for rape cases, this would have constituted very disturbing behaviour on the part of Glaxo Wellcome, driven by nothing else except profit, with no regard for ethics and the health of our people.
It would require that the government take the necessary action to stop what would have been illegal behaviour.
I find it very interesting indeed that you consider the enforcement of the law in this regard as you say in your letter as ``frankly sinister’’.
In the National Assembly and subsequently, you communicated wrong things as fact. Glaxo Wellcome has now also stated that what you conveyed was incorrect.
This may come as a surprise to you, but given this reality, all normal human beings will naturally ask what your motives are in doing this.
Throughout our communication on the matter under discussion I have not resorted to any ``propaganda’’ as you allege. Neither have I sought to silence you.
What we are about is gaining as accurate and factual an understanding as possible with regard to the matter under discussion. As I am doing in this letter, I am quite ready to respond to all your arguments and hope that you are as ready to respond to mine without rancour.
You and Mr Kearney argue, as you say in your letter, that ``the CDC does allow the provision of anti-retroviral drugs by physicians to rape victims.’’
I can only interpret this as being nothing more, or less, than a determined attempt to ensure that rape victims use AZT and other anti-retroviral drugs.
Let me go back to the CDC documents I cited in my letter to you.
The CDC document MMWR September 25, 1998 / 47(RR17) - hereafter RR17 - says:
``Because no data exist regarding the efficacy of this therapy for persons with non-occupational HIV exposure, it should be considered an unproven clinical intervention.’’ (My emphasis.)
Although healthcare providers and others have proposed offering anti-
retroviral drugs to persons with unanticipated sexual or injecting-drug-
use HIV exposures, no data exist regarding the effectiveness of such
therapy for these types of exposures.'' (RR17). (My emphasis.)
Many insurers will not cover the cost of this unproven therapy, so any
possible benefit will be limited, based on the patient’s ability to
pay.’’ (RR17).
``The risk for HIV transmission per episode of receptive penile-anal
sexual exposure is estimated at 0.1%-3%; the risk per episode of
receptive vaginal exposure is estimated at 0.1%-0.2%. No published
estimates of the risk for transmission from receptive oral exposure
exist, but instances of transmission have been reported.’’ (RR17).
Commenting on studies of anti-retroviral agents used to prevent HIV infection in animals, the same document says:
``Treatment initiated within 24 hours of exposure and continued for 28 days appeared to have a greater effect than treatment initiated 72 hours after exposure. However, ZDV (AZT) might not be the optimal agent to demonstrate proof-of-concept because it has not demonstrated potent inhibitory activity against SIV infection in macaques even when treatment is initiated before viral exposure.’’ (RR17). (My emphasis.)
Presumably this is where you and Ms Smith found your figures about the need to dispense AZT within 24 hours of rape and to sustain this for 28 days.
Yet the same document concludes:
``Extrapolating these results to humans is problematic because of several factors … Animal studies offer proof-of-concept and demonstrate the challenges to understanding the requirements for effective use of anti- retrovirals to prevent HIV transmission in humans.’’ (RR17).
In your letter you draw attention to comments made in this document to the entirely different issues categorised in the document as:
-
``percutaneous exposure to HIV-infected blood’’ among health workers; and,
-
``perinatal transmission’’ of HIV to their child by HIV-infected mothers. The CDC goes on to say:
``Despite the apparent usefulness of anti-retroviral agents in perinatal and occupational settings, it is unclear whether these findings can be extrapolated to other settings. Further studies are needed before one can conclude whether using anti-retroviral agents to prevent HIV infection after non-occupational exposures is effective.’’ (RR17).
Whereas the CDC warns against the extrapolation of these findings to other, and specifically non-occupational, settings, you proceed to do precisely this.
You write:
``Thus, if providing AZT to rape victims can prevent an exposure to HIV from becoming an established infection (and there is substantial evidence to suggest it can) the benefit is massive …’’
Nowhere is it suggested in the CDC documents that thus the provision of AZT to rape victims can prevent exposure to HIV! Where is the substantial evidence to which you refer, when in your own letter you also say: ``The reason for the lack of `efficacy data’ is that there have been no prospective trials conducted to measure the effectiveness of AZT for non-occupational exposure’’! The allowance you assert the CDC gives for the provision of anti-retroviral drugs to rape victims is nothing more than a statement that the US Government has not banned the use of these drugs in cases of rape.
Any open-minded reading of its documents can only lead to one conclusion.
As stated by the CDC, that conclusion is that:
``Because of the lack of efficacy data for the use of anti-retroviral agents to reduce HIV transmission after a possible non-occupational exposure, PHS is unable to recommend for or against therapeutic approach … Research is needed to establish if and under what circumstances anti- retroviral therapy following non-occupational HIV exposure is effective.’’ (RR17).
I therefore find it extremely puzzling and very strange indeed that you describe this CDC document merely as ``an attempt to highlight the `potential benefits and risks’ and so provide a guide to physicians on whether or not to pursue such a course of treatment’’.
Repeatedly, the CDC says no data exist to demonstrate or disprove such benefit. Yet you say that the document, among other things, seeks to highlight potential benefits!
What the document does highlight are the risks of toxicity associated with the use of anti-retroviral drugs. Balanced against this, it gives the estimate for the risk of HIV transmission in the case of one episode of receptive vaginal intercourse as being almost zero.
What the CDC says is that if any physician should nevertheless decide to prescribe anti-retroviral drugs, despite everything it says, then such a physician should do a whole range of things, spelt out under 9 bullet points, including obtaining the informed consent of the patient.
So serious is this matter that the CDC says that such informed consent should be ``recorded in the medical charts of all persons prescribed anti- retroviral agents following non-occupational exposure’’.
The CDC says: ``The patient should be told that physicians have diverse opinion about the use of anti-retroviral medications to treat possible non- occupational HIV exposure and that PHS cannot make definitive recommendations because of limited knowledge.’’
Beyond all this, because of the problems of toxicity, the CDC says any
physician who decides to use these medications should do so in
consultation with an expert in the use of anti-retroviral agents'' andIf
physicians decide to use anti-retroviral agents, they should consult with
an HIV-care provider experienced with their use.’’ (My emphases.)
Your letter contains this extraordinary sentence:
``Rape does not constitute `receptive’ sex and as such is likely to lead to trauma and consequently a far greater risk of HIV transmission.’’
In all the literature I have seen, the words receptive'' and
insertive’’ are used to distinguish the passive from the active partner,
as during male homosexual intercourse.
Where the CDC referred to receptive vaginal exposure, this is to differentiate this exposure from receptive anal exposure and receptive oral exposure for women.
Clearly, in the event that no receptive exposure would have occurred, then no rape would have occurred. It therefore makes no sense to say, as you do, that ``rape does not constitute `receptive’ sex …’’
You also make the extraordinary statement that:
``The CDC is not referring to rape or consensual sex when it states PEPs are not `justified for exposures that pose a negligible risk of transmission’.’’
In this letter and, to some extent, the previous one I wrote to you, I quoted estimates the CDC made about the risk of HIV transmission in situations of homosexual and heterosexual sexual intercourse.
I trust that the planets you and I inhabit are not so foreign to each other, as seems to be the case, that we fail to agree that the receptive vaginal exposure to which the CDC refers, constitutes ``sex’’ in the colloquial meaning of this word.
I also trust that we will also agree that by any standard a 0.1%-0.2% risk of transmission in instances of receptive vaginal exposure, constitutes a negligible risk of transmission.
Indeed, the particular paragraph of the CDC document in which these figures are mentioned is headed - Probability of Transmission From One HIV Exposure!
The only conclusion `a reasonable man’ can reach from the CDC document is that the CDC is saying that the Probability of Transmission From One HIV Exposure in the event of receptive vaginal exposure is negligible, whatever the national levels of HIV infection, which you describe in our country as high.
Any other conclusion would obviously be illogical or constitute a wilful
attempt to disregard facts, for whatever reasons.
I do not understand how you came to the conclusion that negligible risk of
transmission' refers only to `contact between infected body fluid and
intact skin’’. Nowhere does the CDC say this.
It says that ``an estimated 95% of recipients become infected from transfusion of a single unit of infected whole blood’’.
Obviously, this represents an almost certain risk of transmission.
In the same paragraph, the CDC says ``the risk for HIV transmission per episode of intravenous needle or syringe exposure is estimated at 0.67%. The risk per episode of percutaneous exposure (e.g. a needlestick) to HIV- infected blood is estimated at 0.4% …’’
The figures relating to anal, vaginal and oral sexual exposure are, again, cited in this same paragraph which, as we have said, is headed Probability of Transmission From One HIV Exposure.
You say that, deliberately to mislead, I did not quote the words that appear in the CDC report, viz, ``e.g. potentially infected body fluid on intact skin’’.
The Oxford English Dictionary explains the expression e.g. as follows:
``Exempli gratia - for the sake of example.’’
Because of the strange twists of logic that litter your letter, you have transformed what was stated by the CDC for the sake of example into the totality of what the CDC sought to convey.
I am puzzled about why you find it necessary to do this.
