- The leader of the most influential African nation has
opened debate in recent months on whether or not HIV causes AIDS, has issued
a blistering attack against the international pharmaceutical industry and
has ordered formation of a commission that will review all of the primary
assumptions about the global AIDS epidemic including whether it even exists.
- South African President Thabo Mbeki leads a country that
estimates 10 percent of its population is infected with HIV.
- Mbeki has revved up his commentary in recent days. His
office issued a statement last week condemning drug companies that "propagate
fear to increase profits; the profit takers who are benefiting from the
scourge of HIV/AIDS will disappear to the affluent beaches of the world
to enjoy wealth accumulated from a humankind ravaged by a dreaded disease."
- Then on Friday his office issued an angry, lengthy statement
denying that Mbeki had ever stated that HIV was not the cause of AIDS.
- His comments have raised red flags in Washington and
at the United Nations AIDS Program in Geneva. Officials are concerned that
American fringe elements that dispute the very existence of AIDS have gained
Mbeki's ear. And they are discreetly voicing two fears: First, that such
notions may spread across Africa, the continent hardest hit by the pandemic,
imperiling public health efforts. And second, that the World AIDS Conference,
scheduled to convene this July in Durban, South Africa, may be endangered
because of resulting tensions.
- Canada's Dr. Mark Wainberg, president of the International
AIDS Societies, said in a speech in Washington recently, "We often
find that the ground is cut out from under our feet by people who should
- Wainberg directly denounced Dr. Peter Duesberg, a professor
in the molecular biology department of the University of California at
Berkeley, and his followers who insist that HIV is a harmless virus and
AIDS a nonexistent disease. Saying that these skeptics are "contributing
to the spread of HIV" by promoting mass denial about the disease,
Wainberg suggested that their actions warrant criminal prosecution.
- AIDS vaccine researcher John Moore of the Aaron Diamond
AIDS Research Center in Manhattan goes further, saying that "a charge
of genocide would not be inappropriate ... Their efforts are already having
a devastating negative effect on public health in South Africa, and the
problems could well spread further if other nations are foolish enough
to take a lead from the South African government."
- Dr. Seth Berkley, head of the New York based International
AIDS Vaccine Initiative, likened the non-belief in HIV "to those that
believe that the Holocaust did not occur."
- Worried about exacerbating what is already a diplomatically
testy situation, U.S. health officials and UNAIDS have declined to comment
directly in public on either Mbeki's or Wainberg's statements. But the
National Institutes of Health and UNAIDS both released fact sheets via
the Internet last week, attacking the allegations made by the HIV skeptics.
And the U.S. agency, with the White House, is reconsidering security needs
for U.S. scientists who attend the Durban meeting because of anticipated
- Neither the allegations nor the scientific community's
rebuttals are new; Duesberg first raised his theory in 1987. But Mbeki's
public support for the skeptics' point of view is the first such action
taken by a head of state. His own nation estimates that 4 million of its
44 million population are infected with HIV, and rates of infection run
as high as 40 percent of young adults in some regions.
- The Mbeki government began its recent campaign on Feb.
28, when South Africa's minister of health announced that an "expert
panel" would convene to review evidence that HIV causes AIDS and allegations
that the AIDS drug AZT is poisonous. On March 14 the nation's Deputy President
Jacob Zuma said on South African radio that the commission will "look
at these issues to get rid of misinterpretations and misrepresentations
or differing opinions. If there are differing opinions they must be scientifically
investigated so we can get at the truth."
- Among those invited to participate in the commission
are Duesberg and Dr. Sam Mhlongo of the Medical University of South Africa,
in Capetown. Mhlongo has said the epidemic was concocted by drug companies
to hook South Africa on costly anti-HIV drugs.
- Increasingly, comments reveal a chasm of misunderstanding
between the industrialized world's AIDS community and that of sub-Saharan
Africa. In the United States, those who voice the dissident views haven't
found much support, but their influence is growing in South Africa.
- In its Friday statement, Mbeki's office said, "Government
is strong in its resolve that we cannot confine our response to the problem
of HIV/AIDS to an injunction not to speak to HIV skeptics or telling people
how to think."
- The skeptics come from a broad range of backgrounds and
political affiliations. There are political conservatives who dispute the
notion that HIV is transmitted heterosexually, gay radicals from San Francisco
and heterosexual men who claim that AIDS is a disease caused by being gay.
All share one common article of faith: that HIV is harmless.
- Prominent San Francisco AIDS activist Jeff Getty recently
circulated an Internet alert warning that San Francisco's chapter of ACT
UP was a militant skeptics group, "a cult...the axiom here is this
'if I don't believe AIDS exists, I don't need to take those nasty drugs
and more importantly, I don't need to have safe sex."'
- One contingent of AIDS skeptics, which calls itself The
Group for the Scientific Reappraisal of the HIVAIDS Hypothesis, has claimed
to have 600 members, including California biochemist David Rasnick and
historian Charles Geshekter. It was to these men that Mbeki turned for
advice in January, after a series of AIDS related public episodes.
- First, in a 1997 cabinet meeting Mbeki, then deputy president,
promoted a substance called Virodene, an alleged cure for AIDS. The chemical
turned out to be an industrial solvent. Shortly thereafter, South Africa's
government and its pharmaceutical industry clashed over the pricing and
importation of medicines.
- Last spring, in hopes of easing such tensions, the Bristol
Myers Squibb Co. offered the South African government a $ 100million, five
year grant for AIDS education and clinical research. After an initial rebuff,
the country accepted the funds. Some skeptics used the grant as evidence
of a pharmaceutical conspiracy directed to Africa.
