AIDS FORUM IN SOUTH AFRICA OPENS KNOTTED IN DISPUTES

By Rachel Swarns & Lawrence Altman

The New York Times 9 July 2000

Durban -- Opening the first international conference on AIDS held in a developing country, President Thabo Mbeki today singled out extreme poverty, rather than the disease ravaging his country and continent, as the leading killer both here and across Africa.

South Africa is the country with the largest number of people infected with H.I.V., the virus that causes AIDS 4.2 million. And its president, who has become embroiled in an international dispute over the disease, pledged to intensify his response to the AIDS epidemic. But he dashed the hopes of thousands of participants, and noisy protesters, who wanted to hear him state clearly that H.I.V. causes AIDS.

Instead, President Mbeki skirted the discussion that has arisen because he has questioned the use of certain drugs in treating H.I.V. and has even questioned whether the virus causes AIDS.

Among the many researchers he has contacted in his quest to understand the epidemic are two American biochemists, Peter Duesberg and David Rasnick, who argue that poverty and malnutrition, not H.I.V., cause AIDS. When word of this consultation became public, international consternation arose.

As Mr. Mbeki described his attempts to understand how one of the worst epidemics in history had enveloped his country just as it had freed itself from apartheid, he reflected on AIDS and a long list of other diseases afflicting his country.

"As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus," Mr. Mbeki said.

The 13th international conference on AIDS is being held here as United Nations officials have been intensifying the alarm about H.I.V., which infects 34.3 million people in the world, mostly in Africa.

Minutes after Mr. Mbeki finished, Dr. Peter Piot, the head of Unaids, a United Nations program that monitors the spread of AIDS, said it would require at least $3 billion a year to take basic measures in Africa to deal with the disease and tens of billions of dollars more each year to provide in Africa the standard drugs used in developed countries.

The $3 billion figure is 10 times what is now being spent in Africa, Dr. Piot said. Unaids estimates that 90 percent of people with H.I.V. do not know that they are infected.

"We need billions, not millions, to fight AIDS in the world," Dr. Piot said, and "we can't fight an epidemic of this magnitude with peanuts."

In news conferences and interviews, Dr. Piot said he welcomed a pledge of $500 million from the World Bank this weekend as a positive step. The rest, he said, needs to come from the affected African countries and the developed countries.

He urged developed countries to cancel the $15 billion in debt repayments that African countries owe each year, so the countries could use the money for health care and social services for AIDS and other diseases.

But political will is as important as money in stopping the AIDS epidemic, he said.

In the last six years, scientists and AIDS activists have repeatedly accused South African leaders of a lack of leadership in combating the AIDS epidemic. In 1993, H.I.V. infected 4 percent of South Africa's adult population. Now, the figure is 20 percent.

Tonight, as those taking part in the conference drifted out of the cricket grounds where Mr. Mbeki spoke, many left feeling disappointed.

"We, the majority of South African scientists, would have liked a clear, unequivocal statement about the relationship between H.I.V. and AIDS rather than the hints he made," said Alan Whiteside, who heads the AIDS research program at the University of Natal in Durban.

Mr. Whiteside and others said they were encouraged by Mr. Mbeki's pledge to intensify his recently announced program to encourage safer sex practices and to sponsor additional research into drug therapy and a possible vaccine.

Thousands of people held a protest rally at City Hall before the meeting opened, with Winnie MadikizelaMandela and others in the crowd berating the government for failing to speak frankly about the link between H.I.V. and AIDS and lagging in its efforts to fight the epidemic.

"AIDS exists," said Mrs. MadikizelaMandela, the exwife of former President Nelson Mandela and a political leader in her own right. "H.I.V. causes AIDS. We cannot proclaim this century the African century and then ignore the AIDS pandemic as some political leaders are."

Mr. Mbeki did speak about the heavy toll that H.I.V. and AIDS take on young people. He also spoke about the toll from malaria, cholera, syphilis and "other illnesses with complicated Latin names," along with vitamin A deficiency, which he said were among the diseases of poverty.

The text of Mr. Mbeki's remarks released in advance of his speech said: "The world's biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty."

He omitted that passage when he spoke but cited a 1995 report by the World Health Organization that described poverty as the world's largest killer. "Five years later," he added, "the essential elements of this story have not changed."

A strong hint that Mr. Mbeki would disappoint most of those taking part in the AIDS conference in not saying that H.I.V. causes AIDS came earlier in the day when scientists canceled a news conference because of what they said was pressure from the South African government.

The news conference had been scheduled to discuss a statement signed by 5,000 scientists around the world, known as the Durban Declaration. It affirmed that scientific evidence supporting the link between H.I.V. and AIDS was "clearcut, exhaustive and unambiguous" and was published in the July 6 issue of the scientific journal Nature after review by scientific peers.

But the news conference was unexpectedly canceled minutes before it was to have begun. The reason was that "the South African government put pressure on us" and threatened to dismiss any signer who worked for the government, said Dr. Charles van der Horst, a professor of medicine at the University of North Carolina who signed the declaration.

In an interview, Dr. van der Horst declined to name the government official who had made the call and said the South African scientist who had received it was a signer of the declaration. Dr. van der Horst said he had been told that the official had spoken on behalf of Mr. Mbeki.

Tasneem Carrima, a spokeswoman for Mr. Mbeki, denied knowledge of any such threat. "We certainly would not threaten anybody," she said.

The declaration came in response to Mr. Mbeki's decision to appoint a panel to review the claims of dissidents who do not believe that H.I.V. causes AIDS, Dr. van der Horst said. The panel included such dissidents as well as signers of the declaration.

"We thought no one would give the denialists credence, and we were wrong," Dr. van der Horst said.

He criticized the scientific community for not having published a summary statement earlier of all of the scientific evidence that H.I.V. causes AIDS. Now, by giving a platform to a small group of dissidents, Mr. Mbeki has helped to divert efforts to fight AIDS, Dr. van der Horst said.

Several scientists say that becoming embroiled in new arguments over the causes of AIDS diverts attention and resources from finding a solution.

The declaration was intended as a scientific statement, Dr. van der Horst said. But he said the South African government viewed it as a political statement. After the declaration was released last week, a spokesman for the president, Parks Mankahlana, said it should be thrown in the dustbin.

This week, Mr. Mbeki's government tempered its stringent criticism of anti-H.I.V. drug therapy by announcing that it had reversed its view about AZT, a drug it had deemed unsafe for pregnant women.

In discussing his administration's plan to battle AIDS and responding to critics, Mr. Mbeki said that "there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of H.I.V-AIDS."

Dr. Piot said developing countries, though poor, would have to spend more on AIDS, because "it is about the survival of the nation."

Mr. Mbeki and Dr. Piot are leaving the conference early to attend a meeting of the Organization of African Unity in Lome, Togo, at which AIDS is to be discussed.