You also complain that I omitted to mention certain CDC words that occur after its statement that anti-retroviral therapy ``is not a morning-after pill …’’ I note that, of course, you make no comment about this very firm CDC statement, given that you seem so keen that AZT should be given to rape survivors, despite the absence of any data to justify this, and despite the comments of Glaxo Wellcome.
Again, I do not understand why you think the particular fragment I did not quote helps your argument.
This fragment starts, ``If proven effective …’’ (My emphasis.) Here, the CDC is making the same point it makes throughout the document from which we have quoted, that the efficacy of anti-retroviral drugs with regard to non- occupational exposure has not been proved.
Accordingly, it says that if such efficacy is proved in future, ``post- exposure anti-retroviral therapy (which is not a form of primary HIV prevention) can constitute a last effort to prevent HIV infection in patients for whom primary prevention has failed to protect them from possible exposure.’’
I fail to see why you think this fragment which I ``pruned’’ from what I quoted, to use your word, helps your very curious determined defence of the scientifically indefensible.
In your letter, you also state that sexually transmitted diseases ``greatly increase the possibility of HIV transmission’’.
On this matter, the CDC says:
``Sexual activities associated with a risk of HIV transmission also are associated with risk for unintended pregnancy and STDs (e.g. syphilis, gonorrhea, chlamydia or hepatitis B virus).’’ (RR17.)
As you will notice, this is very different from what you say about greatly increased possibilities of HIV transmission.
You may have noticed that in my speech at the Opening Session of the 13th International Aids Conference earlier this month, I mentioned the incidence of STDs as one of the conditions that contribute to Africa’s health crisis and referred to teenage pregnancies.
I believe that STDs are very relevant to the collapse of immune systems among many Africans, including our own people, and therefore the acquired immune deficiency syndrome.
There are many scientists who have been conducting research into this matter for some time. One of these, John B. Scythes of Canada has written to the WHO as follows:
``Latent syphilis is chronic active syphilis from the immunological standpoint, and is both more dangerous for immune system genetics and harder to treat than exanthematous late syphilis. Judging from the work of Poland’s Jadwiga Podwinska and the late Tom Fitzgerald from Minnesota, a Th2 cytokine pattern begins to predominate in most persons with latent syphilis, and standard treatment does not reverse this phenomenon.
Subsequent re-exposure without Th1-driven immunologic anamnesis would lead to the silent re-dissemination of treponemes.’’
I hope that the international scientific panel on AIDS that we have convened will address the important issue of STDs.
However, whatever the impact of STDs on the immune system, the correct medical response to infection with these is to treat them using established therapies. None of these include the use of AZT or any of the other anti- retrovirals. The suggestion that because STDs impact negatively on the immune system, as does TB, they should therefore be treated with AZT, would constitute very serious medical malpractice.
I hope this is not what you are suggesting.
I also note that you make no comment whatsoever against the gravely insulting statement made by Charlene Smith about rape being ``endemic’’ in African culture.
Rather, you attach footnotes to your letter which, by trying to talk the rape figures upwards, seek to imply that she may, after all, be right.
My attention has also been drawn to Ms Smith’s denial, in a recent publication, of ever having written the passage I quoted in my letter to you.
In the event that you did not understand its true import, let me cite it once again.
``Here, (in South Africa), (AIDS) is spread primarily by heterosexual sex
- spurred by men’s attitude towards women. We won’t end this epidemic until we understand the role of tradition and religion - and of a culture in which rape is endemic and has become a prime means of transmitting the disease, to young women as well as children.’’
The article in which this appears is subtitled - ``Their Deaths, His Doubts, My Fears’’.
It appears in the Washington Post edition of June 4, 2000. Datelined
Johannesburg, the newspaper says it is By Charlene Smith'', described by
the newpaper asa South African journalist who writes about HIV, (who)
will speak at the International AIDS Conference in Durban in July’’.
Since she denies having made this nakedly racist statement, which you seek to justify in your footnotes, time will tell who between her and the Washington Post is prone to the shameless propagation of unembellished untruths.
The racist stereotype of Africans that many South Africans carry in their
heads has nothing to do with civil society''. The subterfuge of seeking
to hide behind the skirts ofcivil society’’ will not pass.
Your comments suggest that you are not aware of the fact that the figures
published about the incidence of HIV in our country and the rest of our
Continent are estimates.
Mathematicians and statisticians have questioned the reliability of these estimates and the correctness of making extrapolations, in our country, from information gathered among pregnant black (African) women at antenatal clinics, using highly questionable mathematical models. To understand the extraordinary distortion this creates, please try to get figures about the incidence of HIV-AIDS among the white population of our country!
I am certain you will find the search very frustrating and the result very illuminating! But, of course, I am likely to be quite wrong in assuming that a person as well informed as you are about HIV-AIDS does not already have this information.
You may also be unaware of the desperate attempt made by some scientists in the past to blame HIV-AIDS on Africans, even at the time when the USA was the epicentre of reported deaths from AIDS.
To me as an African, it is both interesting and disturbing that the
signatories of the so-called Durban Declaration'' return to the thesis
about the alleged original transmission of HIVfrom (African) animals to
humans’’, given what science has said about AIDS during the last two
decades.
I accept that it may be that you do not understand the significance of this and the message it communicates to Africans, hence your queer observation that I seek to silence our critics, without responding to their arguments.
In my letter of July 1, 2000 I took issue with you about the matter of double standards. In one instance this related to the matter of the rule of law, about which you campaigned with regard to the land question in Zimbabwe.
In this regard, you accuse me of making ``a nonsensical comparison’’.
Since the issue of the rule of law is a matter of principle, I believe that it is fundamentally incorrect to argue, as you did, that AZT should be prescribed for rape, despite the fact that the existing legal procedures had not been followed enabling this drug to be registered and legally dispensed for this purpose.
Strangely, you, the Leader of the Official Opposition, argue that my insistence on the observance of the rule of law is nonsensical.
Whereas you would not accept what I said in the National Assembly about the fact that Glaxo Wellcome neither asserted the anti-HIV efficacy of AZT in cases of rape and had not applied for its licensing for such a situation, I trust you now accept the truthfulness of these statements, since they have been confirmed by representatives of the company.
After all, relative to them, you do not occupy the position of ``an effective opposition’’.
Whatever your personal views, I trust that, as Leader of the Official
Opposition, you will understand and accept the proposition that it is
incorrect to argue for the observance of the rule of law in Zimbabwe and to
categorise its observance as irrelevant'' andnonsensical’’ in South
Africa when AZT is affected.
What I have said in this and the previous letter about the efficacy of AZT
in rape cases does not constitute a ``personal opinion’’, as you assert.
Unless they indicate otherwise, I would also assume that the manufacturers of AZT, Glaxo Wellcome, do not consider what I have said about what the CDC says about AZT and AIDS as constituting a ``personal opinion’’.
If there were any dispute about this, I would be very willing to ask the CDC whether it has changed its mind since 1998. On this matter, our government will therefore continue to act in a manner that is consistent with available scientific evidence. I have a political obligation to ensure that this happens, regardless of your own personal opinions.
I am certain that, as government, we are perfectly aware of the interests of the people we represent. We will continue to do everything we can to ensure that these interests are addressed, naturally within the context of the constraints imposed on us by the stubborn legacy of colonialism and apartheid.
That legacy includes the persistence of racist ideas in the minds and the psychology of many of our people and others elsewhere in the world.
I spend the amount of time and effort I do on the issue of AIDS because as a government we have to do everything necessary to deal with this syndrome and the destructive health crisis in our country and the rest of Africa.
None of this constitutes shadows'', as you allege, which allegation might
be informed by the fact that throughout their lives the majority of those
you represent have had thegood fortune’’ of being perhaps unwilling
beneficiaries of racist practice and recipients of supremacist racist
prejudice, and ideology.
I must also make the point that the formulation of correct policies and programmes makes it imperative that, as government, we proceed from the most accurate information we can access.
We will therefore always seek to obtain the accurate figures about such matters as rape and AIDS so that we adopt correct policies with regard to these important challenges.
We do not have the luxury to play political games with information, merely to advance party-political objectives.
As a government, we will not abdicate our responsibility to work for the health of all our people, leaving this matter exclusively to ``the physician and the patients’’, as you suggest.
I may have no medical expertise, but I have grave doubts that the fact of being the largest opposition party means that you are best placed to advise our government about the medical decisions it should take.
All of us have a moral obligation not to do anything we believe to be fundamentally wrong. This applies as much to Presidents as it does to Ministers who might feel that decisions of the President or the Cabinet are wrong.
No amount of pressure, however virulent, strident and sustained, will persuade me to betray this principle.
If nothing else, this is what many of us have learnt from a very long history of struggle by our people from liberation from oppression, contempt and lies.
I believe that common courtesy required that you inform me that you intended to release our correspondence to the media, as I would if I were handing this letter to the media.
The only thing we had agreed was the principle that the National Assembly and the general public should have access to the communications between us.
But, again, possibly we do originate from different planets with radically different value systems.
Yours sincerely THABO MBEKI
The Hon A. J. Leon, MP Leader of the Official Opposition National Assembly CAPE TOWN
ANNEXURE J 28 July 2000 His Excellency Mr T M Mbeki President of the Republic of South Africa Private Bag X1000 PRETORIA 0001
Dear Thabo
Thank you for your letter of 17 July 2000.
