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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, downplayingbut not denyingthe 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 virusthought 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 criminalityand 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.