Mbeki's views on the causes and treatment of
AIDS have also been criticised. Most notably in April 2000 he defended a small group of dissident scientists who claim that AIDS is not caused by
HIV. His government was applauded by AIDS activists for its successful legal defence against action brought by transnational pharmaceutical companies in April 2001 of a law that would allow cheaper locally-produced medicines. But since then, he and his administration have been repeatedly accused of failing to respond adequately to the epidemic. Current estimates suggest that 5.3 million South Africans have HIV.
AIDS advocates, particularly the
Treatment Action Campaign and its allies, campaigned for a program to use
anti-retroviral medicines to prevent HIV transmission from mother to child; and then for an overall national treatment program for AIDS that included antiretrovirals. Until 2003, South Africans with HIV who used the public sector health system could get treatment for opportunistic infections they suffered because of their weakened immune systems, but could not get antiretrovirals, designed to specifically target HIV.
In the current South African system, the Cabinet can override the President. Although its votes are private, it appeared to have done so in votes to declare as Cabinet policy that HIV is the cause of AIDS; and then, in August 2003, in a promise to formulate a national treatment plan that would include ARVs. But the Health Ministry is still headed by Dr.
Manto Tshabalala-Msimang, who has served as health minister since June 1999, and has promoted nutritional approaches to AIDS while highlighting potential toxicities of antiretroviral drugs. This led critics to question whether the same leadership that opposed ARV treatment would effectively carry out the treatment plan. Indeed, implementation has been slow and activists still criticise Mbeki's AIDS policies.
It is unclear what led Mbeki to hold unorthodox views of AIDS. While serving as deputy President, AIDS was in his portfolio, and he customarily wore a red ribbon while promoting more conventional views. He did preside over a controversial and brief embrace of a South African experimental drug called
Virodene which later proved to be ineffective; the episode appeared to have increased his skepticism about the scientific consensus that quickly condemned the drug.
The largest shift in his views apparently came after he assumed the Presidency. He described AIDS as a "disease of poverty", arguing that political attention should be directed to poverty generally rather than AIDS specifically. Some speculate that the suspicion engendered by a life in exile and by the colonial domination and control of Africa led Mbeki to react against the idea of AIDS as another Western characterisation of Africans as promiscuous and Africa as a continent of disease and hopelessness. For example, speaking to a group of university students in 2001, he struck out against what he viewed as the racism underlying how many in the West characterised AIDS in Africa:
:Convinced that we are but natural-born, promiscuous carriers of germs, unique in the world, they proclaim that our continent is doomed to an inevitable mortal end because of our unconquerable devotion to the sin of lust.
Additionally, his views dovetailed with some broader themes in African politics. Many Africans find it suspicious that black Africans bear the largest share of the AIDS burden, and that the drugs to treat it are expensive and sold mainly by Western pharmaceutical companies. The history of malicious and manipulative health policies of the colonial and apartheid governments in Africa, including biological warfare programs set up by the apartheid state, also help to fuel views that the scientific discourse of AIDS might be a tool for European and American political, cultural or economic agendas.
Whatever Mbeki's views of AIDS are now, ANC rules and his own commitment to the idea of party discipline mean that he cannot publicly criticise the current government policy that HIV causes AIDS and that antiretrovirals should be provided. Some critics of Mbeki assert that his personal views are not in accordance with this policy and still influence AIDS policy behind the scenes, a charge which his office regularly denies.