Let me begin my response by stating something which I should have made more strongly in my previous letter: I do not think it appropriate that politicians should decide upon technical and scientific issues. South Africa has world-class scientists, and they should be allowed to render judgment on such matters. Nonetheless, in your previous letter you chose to debate this issue on the technical and scientific merits of prescribing AZT, obliging me to respond to your arguments as best I could.
In your letter of 17 July you claim that John Kearney of Glaxo Wellcome has
repudiated what he said about your comments being `essentially accurate
on the scientific aspects' ...etc''.3 The basis of this assertion is Mr
Kearney's letter in the Sunday Times where he states that `you are correct
in pointing out that Glaxo Wellcome’s package insert does not mention the
medicince’s use in rape cases’’.
You appear to be making two assumptions: The first is that if a drug is not registered for a particular indication then there is ``no scientific evidence’’ to support its prescription for that particular indication; and, secondly, if it was prescribed for an unlisted indication this would be a violation of the law.
I have been advised that in order for a drug to be registered for a particular indication, a double-blind prospective trial needs to be conducted. In cases like AZT for rape victims (as I pointed out in my previous letter) it is simply impossible conduct such a trial. There are also various other (non-scientific) reasons why a pharmaceutical company may not seek approval for a particular indication. Thus because a (registered) drug is not registered for one or other specific indication does not mean there is ``no scientific evidence’’ to support its prescription for that indication.
I have been advised, further, that your assumption that providing AZT to rape survivors would constitute a violation of the law is equally invalid.
In your letter you state that if Glaxo Wellcome had offered AZT for rape
victims this would have constituted very disturbing behaviour'' and the
government would have totake the necessary action to stop what would
have been illegal behaviour.’’
Further on in your letter you state:
``Since the issue of the rule of law is a matter of principle, I believe that it is fundamentally incorrect to argue, as you did, that AZT should be the prescribed for rape, despite the fact that the existing legal procedures had not been followed enabling this drug to be registered and legally dispensed for this purpose.’’
You argue that it is illegal to provide a (registered) drug for a specific indication if the Drug Regulatory Authority has not registered it for that indication. This is simply not the case. There appears to be a confusion on two issues:
As the law stands no one may prescribe an unregistered medicine (such as Virodene) for any indication. But AZT is registered with the MCC and (as the law stands) doctors are free to use registered drugs for non- indicated purposes if, in their better judgment, they believe the scientific evidence supports it.
My research indicates that in the United States the law is similar. The fact that a drug is not listed for a particular indication, does not mean that it would be either illegal or medically inappropriate to do so.
For example, the American Food and Drug Administration (FDA) states that:
The Food, Drug and Cosmetic Act does not limit the manner in which a
physician may use an approved drug. Once a product has been approved for
marketing, a physician may prescribe it for uses or in treatment regimens
or patient populations that are not included in approval labelling. Such
unapproved'' or, more precisely,unlabeled’’ uses may be appropriate
and rational in certain circumstances, and may, in fact, reflect
approaches to drug therapy that have been extensively reported in medical
literature. (Source: American Medical Association - correspondence -
Chicago, Ill. 21.700).
This view is supported by the American Medical Association (AMA) which states:
The AMA reaffirms its policy that a physician may lawfully use an FDA- approved drug product or medical device for an unlabeled indication when such use is based upon sound scientific evidence and sound medical opinion; and affirms the position that, when the prescription of a drug or use of a device represents safe and effective therapy, third party payors should consider the intervention as reasonable and necessary medical care, irrespective of labeling, and should fulfil their obligation to their beneficiaries by covering such therapy. (AMA policy number H-120.988)
AMA policy definitively supports the unlabeled use of drugs as long as such use is based upon sound scientific evidence and sound medical opinion. Thus, your claim that prescribing a registered drug for a non-indicated purpose would constitute a violation of the rule of law is, with respect, baseless.
The question then is, would the provision of anti-retrovirals to rape
victims be based upon sound scientific evidence? A related question is:
Do politicians have the right to decide what constitutes sound
scientific evidence’ and ``sound medical opinion’’ or should this be
left to medical professionals?
In your letter you restate your arguments that there is no scientific evidence to support the provision of AZT to rape survivors and, further, that the CDC regards the risk of transmision through heterosexual sex (as well as rape) as ``negligible’’.
You claim that my description of the CDC document as an attempt to
highlight the `potential benefits and risks' and so provide a guide to
physicians on whether or not to pursue such a course of treatment'' is
extremely puzzling and very strange indeed.’’
I do not quite understand your reasoning here, for the document itself says:
``Health-care providers and their patients may opt to consider using anti- retroviral drugs after non-occupational HIV exposures that carry a high risk for infection, but only after careful consideration of the potential risks and benefits and with a full awareness of the gaps in current knowledge.’’ (Summary.)
The document then proceeds to discuss these potential benefits and risks, as well as the gaps in the current knowledge.
As the CDC study points out (and you repeatedly highlight) there is no direct data on the efficacy of anti-retrovirals as PEPs following non- occupational exposure. For this reason the CDC has had to resort to evaluating indirect evidence from animal trials; as well as from studies of the efficacy of AZT in reducing transmission of HIV both from mother to child, and in occupational settings.
You chastise me for mentioning these aspects of the CDC report (which you assert is an unacceptable widening of the scope of our correspondence) and claim that these are ``entirely different issues’’ not relevant to the matter under discussion. In fact, these studies are directly relevant for they show the efficacy of anti-retrovirals in preventing sero- conversion following HIV exposure.
In May 1998 the CDC released fairly prescriptive guidelines on the
management of occupational exposures to HIV (MMWR 47 (RR-7) 15 May 1998).
The decision to make these recommendations was based on the French case
control, which associated the provision of anti-retrovirals with an 80%
decrease in the risk of HIV sero-conversion following needle-stick
injuries, along with data on ZDV efficacy in preventing perinatal
transmission'' andevidence that post-exposure prophylaxis prevented or
ameliorated retroviral infection in some studies of animals.’’ (My
emphases.)
Thus, just as animal data and perinatal data were relevant in drawing up recommendations for occupational exposure, so is such data relevant (although not conclusive) in evaluating the efficacy of PEPs for rape survivors. What these various studies, cited by the CDC, show is that anti- retroviral drugs can prevent sero-conversion following HIV exposure. As the CDC states, ``Information about primary HIV infection indicates that systemic infection does not occur immediately, leaving a brief `window of opportunity’ during which post-exposure anti-retroviral intervention may modify viral replication.’’ (RR-7)
In your letter you state that the CDC document gives the estimate for
the risk of HIV transmission in the case of one episode of receptive
vaginal intercourse as being almost zero''. You then proceed to repeat
your argument that when the CDC statesanti-retroviral agents should
not be used for persons with HIV exposures that have a low risk of
transmission’’ they are referring to heterosexual intercourse. You state:
The only conclusion `a reasonable man' can reach from the CDC document
is that the CDC is saying that the Probability of Transmission From One
HIV Exposure in the event of receptive vaginal exposure is negligible,
whatever the national levels of HIV infection, which you describe in our
country as high.''
It is simply not true to assert that the CDC regards rape (or consensual
sex for that matter) as constituting anegligible risk of
transmission’’. When the CDC use the term negligible'' they are
referring to risks in the order of potentially infected body fluid on
intact skin. (Shaking hands and blowing kisses across a park would also
constitutenegligible’’ risks of transmission.) Quite obviously, there
is a far greater risk of acquiring AIDS from receptive vaginal exposure
than from body fluid on intact skin.
The CDC does regard risks in the order of 0.1% to 0.2% as constituting a
sufficient risk of transmission to justify the provision of anti-
retroviral drugs. This can be seen by referring back to the CDC report on
the management of occupational exposure to HIV (RR-7). That document
estimates that the average risk for HIV transmission after a
percutaneous exposure to HIV-infected blood is approximately 0.3% and
after a mucous membrane exposure is 0.09%.'' The CDC regards such levels
of exposure as constituting sufficient risk to warrant abasic 4-week
regimen of two (anti-retroviral) drugs for most HIV exposures.’’
Furthermore, forced sexual intercourse is likely to constitute a far higher risk of transmission than consensual sex (which is what the 0.1% to 0.2% figure is referring to.) Forced sexual intercourse can lead to trauma, which (as I said before) will lead to an increase in the risk of transmission. In the case of child or gang rape the risk of transmission (for obvious reasons) is even higher still.
In my previous letter I stated that the risks of transmission were increased by the high levels of STDs in South Africa. You then proceed down a side track, which ends up at this particular dead end:
``Whatever the impact of STDs on the immune system, the correct medical response to infection with these is to treat them using established therapies. None of these include the use of AZT or any of the other anti- retrovirals.
The suggestion that because STDs impact negatively on the immune system, as does TB, they should therefore be treated with AZT, would constitute very serious malpractice. I hope this is not what you are suggesting.’’
