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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 excellentand 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 overthrownand 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" factorsespecially the use of various recreational drugsand 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.