ADDED FOE IN AIDS WAR: SKEPTICS

By Laurie Garrett

Newsday 29 March 2000

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 know better."

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 confrontations.

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 health."

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," Piot said.

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 funds.

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 rates..."

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 underscores.

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.