I was not suggesting that AZT should be prescribed for STDs. My point was that if one person has an STD there is a substantial increase in the chance of HIV transmission. The CDC states that an STD increases the chance of transmission of HIV three to five times. In a case of heterosexual sex this could increase the risk of transmission from 2 in a 1 000 to 1 in a 100. The CDC report (RR17) states that vaginal tears or bleeding, visible genital ulcers or other evidence of an active STD would all increase the risks of HIV transmission.
Although the CDC does not make a binding recommendation for or against the provision of anti-retrovirals following non-occupational exposure, it does regard such treatment as a perfectly acceptable clinical intervention by individual doctors. However, the lack of direct clinical data was not the only reason for the lack of a firm recommendation; there were two other considerations:
Firstly, the CDC document was not concerned solely (or even primarily) with possible HIV exposure caused by sexual assault. A major concern of the CDC was that if the general public thought that anti-retrovirals could be used as a ``morning-after pill’’ there would be an increase in risky behaviour and a decrease in adherence to preventative measures. Since no woman chooses to be raped this consideration is not applicable in cases of sexual assault.
Secondly, America has a far lower rate of both HIV infection and sexual assault than South Africa. This means both that in America rape is not a major means of HIV transmission, and that in a case of sexual assault there is far less likelihood that the rapist would be HIV positive. There is consequently a far lower risk of HIV transmission following sexual assault in America than in South Africa. Thus, it is not the important concern of public health policy in America that it is (or should be) in South Africa.
What I argued in my previous letter was that anti-retrovirals should be made available in the public health system for doctors to prescribe (according to proper guidelines) to rape victims. Such a course of action would be both legal and medically acceptable.
Indeed, as Mr Kearney notes in his letter to the Sunday Times ``the medical profession’s discretion to administer AZT to rape survivors is supported by the recommendation of the Centre for Disease Control in Atlanta, US, the worldwide authority on communicable diseases.’’
By refusing to make AZT or other anti-retrovirals available within the public health system you are preventing doctors from exercising that discretion.
This brings me to the issue I raised earlier: Do politicians, whatever their enthusiasm for scientific research, have the right to decide what constitutes ``sound scientific evidence’’?
In your various statements on the many aspects of the AIDS debate (Virodene, anti-retrovirals, the provision of AZT to pregnant mothers and rape victims, etc.) you have chosen to act as effective final arbiter on technical scientific questions.
I have tried to answer your assertions as completely as possible. But I
do not believe there should be a Mbeki theory of AIDS'' or aLeon
AIDS theory’’ for that matter. All of us have a simple duty, as public
figures, to consult the most scientifically informed - and best supported
- medical view and to go on that. It seems clear - and it was made clear again at the AIDS Conference in Durban - that the overwhelming weight of world scientific opinion is on the crisis before us. I think we must all have the humility to accept that, and not to second-guess the experts.
But I do not think that politicians are under any ``moral obligation’’ (in fact quite the opposite) to claim the right to deliver final judgment on questions of scientific fact. It is a totalitarian principle that political leadership is somehow on a higher plane to technical expertise, and is thus entitled to override the autonomy of all institutions in society.
There are, however, one or two other issues I must raise. First, I have no brief to defend or attack Charlene Smith. She is her own person.
But I think it is a fundamental mistake and profoundly misguided to associate matters of race with the AIDS crisis. This matter is just too serious for any of us to play politics, racial or otherwise, with the figures, since in our society allegations, or repeated assertions of racism, are appropriately very serious matters. Therefore, in my view, there needs to be a very clear basis in fact before one pronounces persons guilty of racism. There does not, with respect, appear to be such a basis in your gratuitous assault on Charlene Smith.
In your letter you dismiss Charlene Smith’s defence of herself in the Mail & Guardian and once again re-quote her as saying in the Washington Post (4 June):
``Here, (in South Africa), (AIDS) is spread primarily by heterosexual sex
- spurred by men’s attitudes towards women. We won’t end this epidemic until we understand the role of tradition and religion - and of a culture in which rape is endemic and has become a prime means of transmitting the disease to young women as well as children.’’
You claim that this is a ``nakedly racist statement’’. Yet nowhere in this quote does Charlene Smith make a racial distinction between Black, Coloured, Indian or White South Africans. You are reading into the statement a racial intention that is by no means evident.
In fact what she actually wrote was this:
``In Africa, even if we develop a vaccine or distribute billions of
condoms, and the continent is already awash in latex, unless we begin
working on male attitudes toward women - and that requires looking at
the role of culture, tradition and religion; we will get nowhere. In
doing this there is a need to reflect on how modernisation has warped
cultural attitudes. (Mail & Guardian 14 July 2000).
As you can see, in the article Charlene Smith sent to the Washington Post, she did not say (or imply) that rape was endemic in South African culture. What happened was that the Washington Post sub-editors cut down the article (by about a third); the question is, was there a dark and sinister racial motivation behind their action, or were they just trying to fit the article onto the page?
I actually think of Ms Smith as a rape victim and that she has been
publicly brave about her awful experience. She deserves your
understanding, not your vilification.
The ANC’s Statement to the HRC Inquiry on Racism in the Media made the
claim that all whites carry around a racist stereotype in their heads all
the time. This claim was made on the basis of no factual evidence
whatsoever and paid no regard to the deep changes this country has
experienced over the last twenty years. Nonetheless it seems to be a
belief shared by your spokesman, and it is implicit in your statement
that Many South Africans carry in their heads'' aracist stereotype
of Africans’’.
I would suggest that you take a moment to consider how deeply racist (in the true sense of the word) and offensive is this assertion. Just because a group of racially prejudiced ANC members sit around a table and agree with each other on how morally reprehensible a particular minority is, does not transform those prejudices into fact.
By labelling your critics (even those who mildly disagree with government
policy) as racist'', you cut your party off from new ideas. Since, you
could so easily dismiss your critics (both publicly and to yourself) you
did not test your ideas against those of your opponents in reasoned and
rational debate. It was far easier to dismiss a person asracist’’ than
to argue issues on the merits, or even acknowledge that your opponents
might just be right every now and then. As a result the thinking of your
party has stiffened into orthodoxy.
You will find that on the AIDS issue, South African and international opinion will simply not be bludgeoned into silence by tactics of moral blackmail or demonisation. I can understand your deep sense of frustration at this turn of events.
Lastly, you state that ``I believe that common courtesy required that you informed me that you intended to release our correspondence to the media.’’
As a matter of fact I observed all the courtesies which you suggest I did not. Although I dictated the letter from overseas our Executive Director, Ryan Coetzee, informed your Mr Mankahlana by telefax of our intention to publish (as we understood with your concurrence) the correspondence. Since we received no response from either fax number, we assumed that our proposal met with no disagreement from your Office. In fact it was you, not I, who specifically suggested we publish the correspondence in the first place.
But since you raise the issue of ``common courtesy’’ in our dealings perhaps you will allow me to comment on this issue more broadly. I have always treated you and your Office with the courtesy and the decorum your position and you personally are entitled to expect. However, I believe that as elected Head of State you have treated me, as elected Leader of the Opposition, with basic discourtesy since June 1999. I think you will find if you consult your opposite numbers in other constitutional democracies that the relationship between head of government and the leadership of the opposition in other countries, ranging from Botswana to Britain, is somewhat different from how you have chosen to conduct this relationship. Your immediate predecessor chose the path of consultation and will confirm that not once, or ever, was any confidential briefing in which he engaged the opposition, breached by the opposition.
Be that as it may, you are obviously entitled to adopt any style of behaviour that you deem appropriate. But you might wish to reflect on the fact that you have never once issued an invitation to the opposition to discuss matters of common concern to the country. It is only when the opposition has sought a meeting with government that same has been acceded to. In respect of projects which should unify the country, whether they be the Presidential Inauguration, the Millennium celebrations, the new Coat of Arms and national symbols, or even the latest ``South Africa Unlimited’’ project, such were either never discussed with the opposition, or we were slighted at the event concerned, or our participation in them was never sought.
The Constitution obviously requires of us robust debate and in this regard I have always accepted your original commitment in Parliament on 23 September 1994 when you stated:
``With regard to the matters that the hon member Mr Tony Leon raised, I
would like to agree with him about the role of the opposition and the
need for openness and candour, the need for good and robust debate, and
the need for us to accept the bona fides of our interlocutors.''
In the event, you appear to have changed your mind, fairly fundamentally, since then.
In conclusion, let me revert to the AIDS pandemic: I would far rather, Mr President, that you and I should work together on this supreme crisis facing our country. I agree entirely, for example, with what you say about other sexually transmitted diseases. I would be only too happy to stand on the same platform with you to back a campaign for the eradication of STDs whose prevalence does so much to help spread HIV/AIDS. I am not interested in whether my supporters or yours suffer more from STDs: this is not a matter of, as you put it, ``political obligation’’ or of whom one represents. You and I are both patriotic South Africans. We both want the best for our country and for all our countrymen and women. I will be only too happy to meet you at your earliest convenience to discuss how we may work together to dramatise that this is a crisis for all of us, that death and disease know no distinction of politics, creed or race. I believe that the sight of the President and the Leader of the Opposition working together in such a way would have a very great public impact and would show just how serious we are and how great the crisis is. This in itself could save lives. I beg you, let us make that our sole priority.
