The human cost of ’s misguided AIDS policies wasted lives AIDS activists and researchers argued study by HSPH’s Pride Chigwedere, company’s donated supply of nevi- for years that the negligent HIV/ who graduated with a doctor of rapine, another drug that helps keep AIDS policies of former South science in and infec- newborns from contracting HIV. African President were tious diseases in June of 2008. causing a massive, unconscionable Chigwedere laid South Africa’s heavy A doctor’s suspicions loss of human life. Now, thanks to toll from HIV at the feet of Mbeki, Chigwedere, a , came to the doctoral thesis of a student at who delayed launching an antiretro- HSPH in 2000 from , the Harvard School of viral (ARV) drug program, charging where he had watched his AIDS (HSPH), they know the full extent of that the drugs were toxic and an patients die because no ARVs were the damage. effort by the West to weaken his available. For two years, he worked on More than 330,000 people died country. Mbeki withdrew government an AIDS vaccine design as a research prematurely from HIV/AIDS between support from clinics that had started fellow with , the Mary 2000 and 2005 due to the Mbeki using AZT to prevent mother-to- Woodard Lasker Professor of Health government’s obstruction of life- child transmission of HIV. He also Sciences and head of the HSPH saving treatment, and at least 35,000 restricted the use of a pharmaceutical AIDS Initiative. After enrolling as a

babies were born with HIV Bode/ de Chris that could have been prevented. CHILDREN HEADING HOUSEHOLDS Lihle Mbule of South Africa holds a These estimates appeared online photo of herself and her mother, who died of AIDS-related illness. Lihle in October in the Journal of Acquired is now responsible for her two younger siblings, her cousins, and an aunt Pa Immune Deficiency Syndromes in a who is ill with AIDS and TB. nos

26 Harvard Public Health Review doctoral student, Chigwedere shifted number the country might reason- What next? his attention to working on ARV ably have treated, based on the Mbeki refuses to comment on the drugs. Initially he focused on drug performances of neighboring coun- paper but does not deny its find- resistance. This led him to look more tries. Factoring in the drugs’ effective- ings. He is serving as a regionally deeply into why the drugs were not ness rate, Chigwedere calculated the appointed mediator in Zimbabwe’s widely available in Africa. total years of life lost. political crisis. Some countries’ track records Commenting on the study’s “Ashamed” was the reaction of suggested policies that were “inap- methodology in the New York South Africa’s new health minister, propriate or frankly wrong,” says . A longtime Mbeki Chigwedere. Chief among the trans- critic, Hogan took office the same gressors was South Africa. day as Mbeki’s interim successor, Even as the country’s neighbors . Hogan has ramped up prevention and treatment made HIV/AIDS a priority, mobi- efforts, Mbeki—president from 1999 lizing the public through a new until he resigned under pressure last prevention campaign and brokering September—publicly challenged the a $22 million donation from the scientific consensus that HIV causes British government to help cover AIDS. His health minister, Manto ARV costs. Tshabalala-Msimang’s Tshabalala-Msimang, promoted herbal role is diminished in the new remedies, including beetroot, garlic, administration. and lemon, as alternatives for ARVs. Treatment Action Campaign Such policies condemned thousands to leader Zackie Achmat called for die, Chigwedere says. But could their Mbeki and Tshabalala-Msimang to EMERGING LEADER A study by impact be measured? be tried by a judicial board similar Pride Chigwedere, who earned a doctorate at HSPH in 2008, finds to the Truth and Reconciliation Calculating losses that 330,000 South Africans died Commission, which rendered judg- Under relentless pressure from the prematurely and 35,000 newborns ment on -era abuses. wasted lives Treatment Action Campaign, an contracted HIV because their Chigwedere’s next paper will activist group, South Africa finally former president denied his people look broadly at how governments launched a program in 2003 to prevent life-saving anti-HIV drugs. might be held accountable for their mother-to-child transmission of HIV public health policies. “Once it’s Times, James Chin, a professor of and a national ARV program the been determined whether a policy at the University of following year. Still, by 2005, report is beneficial or harmful, that leads California at Berkeley’s School of Chigwedere and his colleagues, only 23 to the discussion of public health Public Health, called the numbers percent of AIDS patients were on life- malpractice,” Chigwedere says. “conservative” and “quite reason- saving drugs, and fewer than 30 percent “How do we develop standards in able.” The study hit page one of the of pregnant, HIV-infected women were public health? This is a whole new paper on November 26, 2008, and receiving nevirapine. By comparison, area opening up.” the front pages of the and were treating International Herald Tribune and the Times of more than 70 percent of patients. To read Chigwedere’s paper, visit: South Africa. The BBC, Al Jazeera, To put Mbeki’s failings into www.aids.harvard.edu/Lost_Benefits.pdf. Fox News, and other media outlets terms the world could understand, picked up the story. Chigwedere, Amy Roeder is the development Chigwedere estimated the number who now works with communications coordinator in the of deaths caused by delaying and Office for Resource Development at care companies at McKinsey and restricting ARV use. He compared the HSPH Company, a management consulting number of South Africans on ARVs firm, is still giving interviews. between 2000 and 2005 with the “The response has been beyond our wildest dreams,” he says.

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