VIRUSMYTH HOMEPAGE
FLIRTING WITH PSEUDOSCIENCE
South Africa’s President May Become the First World Leader to Believe That HIV Is Not the Cause of AIDS
By Mark Schoofs
The Village Voice 15 March 2000
Johannesburg, South Africa — While the scientific world has long
accepted that HIV causes AIDS, a fringe group of scientists has
stubbornly denied that the virus plays any role in the disease. Now,
these so-called AIDS dissidents have captured the attention of Thabo
Mbeki, the powerful president of South Africa, where a staggering 12.5
percent of adults are estimated to be infected with HIV.
The news has exacerbated the long-standing conflict between the
South African government and frontline AIDS doctors, scientists, and
activists, who accuse the government of shirking its duty to combat
the raging epidemic. And it raises profound questions about Mbeki's
leadership on the most pressing health issue facing southern Africa.
Mbeki has not said publicly whether he believes HIV causes AIDS, and
presidential spokesperson Parks Mankahlana insisted that Mbeki is "not
an advocate of the dissidents." Still, Mankahlana told the Voice that
Mbeki has ordered his health minister to assemble an international panel
to look into "everything about AIDS," from the merits of various
treatments such as AZT to "whether there's this thing called AIDS,
what it is, whether HIV leads to AIDS, whether there is something
called HIV, for an example. All these questions."
It was news of this international panel, first reported by the South
African Press Association two weeks ago, that brought the matter into
public view and sparked immediate protest. The Treatment Action
Campaign, a local activist group modeled on ACT UP, took the lead,
charging that giving any credibility to the "inaccurate and harmful
medical ideas" of the AIDS dissidents would "cause tremendous
confusion among people at risk and undermine prevention efforts."
The health ministry hastily issued a response, downplaying—but not
denying—the possibility that the panel would address the views of AIDS
dissidents such as California virologist Peter Duesberg. The statement,
which acknowledged that AIDS is "the most serious health challenge
facing South Africa," said that the panel's primary objective would be
"developing prevention and treatment strategies that are appropriate to
the African reality." Given the apparent split between the health
department and the president's office, it remains unclear what kind of
public airing the dissident views will receive.
Meanwhile, the government insists it is going ahead with its current
AIDS programs, including research into an HIV vaccine, and it is putting
the best face on Mbeki's musings. The president, an Internet
enthusiast, "has read much literature on the issue of AIDS, including
the literature of those who might not hold the conventional view," said
Joel Netshitenzhe, chief of government communications. "And the
question he has posed from time to time is whether there has been
sufficient interrogation of the issue. He merely says, 'Instead of
believing, be sure you have established the facts.' And I thought that
would be a measure of a good president."
But Mbeki may have gone beyond mere academic questioning. There is
evidence that the dissident arguments influenced one of his most
controversial acts: the decision to delay making AZT available to
pregnant women in order to reduce the number of babies born with the
virus—thought to be as many as 60,000 infants a year. Moreover,
critics say, the fact that Mbeki would give serious credence to views
that have long been discredited indicates a desperate urge to deny the
epidemic rather than grapple with it head-on.
"It's irresponsibility that borders on criminality—and I know those are
harsh words," said Mamphela Ramphele, vice chancellor of the
University of Capetown and a physician who is famous for her
anti-apartheid activism. She said that if the government gives
credibility to "this voodoo science, there's a real danger that people
might say, 'I don't have to worry about condoms.' "
Scientists in other African countries also reacted with shock and
dismay. "I can't believe it," said Peter Mugyenyi, a veteran Ugandan
doctor and researcher. "This would be a highly dangerous and
retrogressive step with very serious public health consequences. It
could cost lives." His colleague David Serwadda added that Duesberg's
ideas were considered in Uganda, "but we realized his theories would
not help us. If he finds fertile ground in South Africa, it would be very
unfortunate."
Just how seriously is Mbeki taking the AIDS dissidents' views? One of
South Africa's most senior scientists, who spoke on condition of
anonymity, told the Voice that Mbeki asked four top South African
researchers to review large dossiers of literature written by the AIDS
dissidents. Some of those handpicked scientists presented their case
that HIV does cause AIDS to the president this February, and yet last
week Mbeki's spokesperson was still saying that the president wanted
an international panel to review the issue. "I think we may have a
president who doesn't believe HIV causes AIDS," said this source.
In addition, David Rasnick, a prominent dissident who has long argued
that AIDS is not infectious, told the Voice that Mbeki's office asked him
to answer faxed questions about AIDS and to comment on answers to
those same questions provided by the health minister. Rasnick, a
chemist and colleague of Duesberg, also said that Mbeki had personally
telephoned him this January, telling Rasnick that he was planning "a
public airing" of issues such as whether AIDS is sexually transmitted
and whether HIV causes AIDS. Mbeki's spokesperson refused to confirm
or deny whether he has asked researchers to review dissident literature
and whether he has had contact with Rasnick.
Well-connected South African scientists and activists have known for
months that Mbeki was flirting with the dissident theories, and their
e-mails, some of which have been obtained by the Voice, show an ever
increasing concern. The first tip-off came last October, when Mbeki
ordered his health minister to review the safety of AZT, saying that "a
large volume of scientific literature" alleges that the drug is so toxic
that "it is in fact a danger to health." That effectively put on hold plans
to make the drug available to pregnant women. "That's when I started
feeling a very strange plot was afoot," said Ashraf Grimwood, a
physician who chairs the National AIDS Convention of South Africa.
Mbeki's statement sharply contradicted the international medical
consensus that the benefits of AZT outweigh its risks, and it also ran
contrary to a South African study of AZT used in combination with
another drug, 3TC. That large study found no more side effects among
women and infants taking the drugs than among those taking a
placebo.