Kind regards Yours sincerely TONY LEON
ANNEXURE K
August 5, 2000
Dear Mr Leon
Thank you for your letter dated 28 July 2000. The positions you have taken with regard to the matter we have been discussing, the use of AZT in cases of rape, have been consistently wrong from the day this matter came up in the National Assembly in June.
The problem is that you seem to find it extremely difficult to admit this obvious fact.
The result of this is that the harder you try to advance indefensible propositions, the greater the difficulties you get yourself into. It seems clear that you are determined that neither established fact, nor anything else whatsoever, will deter you from pursuing your set goal of ensuring that rape victims use AZT.
In your letter of June 19, you claimed that AZT ``will prevent sero- conversion in rape victims who are raped by an HIV positive person’’.
As you must surely know by now, this statement has no substance in fact, since no trials have been carried out anywhere that would enable anybody to come to such a conclusion.
In the same letter you said, ``a 28 day course of AZT will boost the immunity of a woman raped by an HIV positive person.’’
Again, as you must surely know by now, this statement has no substance in fact, since no trials have been carried out anywhere that would enable anybody to come to such a conclusion.
You will also remember that in his 21 June letter to you, the CEO of Glaxo Wellcome South Africa, Mr Kearney, said ``your reply to the President is essentially accurate on the scientific aspects of using AZT as post- exposure prophylaxis in individuals who have been raped.’’
In my letter to you of July 17, I quoted Mr Kearney and Dr Moore, Medical Director of Glaxo Wellcome South Africa, as essentially repudiating this statement.
As you will remember Mr Kearney said his company does not promote (AZT)
for (rape survivors)''. Dr Moore said thatemphatically, (the company
does not recommend AZT) for use after rape’’.
In your response of 28 July, you carefully avoid any reference to these straightforward statements by the manufacturers of AZT, which address the very heart of the matter we have been discussing.
Despite this evasive action, you must surely know by now that not even the manufacturers of AZT support you in your campaign to sell AZT to rape victims.
In your letter of 19 June you said that it was ``irrelevant’’ that AZT was not licensed in this country for use by rape survivors. To prove your point, you cited the use of a particular drug to induce abortions, even though it was not licensed for these purposes.
Again, you advanced these arguments to promote the use of AZT by rape victims.
To assist you in your campaign and as you correctly point out, once more, Mr Kearney of Glaxo Wellcome came to your aid.
Indeed, he wrote in his Sunday Times letter that ``the medical profession’s discretion to administer AZT to rape survivors is supported by the recommendation of the Centres for Disease Control …’’
In your letter of 28 July you expend a lot of effort to defend this position, to promote the administration of AZT to rape survivors.
The FDA and AMA statements you cite in this letter make the points that the use of approved drugs for indications for which they are not registered would be permissible ``in certain circumstances’’. (FDA).
In the text you have cited, the FDA says such use ``may, in fact, reflect approaches to drug therapy that have been extensively reported in medical literature’’.
In the text you have cited, the AMA says such use should be ``based upon sound scientific evidence and sound medical opinion …’’
Surely, you must know by now that the use of AZT in cases of rape meets neither of these FDA and AMA conditions.
Apart from anything else, you restate the point that ``in cases like AZT for rape victims … it is simply impossible to conduct such a trial’’, (that would provide sound scientific evidence proving the efficacy of AZT in cases of rape.)
In my letter of July 1, I told you that ``if it is necessary, I can present the argument about the obvious logical absurdity of the claim that viral infection can be stopped by the use of drugs, provided that the virus was communicated in circumstances of forced heterosexual sexual intercourse.’’
Imminent within this logical absurdity, is the equally absurd notion that drug trials can be conducted to test the efficacy of AZT in cases of rape.
I am glad that you have now understood that ``it is simply impossible to conduct such a trial’’.
I am still puzzled about where you and Ms Charlene Smith found the evidence you presented to the National Assembly that, if given AZT, ``80% of (women) would not have sero-converted and become HIV positive if raped by an HIV positive person.’’
Given what you, yourself, quote from the FDA and AMA, I am deeply concerned that Mr Kearney of Glaxo Wellcome still finds it possible publicly to state, in support of your campaign, that ``the medical profession’s discretion to administer AZT to rape survivors is supported …’’
Glaxo Wellcome is a major and long-established pharmaceutical company. I do not believe that its representatives are not familiar with the rules and guidelines laid down by such bodies as the FDA and the AMA.
Neither do I believe that its senior representatives would not know that there is no basis whatsoever for the claim that ``the medical profession’s discretion to administer AZT to rape victims is supported …’’
Taking the totality of Mr Kearney’s public comments together, I find it difficult to avoid the conclusion that he is determined to say things here that no Glaxo Wellcome representative would say, for instance, in the US or the UK.
When I have said that we should act to enforce the spirit and the letter of the law with regard to the use of medicaments, you have sought to express your horror at this idea.
Nevertheless, I must remind you that our oath of office enjoins us to defend the laws and the Constitution of the Republic.
In your letter of July 28, you say that you have been advised that my ``assumption that providing AZT to rape survivors would constitute a violation of the law is equally invalid’’.
I trust that you now understand that you have no basis of any kind to substantiate the argument that the positions I have taken are invalid on scientific/medical grounds.
However passionate your commitment to AZT, I also hope that now you understand that your FDA and AMA quotations provide you no basis to assert the legal invalidity of my arguments.
You are a lawyer and I am not. Nevertheless, I must disagree with your interpretation of South African law, as it applies to the matter we are discussing.
In your June 19 letter you refer specifically to a medicament used to induce abortions, despite the fact that it is not licensed for this purpose. You identify this product as ``Misoprostal’’.
In a legal opinion to the Director General of Health dated 1997-02-04,
relating to this specific matter of what they call misoprostol'', the
State Law Advisers say:
With regard to the Department’s view that medical practitioners can use
a medicine for an unapproved indication in a professional situation where
it is deemed in the interest of the patient, Steyn Die Uitleg van Wette,
(5th ed.) on page 228-229, remarks that where the authorised person or
body uses his statutory powers in the public interest but for an
unauthorised purpose, the act will be ultra vires.’’
Further, the State Law Advisers say:
``We are … of the opinion that the Council (MCC) cannot in terms of section 21 of the (Medicines and Related Substances Control) Act, authorise the use of the medicine (misoprostol) for a purpose not previously provided for …’’
On this same matter, Professor S.A. Strauss, Professor Emeritus of Law of the University of South Africa has written:
``Off-label use can legally take place only if the conditions of
registration have been duly amended. Application may in terms of
section 15A of the Act be made for amendment of entries in the medicine
register. But the section makes provision for such amendment only `on
application by the holder of the certificate of registration', which
will normally be the manufacturer or its authorised distributor of the
medicine involved.''
Later, Professor Strauss says:
A practitioner who uses a medicine for the treatment of an indication
not approved of by the MCC when registering a medicine, may expose
himself to a civil action under common law for damages if the patient
were to suffer harm in consequence of off-label use ... The mere fact
that off-label use might constitute atechnical’’ criminal offence in
terms of the Act, would not lead to an inference of negligence. But in
the event of a criminal conviction, the Medical Council might take
disciplinary action against the practitioner for unethical conduct.
Unjustified and potentially harmful off-label use would in any event
decidedly be regarded as unethical.’’
I accept that the above are, merely, `legal opinions’.
You write that you have been advised that the view of government, that it is illegal for medical practitioners to use drugs for purposes other than those for which they have been licensed, is invalid.
That, too, is merely, a legal opinion.
I hope that any medical practitioner who acts on your advice, and dispenses AZT to rape victims, will do so knowing the possible legal consequences indicated in the medical opinions I have cited.
Relying on these opinions, our Department of Health is of the view that
medicines should be used for the specific indications for which they are
registered, in compliance with the requirements of the Medicines and
Related Substances Control Act of 1965. I do not agree that providing
AZT to rape survivors'' would notconstitute a violation of the law.’’
Accordingly, I will continue to insist that respect for the rule of law requires that all of us must demand that AZT should not be used for a purpose for which it is not registered, for which no registration application has been made and for which no efficacy data exist.
I still find it completely unacceptable that the Leader of the Official Opposition should, in a democracy, blatantly urge defiance of the law. Given that you seem to agree with Glaxo Wellcome on a number of issues, it might help that you talk to them to overcome their reticence and try to have AZT registered for use in cases of rape.
If, for some reason, the MCC agreed to this, that would end the prospect of possible civil and criminal action against medical practitioners who prescribe AZT in rape cases, which you fervently urge.
Such an MCC decision would be taken despite the fact that the manufacturer does not approve of this and despite the fact that no scientific evidence exists to justify such use.
Given the extant literature on non-occupational PEP, some of which I have cited in the previous letters, I do not believe that there is any need for me to comment on the outlandish remarks you make in your last (28 July) letter.
In this letter you say: ``if one person has an STD there is a substantial increase in the chance of HIV transmission.’’ (My emphasis.)
There is no evidence anywhere to support this bold assertion.
