DURBAN, South Africa — When former South African president Nelson Mandela issued his forceful call for action to stop the AIDS epidemic ravaging his country and much of the continent, it was a great relief to the 12,500 participants at the 13th international AIDS conference, which ended here on Friday.
Meeting in the most-infected province of the most-infected country on the most-infected continent, they were bitterly disappointed when the current South African president, Thabo Mbeki, did not acknowledge forthrightly that HIV causes AIDS, emphasizing instead social factors like poverty as a major force behind the epidemic. In a way, however, Mandela's call for immediate action and Mbeki's emphasis on poverty were making similar points.
For while a virus causes AIDS, social conditions feed the epidemic. Patterns of behavior — fed by poverty, ignorance and despair — have resulted in a disease so widespread that it has left millions of orphans and threatens to destroy much of Africa's economy and to wipe out a generation of young people.
But what is implicit in the remarks of both Mbeki and Mandela is the idea that some AIDS problems can be attacked now, even without the vaccines and cures that have yet to emerge from laboratories in the developed world.
Mandela cited two African countries, Uganda and Senegal. The first turned around a major epidemic of AIDS. The second prevented a small one from becoming larger. Those successes, using relatively inexpensive public health tools like education, suggest that other countries severely affected by HIV might do as well, if they can only muster the political will to act.
South Africa is seeking ways to help an estimated 20 percent of adults infected with the virus. Because few have access to tests for the virus, most are ignorant of their condition. And almost none have access to the drugs that have helped control the infection in richer countries.
Zola Skweyiya, the South African minister of welfare and population development, was quoted in the nation's newspapers as offering an even more drastic assessment: If the AIDS trend goes unabated, South Africa could end up with a white majority.
Though the meeting was held in Africa to encourage the world's AIDS experts and government leaders to focus on the dire conditions here, participants also cited the rapidly worsening epidemic of HIV in Russia and voiced particular concern about the threat to the world's most populous countries, India and China.