Mbeki's office has consistently refused to divulge what scientific
literature prompted the president to remand AZT for a new medical
review. Health Minister Manto Tshabalala-Msimang said there is "lots of
literature," but cited only the package insert that comes with the drug,
adding, "I don't keep authors in my head." She added that no study had
followed patients for more than five years.
But three well-placed sources, who requested anonymity, reported that
Mbeki has privately cited well-known AIDS dissidents such as Duesberg
and a group of Australian scientists as sources for his concern about
AZT. In addition, the large dossiers of dissident material given to four
of the country's top scientists contain a great deal of material alleging
that AZT is dangerous.
If Mbeki did call for a review of AZT based in part on the dissidents'
writings, it would mark the only time that their opinions have influenced
a government decision to withhold life-saving medication.
Why would Mbeki take the dissidents seriously? Many observers chalk it
up to denial, but Salim Abdool Karim, scientific chairperson of the World
AIDS Conference that will be held this July in South Africa, isn't so
sure. "The president's talk on World AIDS Day was excellent—and he
writes most of his own speeches," said Karim. "He clearly understands
this epidemic. So I don't know. It's not denial, it's more complicated
than that."
Mbeki is famously inscrutable, almost sphinxlike. What is known is that
he is proud and considers himself an intellectual. When he was a little
boy, according to an extensive profile that ran in South Africa's
largest-circulation paper, the Sunday Times, he read letters aloud for
the illiterate adults in his village, and even wrote their letters. He is
accustomed, therefore, to feeling intellectually superior to people with
much more experience.
He is also a contrarian. Though a member of the Communist Party, he
was one of the first and fiercest ANC advocates of market reforms.
And, of course, he himself was a dissident until apartheid was
overthrown—and may very well still consider himself one. After all,
whites still control most of the wealth in South Africa, and Americans
and European pharmaceutical companies have priced the life-saving
AIDS drugs far out of South Africa's reach. It is often said that Mbeki,
unlike Mandela, is bitter.
And so, it is entirely possible that Mbeki, in one of his frequent Internet
trawling sessions, came across one of the dissident Web sites, read its
contrarian arguments, and began to doubt mainstream Western
science. The AIDS dissidents are "a small group of people who spend an
enormous amount of time making sure their message will have an
impact," noted Malegapuru William Makgoba, president of South Africa's
Medical Research Council. "When you see it for the first time, and if you
are not experienced, you are likely to be seduced by it."
Using scraps of truth, along with distortions and outright
misstatements, the AIDS dissidents patch together a coherent, if
erroneous, theory of AIDS. In the industrialized world, they believe that
AIDS is caused by "lifestyle" factors—especially the use of various
recreational drugs—and even by anti-HIV drugs such as AZT. Even
before the drug cocktails reduced AIDS death rates throughout the
industrialized world, that theory had been demolished by epidemiological
studies. According to a report from the U.S. National Institute of
Allergy and Infectious Diseases, "Individuals as different as homosexual
men, elderly transfusion recipients, heterosexual women, drug-using
hetero- sexual men, and infants have all developed AIDS with only one
common denominator: infection with HIV."
Of course, the Western lifestyle theory is patently absurd for AIDS in
Africa, where illicit and pharmaceutical drugs are rare, so the dissidents
argue that AIDS in underdeveloped countries is simply a new name for
long-standing diseases caused by malnutrition, unclean water, and the
other scourges of poverty.
Thus Rasnick and fellow AIDS dissident Charles Geshekter wrote to
Mbeki asking his government to consider "what evidence is there that
people with antibodies to HIV live shorter, poorer lives than people in
the same community who do not have antibodies to HIV? We know of
no such evidence." But various studies in Africa have answered exactly
this point. A study of 1400 Rwandan women, for example, found that
those who tested HIV antibody positive were 20 times more likely to die
than their negative counterparts, while two studies from Uganda also
found stark differences in the death rates between HIV-positive and
-negative adults.
Despite a decade of vociferous argument, the dissidents have failed to
convince a single major medical authority—and precious few doctors.
Ugandan physician Elly Katabira recalled a visit by an AIDS dissident to
his clinic in Kampala years ago. He has forgotten the dissident's name,
but he remembers an exchange. At the time, his clinic couldn't afford to
give patients HIV tests, and so Katabira was asked, " 'How do you
know these people have AIDS if you don't test them?' I said, 'What we
are seeing now is not what we used to see. Do you think we are
stupid?' "
For South Africa, the larger issue is leadership. It has been more than
four months since the president asked the health minister to review the
risks and benefits of AZT, and despite having received three official
reports, she has not acted, telling the Voice that she will not act until
the new advisory panel gives her its advice, which will take at least
another month or two. Thus, whether the government will fund AZT for
pregnant women or use that money for some other pressing priority
remains undecided. Last week, it was revealed that the health ministry
failed to spend a shocking 40 percent of its AIDS funds. (The
government said that most of these unspent funds "are committed.")
And now, the president seems to be entertaining a discredited theory.
So, protest is building. Ramphele, the University of Capetown vice
chancellor, made a speech charging the government with having "no
coherent management strategy" on AIDS. Last week, at a national
convention of people with HIV, the health minister was booed and
jeered. And at the same convention, Edwin Cameron, a judge on South
Africa's Constitutional Court, the equivalent of the U.S. Supreme Court,
took the highly unusual step of castigating the government's failure to
lead, saying, "It simply does not seem that the government can begin
to get it right on AIDS." After referring to the reports of Mbeki's
flirtation with AIDS dissidents, the openly HIV-positive Cameron said,
"There are too many lives, too much happiness, too much human
prosperity at stake for flirtation with dangerous and wayward theories."
Research intern: Elinore Longobardi
VIRUSMYTH HOMEPAGE