The `orthodox’ position, as I understand it, would be stated thus: any person suffering from an STD stands a greater possibility of HIV infection.
According to this proposition, whatever its merit, the transmitter of the HIV may very well be free of any STD. If, however, the `receptive’ person suffers from an STD, his or her risk of being infected by HIV increases.
Your bold and wrong assertion is based on the assumption that there is a strong relationship between affliction with an STD and being an HIV carrier.
To clarify this matter, in my last letter I drew your attention to the association between STD’s and acquired immune deficiency.
It is most odd that, even as the CDC is working to improve its focus on
STD’s precisely because of this, you consider my comments a side
track'' and adead end’’.
With regard to the issue of comments that appeared under Ms Charlene Smith’s name in the Washington Post of June 4, 2000, clearly, in terms of your July 28 letter, you have access to the sub-editors of this newspaper that I do not have.
Because of this, you even know by how much her article was cut down by these sub-editors.
You must also maintain particular relations with her to state so unequivocally, (in your July 28 letter), that ``in fact what she actually wrote was … ‘’ (My emphasis.)
For our present purposes, let us accept that in her unedited article (and her convictions) Ms Smith was referring to Africa, rather than South Africa specifically.
Perhaps wrongly, I wonder what Ms Smith knows about Africa.
I would be very interested to hear from you how, in her view, ``modernisation has warped cultural attitudes’’ in Egypt and Morocco, Mali and Nigeria, Cameroon and Rwanda, Ethiopia and Tanzania, Namibia and Mozambique, Cape Verde, Madagascar and Reunion.
I would be very interested to hear from you what she says about ``the role of culture, religion and tradition’’ in these countries, which leads her to conclude that vaccines or condoms will prove useless in the fight against AIDS in these countries.
For example, how have the Hausa-Fulani, Yoruba and Ibo traditions and cultures of Nigeria been warped by modernisation, such that the accepted anti-AIDS interventions will not work?
How do the African, Moslem and Christian religions of Nigeria relate to this matter, such that they make it impossible for these interventions to achieve results?
In what ways do the traditions, cultures and religions of Nigeria make Nigerian women and Nigerian society as a whole, prone to HIV/AIDS, unless warped Nigerian cultural attitudes are `reflected’ upon, by whosoever?
You say that what I read in the Washington Post was not what Ms Smith intended to say.
Clearly, you are best placed to pose the question to the Washington Post, whether its sub-editors were promoting a racial objective, or were merely trying ``to fit the article onto the page’’, when they reduced (and rewrote?) Ms Smith’s article. Unlike you, like the normal readers of the Washington Post, I had to proceed from what I read, and not what had been written originally, which, allegedly, was subsequently edited in a particular way.
The article I read, attributed to a South African journalist, has a
paragraph I quoted, which begins with the word here''. Accordingly, I
readhere’’ to mean South Africa.
In my letter to you, I said the statement I read was racist, a view I have not abandoned, but which you contest.
In the main, white South Africans are, in their religions, Christian and Jewish. They have cultures and traditions that are somewhat different from those in your letter you describe as ``Black’’.
I would be most interested to see the evidence you and Ms Smith have that
demonstrates that, as a consequence of tradition, religion and culture
among these white South Africans, rape is endemic'' and isa prime
means of transmitting (AIDS) to young women as well as children.’’
Could you also produce similar evidence with regard to the groups you identify as ``Black, coloured (and Indian)?’’
The valuable information you will supply on this matter will help us to settle the issue whether I was right or wrong to interpret Ms Smith’s published comment as racist.
All rape is reprehensible. I was as distressed when I heard about Ms Smith’s rape as happens whenever I hear of any incidence of rape. Accordingly and unreservedly, I sympathise with her.
In Ms Smith’s case, I immediately spoke to the then Minister of Safety and Security to take all necessary measures to ensure that the culprit was apprehended and charged.
The Minister kept me informed about this matter constantly, relating even to the means the SAPS used to identify the culprit.
I know that none of this could ever undo the grave harm and damage done to Ms Smith. Over this specific incident, I have no influence. I, like other people, did what I had the power to do.
I have not sought to vilify Ms Smith.
But, neither do I accept that her terrible and unacceptable ordeal gives her licence to propagate racism, as I am convinced her published Washington Post comments do.
I also do not accept that her terrible and unacceptable ordeal entitles her to say wrong and absurd things about AZT and rape.
Comment by anybody on such matters as the efficacy of drugs and the roles of tradition, religion and culture have to be dealt with on their merits.
We have fought against racism throughout our lives. We have made enormous sacrifices to achieve the goal of a non-racial South Africa, which is yet to be realised. We have occupied and continue to occupy the frontline in the struggle to avoid a racial explosion in our country.
We do not need anybody to educate us about the imperatives to fight against racism and to transform South Africa into a country that belongs to all who live in it.
You would do well to listen to those who have been and continue to be victims of the most virulent racism.
Difficult as it may be, the least you might try to do is to fight against the tendency to hold in contempt those whom white South Africa has held in and treated with contempt for many centuries, even if you do not quite understand everything they mean when they speak.
I do not understand how you can be a fighter against racism in our country, if you do not understand the simple, obvious and unhidden reality that ``many South Africans carry in their heads a racist stereotype of Africans.’’
That you contest this tells me that you would not understand the racism in the classic white statement - some of my best friends are black - and its equivalent black statement - some of my best friends are white.
As a result of your determined effort to promote AZT, you make the meaningless statement in your 28 July letter that it is not ``appropriate the politicians should decide upon technical and scientific matters.’’
The National Assembly, in which you sit as Leader of the Official Opposition, has to take decisions about many ``technical and scientific matters’’, when it considers many of the draft statutes it has to pass into law.
In its normal work, the executive has to take many decisions on ``technical and scientific matters’’.
For example, our legislature and executive have taken the decision to spend public funds to build a new and powerful telescope, located in the Northern Cape.
You argue that neither the legislature nor the executive should have taken this decision, as it was a ``technical and scientific matter.’’
The US government has been discussing the highly technical and
scientific matter'' of the possible development, deployment and use of
anti-ballistic missiles, seemingly a version of thestar wars’’ of the
Reagan years.
This is one of the issues on which the presidential candidates in the US are campaigning. The development etc., of ABM’s is highly ``technical and scientific’’. You argue that, because of this, politicians should play no role with regard to the development etc of ABM’s.
You need to know this that US politicians will be involved, in a decision- making capacity, at all stages of the evolution of this issue, however ``technical and scientific’’ it may be.
They are morally obliged thus to be involved. There is absolutely nothing totalitarian about this. Neither does it constitute ``overriding the autonomy of all institutions of society.’’
I would like you to understand this that it is deeply offensive for you to present yourself as the great defender of democracy in contrast to us, whom you are determined to project as a present and imminent threat to democracy.
You take exception to the statement I make in my letter of July 17 that ``all of us have a moral obligation not to do anything we believe to be fundamentally wrong’. The position you have taken, that there is no moral obligation that attaches to our actions if we are acting on the advice of technicians and scientists, tells me that I was correct when I said, in my July 17 letter to you, that perhaps we inhabit different planets.
Let me assure you that as long as I have to occupy a decision-making position within our politics, so long will I take such decisions as may be necessary and morally defensible, whatever institution makes recommendations according to its mandate and possibilities.
The idea that, as the executive, we should not take decisions we can defend, simply because views have been expressed by scientist-economists, scientist-agriculturists, scientist-environmentalists, scientist- pedagogues, scientist-soldiers, scientist-health workers, scientis- communicators, etc, is absurd in the extreme.
It is sad that you feel compelled to sink to such absurdity, simply to promote the sale of AZT.
Parks Mankahlana did not know that we were writing to each other on the matter we have been discussing.
When you took the unilateral decision to give our letters to the Sunday Times, you should have consulted me on the issue, rather than refer it to Parks Mankahlana.
My ``office’’ did not write to you. I did.
Common courtesy required that you tell me, not Parks Mankahlana or my ``office’’, that you intended to hand our correspondence to the Sunday Times.
The broader issue you raised about how the President of the Republic and the Leader of the Official Opposition should relate to each other is completely irrelevant to the matter we have been discussing.
We have to develop our own South African conventions in this regard. References to such countries as Botswana and Great Britain will not necessarily help.
It has seemed to me that you set great store by your being a vigorous and uncompromising opposition to the government. You have argued that unless you played this role, democracy in our country would be threatened.
I am told that your party has put up posters suggesting that if you were not the vigorous opposition you pride yourselves to be, South Africa would degenerate into a ``Zimbabwe’’.
I have also heard and seen comments made that our efforts to encourage the development of a consensus around a jointly determined national agenda, amounts to an attempt at cooption and the silencing of alternative, critical points of view.
This has given cause to some to reject the call Nelson Mandela made for the development of an adherence to a new patriotism.
So vital to the survival of democracy is the existence of this consistently opposition view, that, so it has been said, various actions of the President cause concern.
Among these actions was our failure to appoint certain people as Ministers, who were thought by some to be precisely the people who, within Cabinet, would differ with the President.
It was these, so it was said, who would guarantee the health of our democracy, rather than, again it has been said, the time serving ``yes- men’’ who dare not speak their minds and criticise the President, if they think he is wrong.