- Last June, following Mbeki's election to the presidency,
Manto Tshabalala Msimang was named minister of health. UNAIDS then brokered
a deal with British pharmaceutical company Glaxo Wellcome for cut rate
AZT to be used in Africa to reduce the spread of HIV from infected mothers
to their babies. Such AZT interventions reduced the number of HIV positive
babies born in the United States to just 32 last year.
- But skeptics argue that AZT is a poison; AIDS, they insist,
is actually caused by the drug used in its treatment. South African skeptic
Anthony Brink of Pietermartizburg, an attorney, insisted that "no
one has ever been cured by AZT, but it sells like hotcakes all the same...and
it reaps profits counted in billions."
- On Nov. 5, Mbeki addressed the South African Parliament,
noting that the United States, UNAIDS and other outside interests were
pressuring his government to provide AZT to prevent an epidemic of HIV
positive babies. Mbeki cited Internet sources that, he said, indicated
"the toxicity of this drug is such that it is in fact a danger to
- Mbeki instructed Tshabalala to investigate further, to
be "certain of where the truth lies."
- At that point the government took seemingly contradictory
stances. Mbeki said AZT might be too dangerous. On the other hand, Tshabalala
said, it was too expensive, and drug companies ought to lower their prices.
- Further, such U.S.-based groups as the Elizabeth Glaser
Pediatric AIDS Foundation and the Global Strategies for HIV Prevention
had offered free Nevirapine to South Africa, a safer alternative to AZT
that also blocks HIV transmission to newborns. That offer, too, was rebuffed
because Dr. Ian Roberts, special adviser to Tshabalala, said, "We
are not satisfied that it is proven safe. We must test its safety, by South
African standards." (Ironically, when Deputy President Zuma's wife
was raped in South Africa last summer she was immediately put on Nevirapine
in hopes of blocking HIV transmission.)
- Late on the night of Jan. 19 Mbeki fired off a fax to
skeptic Rasnick, asking what evidence existed that:
- "1. AIDS is contagious.
- "2. AIDS is sexually transmitted.
- "3. HIV causes AIDS.
- "4. The anti-HIV drugs promote life and health."
- Rasnick and Geshekter swiftly crafted their response.
In December Geshekter had briefed Tshabalala and toured the rural regions
of the nation.
- Geshekter, a professor at California State University
in Chico, said in an interview he disputes the estimates of HIV and AIDS
rates in South Africa.
- "I think it's important to me personally because
my training is as a scholar concerned about numbers, statistics...and Africa.
When I see those kinds of numbers I say, 'Put your statistics on the table."'
- UNAIDS readily concedes that its AIDS and HIV estimates
for Africa involve extrapolations from spot studies, Peter Piot, UNAIDS
executive director, told Newsday. "The reality is that some African
countries have among the best HIV surveillance systems in the world,"
- Even the United States doesn't have an HIV reporting
system and must approximate rates of infection from mandated reporting
of AIDS caseloads.
- In South Africa the extrapolations are made from surveys
done in pregnancy clinics, where upwards of 20 percent of tested women
now turn up HIV positive. The test used on these women, a screening procedure
known as ELISA, is not considered adequate in the United States, as it
often yields false positive results. So the United States requires two
additional tests. But South Africa relies on ELISA alone because of insufficient
- Geshekter also disputes the use of the system called
the Banqui Definition to make HIV diagnoses. Formulated by the World Health
Organization more than a decade ago, Banqui, commonly used in Africa, offers
doctors a list of symptoms some combination of which must be present to
diagnose AIDS. Geshekter argues that the symptoms including rapid weight
loss, diarrhea and specific types of skin cancers are more likely to be
reflections of economic underdevelopment.
- "I see a real infrastructural deterioration in Africa
over the last 20 years," Geshekter argued. "We need to look...very
closely at deteriorating public health facilities, rising malnutrition
- His hypothesis can't account for the HIV rate in successful
countries like Botswana, estimated at a third of its reproductive age adults.
Until three years ago, when it was slammed by what its own government labels
an AIDS epidemic, Botswana was considered a World Bank "economic miracle,"
with phenomenal financial growth. Nor can economics explain why the upper
classes of most African societies have the highest AIDS death tolls.
- Duesberg insists that AIDS in the African context is
"nothing more than a new name for old diseases," which may be
taking a greater toll today because of the sorts of economic factors Geshekter
- The U.S. National Institute of Allergy and Infectious
Diseases counters on its Internet site that three studies from Uganda,
Rwanda and Zaire show soaring epidemic AIDS death rates in Africa.
- Nevertheless, argues Tom Bethell of the conservative
American Spectator magazine, "People are not dying of AIDS but of
the diseases that have always afflicted those parts of the globe where
water is not clean and sewage is not properly disposed of."
- Where is this all headed?
- Last week organizers of the upcoming World Conference
on AIDS met in Johannesb urg and were barraged with questions about the
Mbeki government's policies.
- Among the most outspoken was Dr. Helene Gayle, who heads
up AIDS programs for the U.S. Centers for Disease Control and Prevention.
She denounced the skeptics and said that "there is no merit in questioning
conventional wisdom" about HIV.
- Kenya's Dr. Ruth Nduati, of the University of Nairobi,
added that Mbeki's actions are "taking us backwards...that such discussions
may unravel our significant gains in terms of managing the disease."
- The comments drew ire from Mbeki, who convened a cabinet
meeting to discuss his country's continued hosting of the prestigious conference.
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