Your Party and its supporters have been very active in promoting this overall view.
I am quite happy to restate that I will not oppose this approach ``about the role of the opposition and the need for openness and candour, the need for good and robust debate, and the need for us to accept the bona fides of our interlocutors’’.
Contrary to what you write, I can think of nothing that would indicate that we have changed from this position.
In addition, I have said this is in the National Assembly, that in any case, the DP and the ANC differ so radically in their philosophy and politics that they are, truly, objectively and effortlessly, opposed to each other.
Given all this, it seems to me that your remarks in your letter of 28 July, prompted by my comments about `common courtesy’, represent an attempt to have your cake and eat it.
Accordingly, you want to present yourself as an uncompromising opposition force, naturally, in the interest of democracy.
Simultaneously, you want to be seen as being of such importance that you are given the space to help determine the decisions of the executive, and therefore the evolution of our country.
In your letter, you argue that the President should assist you to evolve and present this Janus-face, in your interest. Frankly, I do not see why, in the interests of a better South Africa, I should.
I am certain that, in time, conventions will develop, governing the relations between the President and the Leader of the Official Opposition.
You have not listened to the suggestions I have made in this regard, deeming them to be inimical to democracy.
I respect your views on this matter and accept your bona fides. The future will decide the matter of what stable conventional balance our country arrives at, relative to our respective views.
In the meantime, I will continue to respect and defend your right to be a vigorous opposition, without seeking to find conventions from anywhere in the world, that seek to give the possibility to the executive to circumscribe this legal and constitutional right.
The ruling party, which constitutes the first point of the origin of the mandate the President exercises as head of government, must also discharge its popularly mandated obligation to rule.
I trust that, as the opposition, you will respect and defend the legal and constitutional right of the ruling party to govern, without seeking to circumscribe this by invoking supposed conventions in Botswana, the UK and other countries.
I would like to encourage you that, indeed, you must campaign for the elimination of STD’s, as well as all the other obstacles that obstruct our people’s effort to rebuild their lives.
There is no need, whatsoever, that you wait for the moment when the President and the Leader of the Official Opposition can do this together, sharing the same platform.
You state that the appearance of the President and the Leader of the Official Opposition on the same stage, campaigning on the same health issue, would make ``a very great public impact’’.
You may very well be correct.
But I can also imagine how many people there would be, at home and abroad, who would ask a particular question.
That question would be - why does the elected President not have sufficient courage to discharge his responsibilities about the health challenge we face, without requiring that the Leader of the Official Opposition should hold his hand!
Surely, you must admit that the executive role you seek is somewhat strange in any normal democracy. It is also inconsistent with everything you say and do everyday to convince all and sundry how rotten our government and its policies are.
I do not believe that we should encourage the convention whereby the opposition is both an effective opposition and an effective player with regard to the decisions of the executive.
The most difficult problem we face as a country and people is the wiping out of the deeply entrenched and pervasive racist legacy of colonialism and apartheid. It is about this that we should share a common patriotism.
It would be obscene to reduce this to an HIV/AIDS issue, as you do. It would be a fundamental error to reduce the challenge we face to the incidence of disease in our country, as you do.
You are entirely wrong to claim, as in your 28 July letter, that ``death and disease know no distinction of politics, creed or race’’.
Perhaps, this illustrates graphically the point that we do, indeed, occupy different planets.
Contrary to what you say, even a child, from among the black communities, knows that our own `burden of disease’ coincides with the racial divisions in our country.
I think you made your point about your importance when, in the National Assembly, to depart from the physical position occupied by F.W. de Klerk, the first democratically elected Leader of the Official Opposition, you moved from the bench opposite the Deputy President’s, to the bench opposite the President’s bench.
As for the rest, I wish you successes as the Leader of the Official Opposition.
In keeping with what I proposed to you in my letter of July 1, to which you agreed, I will ask my Parliamentary Counsellor, the Hon Charles Nqakula, to submit the entirety of our correspondence, to date, to the Speaker of the National Assembly and the Chairperson of the NCOP.
I do not believe that the dialogue in which we have been engaged is of any help in helping the people of our country to understand the truth about what we have been discussing.
The presentation of the truth is somewhat different from what you and I might consider to be an effective representation of whatever ``macho’’ image we might have of ourselves.
The first common stage we have the possibility to occupy is surely this, which requires that we treat the truth as primary, above the impulse to play to the gallery.
Please consider carefully whether you have responded correctly and adequately to this requirement.
Please consider also whether, from this limited experience, you are ready to fight together with us, for the realisation of the objectives of an agenda targeted at genuine social transformation.
Necessarily, these advisory strictures apply as much to you as they apply to us.
Yours sincerely Thabo Mbeki The Hon Mr Tony Leon Leader of the Official Opposition National Assembly CAPE TOWN
ANNEXURE L
24 August 2000
By hand and by telephone
His Excellency Mr T M Mbeki President of the Republic of South Africa Private Bag X1000 PRETORIA 0001 Dear President Mbeki
Thank you for your letter of the 5th of August.
I will deal first with some outstanding issues concerning the provision of anti-retrovirals to rape victims. I will then raise some of my concerns about this correspondence. I will try to be as brief as I can.
In my letter I quoted from AMA and FDA guidelines which showed that, in
America at least, the use of registered drugs for off-label indications
is perfectly acceptable. This use should be based upon sound scientific
evidence and sound medical opinion'' and mayreflect approaches to drug
therapy that have been extensively reported in medical literature’’.
In your letter you claim that the ``use of AZT in cases of rape meets neither of these FDA and AMA conditions’’. According to your argument it would be illegal and unethical to prescribe anti-retrovirals to a rape victim in the United States. This is not the case.
Such treatment has been extensively reported in medical literature (see for example American Journal of Medicine March 1999 Vol. 106). And while the CDC has not made a binding recommendation as a matter of public health policy, it does regard the provision of anti-retrovirals for rape victims as a perfectly acceptable clinical intervention by individual doctors. Mr Kearney is absolutely right in this regard. If the provision of ant-retrovirals to rape victims was really illegal in America then why do the CDC not say so, instead of providing long guidelines for such treatment?
You write that in this country the view of the government is that it is
illegal for medical practitioners to use drugs for purposes other than
those for which they have been licensed'', that the Department of Health
is of the view that medicines should be used for the specific
indications for which they are registered’’; and that if doctors
prescribe registered medicines for unlisted indications they are liable
for possible civil and criminal action''. On this basis you continue to
accuse me ofblatantly’’ urging ``defiance of the law’’.
You use two legal opinions to support these claims: that of the State Law Advisors on Misoprostol and that of Professor S.A. Strauss. Unfortunately, if read carefully and in context, neither opinion actually supports your case.
What both the State Law Advisors and Professor Strauss are discussing are the statutory powers of the MCC. In terms of the law, it is only the manufacturer or authorised distributor of a particular drug, who can apply for that drug to be registered for a particular indication. Neither the Health Department, nor a doctor, nor the MCC is allowed to apply for a drug to be registered for a particular indication. This is the sole prerogative of the pharmaceutical company concerned.
What the State Law Advisors are saying is that the MCC would be acting outside its powers if it tried to register a drug for an indication not applied for by the pharmaceutical company. When they state ``where the authorised person or body uses his statutory powers in the public interest but for an unauthorised purpose, the act will be ultra vires’’ they are referring to the MCC not individual doctors.
Thus, the advice of the State Law Advisors dealt with the authority of the MCC and its exercise of statutory powers. It was not concerned with the obligations and responsibilities of individual doctors.
Indeed, Misoprostol continues to be used for abortions within the public health system, even though it has not been listed for that indication and a current Health Department document states the following:
``The current registration of Nevirapine could possibly enable any
physician to prescribe Nevirapine for a mother-to-child transmission
indication as ``off-label'' usage. Until the MTCT has been registered
as a specific indication, there should be some reluctance by government
to promote a policy of Nevirapine use. There are, however, several
examples of such ``off label'' use of other drugs where failure to use
them would be considered bad practice, or in some circumstances
malpractice. These include the use of Misoprostol for termination of
pregnancy and the use of corticosteroids for preterm labour.''
As far as Professor Strauss is concerned, you are guilty of extremely selective quotation. You quote Professor Strauss as saying:
``A practitioner who uses a medicine for the treatment of an indication not approved of by the MCC when registering a medicine, may expose himself to a civil action under common law for damages if the patient were to suffer harm in consequence of off-label use.’’
You then omit the following:
``A patient may successfully sue the practitioner if he or she can prove that off-label use in the circumstances was negligent, i.e. harm was reasonably foreseeable.
South African law does not yet recognise `product liability’ in the sense of no-fault liability for harm caused by the mere use of the product.
Accordingly, if off-label use by practitioners has taken place regularly and `openly’ - colleagues knowing of it and possibly doing the same - over a considerable period of time with a reasonable degree of success in the treatment of patients and without harm being caused by patients, a prospective patient would have an almost impossible burden to establish a case of reasonable foreseeability of harm. The position of the defendant- doctor would obviously be strengthened by scientific evidence to the effect that off-label use for a specific condition is quite acceptable, harmless and possibly effective.’’
Professor Strauss then says (and you quote) The mere fact that off-label
use might constitute atechnical’’ criminal offence in terms of the Act,
would not lead to an inference of negligence.’’ (SA Practice Management
1998 (1) pp 12-15).
Thus, according to Professor Strauss, a doctor will be liable for off-label use only if they have acted negligently in prescribing that drug. They are not guilty of a criminal offence and liable for civil action merely for prescribing a drug for an non-listed indication. As the law stand in South Africa, doctors are free to exercise their independent judgement in prescribing drugs for off-label purposes as long as this is done in good faith.
To deny doctors this discretion would represent a gross intrusion by the state into the autonomy of the medical profession. It would also lead to the health profession being strictly constrained within boundaries set by the pharmaceutical industry - since it is only the pharmaceutical company who can apply for their drug to be listed for a particular indication. As I noted in my previous letter, a drug company may not choose to register a drug for a specific indication for a variety of (non-medical) reasons: They may not want to pay for the necessary clinical trials; or they may not want to offend a powerful political lobby in that (or another) country.
To restate my case: Although there is a lack of direct clinical data on the
efficacy of anti-retrovirals as post-exposure prophylaxis, there is sound
medical evidence supporting the provision of such treatment. Furthermore,
it would not be against the law to make anti-retrovirals available within
the public health service for the treatment of rape victims. Currently,
such treatment is available to those who use private health care and can
afford it. Recently I heard an SABC report on how a Norwegian tourist had
been raped but was immediately treated with AZT. The effect of your
government policy is merely to deny such treatment to those dependent on
the public health care system.
You have asked for a rational discussion of HIV/AIDS'' (July 1). You have
also stated that we musttreat the truth as primary’’ (5 August). I would
like to raise a couple of concerns in this regard.
During the course of this correspondence, you have made it clear that you wish to confine this debate to the issue of PEPs for rape survivors. This is a fair request and I have respected it. However, there are certain inconsistencies between the arguments you have used in this correspondence and those you have used in other public statements particularly on Virodene and the provision of anti-retrovirals to pregnant women.
In debating the provision of anti-retrovirals for rape victims you argued that there was a lack of direct clinical data; you cited (incorrectly) the recommendations of the CDC; and you claimed that it would be a contravention of the rule of law to provide a registered drug for off-label use.
On the question of providing anti-retrovirals for pregnant women you ignored the copious amounts of clinical data, the unambiguous recommendations of the CDC, and the fact that AZT is registered for that indication. Instead you refused to make AZT available in the public health service on the basis that ``the toxicity of this drug is such that it is in fact a danger to health’’.
I find it even more difficult to reconcile the arguments in our correspondence with your statements of Virodene, which your party so aggressively promoted as a cure for AIDS.
On 8 March 1998 you defended the Virodene researchers by saying that ``those who seek the good for all humanity have become the villains of our time!’’
You then proceeded to attack the MCC for refusing to allow the testing of this industrial solvent on AIDS patients. You stated:
``Alas, the local review board', the MCC, still refuses to accept the
application, despite its knowledge of these learned and highly qualified
professionals’ [whom you had quoted], and whose credentials it is
perfectly aware of. To confirm its determined stance against Virodene,
and contrary to previous practice, the MCC has, with powers to decide who
shall live or die, also denied dying AIDS sufferers the possibility of
`mercy treatment’ to which they are morally entitled. I and many others
will not rest until the efficacy or otherwise of Virodene is established
scientifically. If nothing else, all those infected by HIV/Aids need to
know as a matter of urgency. The cruel games of those who do not care
should not be allowed to set the national agenda.’’ (Sunday Tribune 8
March 1998)
Thus, on AZT and Virodene you have taken the following contradictory
positions: AZT is a toxic danger to the public health'' but Virodene is
amercy treatment’’; AIDS sufferers are morally entitled'' to
Virodene but doctors should not be allowed to prescribe AZT to rape
survivors; Glaxo Wellcome is driven solely by a concernto increase the
sales of AZT’’ but the owners of Virodene were seeking good for all
humanity''; and arguing for off-label use of AZT is aviolation of the
law’’, but the refusal by the MCC to allow Virodene to be tested on AIDS
sufferers are the ``cruel games of those who do not care’’.
My second concern is with the way you have attempted to play the race- card in this debate. You have misrepresented your opponents, twisted their words and tried to impose your own meaning on what they said, all in an attempt to blindside your critics. I cannot judge whether this is merely a cynical attempt to silence debate, or whether you really believe that anyone who criticises you or your government is (by definition) a ``racist’’.
You write again and at length about Charlene Smith. I will leave her to speak for herself. I can’t but agree with her that we suffer from a virtual epidemic of rape in this country. The racial characterisation of this problem must be, surely, irrelevant. All rape is equally wrong, it is not the colour of the rapist which is at issue but the criminal violence of the act.
I am perfectly willing to enter into a separate correspondence on your
eccentric definitions of racism'' andnon-racialism’’. However, I
think it is important for us to debate the issues around HIV/Aids on
their merits.
South Africa is facing a massive human tragedy. HIV/AIDS will kill more South Africans than any war has. It is already leading to enormous human suffering. There is an urgent need to put in place a preventative campaign with a clear and consistent message. As politicians we have an obligation to provide political support for such a campaign and not to muddy the waters by squabbling with international opinion.
The government has a moral obligation to urgently take steps to make anti- retrovirals available to pregnant women and rape survivors within the public health system. And where we lack the systems to provide such treatment, to put those in place.
There is an urgent need to reform and extend the welfare system so that the state assists those looking after the sick, the dying and the orphaned.
To fight the war against HIV/AIDS successfully our whole country needs to pull together. This is not the time (or the issue) to indulge in racial politics - to try and turn black against white.
We now have a non-racial constitution and franchise. We have no segregation of public facilities or services. We should now be free to confront the real problems facing our country. It would be disastrous to respond to this crisis by trying - like the old general - to fight the last war.
We live in the same country, face the same problems and share a common concern for our people. We must, on the HIV/AIDS issue at least, set aside personal differences and personal pride and work together for the good of the country.
I believe that you and I ought to follow the conventions of reasonable, regular and frank discussion that were established during the Constitutional negotiations and continued by your predecessor during the ANC’s first term in office.
These are conventions that have been painfully built up. They were based upon a recognition of shared concerns, common challenges, and the acknowledgment of equal legitimacy. It is important that we should meet on occasion to discuss major problems or crises facing our country. This would not end the proper and robust debate between ruling party and opposition which is fundamental to democracy, nor would it be an intrusion on the functions of the Executive. But it would follow a path bequeathed to us by our predecessors, one which led our country away from a civil war. It would also send a message to the voters that we contest issues as opponents not enemies. We should not turn our back on that tradition now.
I agree that this correspondence should be published when Parliament reconvenes.
Kind regards
Yours sincerely
TONY LEON
ANNEXURE M
September 1, 2000
Dear Tony
Thank you for your letter dated 24 August 2000. As I indicated in my last letter, it is perhaps best that we close this written exchange of views.
You will therefore understand why I will not respond to your latest letter of August 24th though I would contest many of the points you make.
I would like to assure you that the government will continue to do everything it can to respond to the health challenges facing our people.
Yours sincerely
Thabo Mbeki
The Hon Mr Tony Leon, MP
Leader of the Official Opposition
National Assembly
Cape Town
TABLINGS: National Assembly and National Council of Provinces:
Papers:
- The Minister of Trade and Industry:
Report and Financial Statements of the South African Bureau of
Standards for 1999-2000, including the Report of the Auditor-General on
the Financial Statements.
COMMITTEE REPORTS:
National Assembly:
-
Report of the Portfolio Committee on Provincial and Local Government on the Local Government: Municipal Structures Amendment Bill [B 51B - 2000] (National Assembly - sec 75), dated 4 October 2000:
The Portfolio Committee on Provincial and Local Government, having considered the Local Government: Municipal Structures Amendment Bill [B 51B - 2000] (National Assembly - sec 75) and proposed amendments of the National Council of Provinces (Announcements, Tablings and Committee Reports, p 796), referred to the Committee, reports the Bill with amendments [B 51C - 2000].
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Report of the Portfolio Committee on Housing on the Home Loan and Mortgage Disclosure Bill [B 53 - 2000] (National Assembly - sec 75), dated 4 October 2000:
The Portfolio Committee on Housing, having considered the subject of the Home Loan and Mortgage Disclosure Bill [B 53 - 2000] (National Assembly - sec 75), referred to it and classified by the Joint Tagging Mechanism as a section 75 Bill, reports the Bill with amendments [B 53A - 2000].
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Report of the Portfolio Committee on Foreign Affairs on the African Renaissance and International Co-operation Fund Bill [B 65 - 2000] (National Assembly - sec 75), dated 3 October 2000:
The Portfolio Committee on Foreign Affairs, having considered the subject of the African Renaissance and International Co-operation Fund Bill [B 65 - 2000] (National Assembly - sec 75), referred to it and classified by the Joint Tagging Mechanism as a section 75 Bill, reports the Bill with an amendment [B 65A - 2000].