Debating the Obvious

Inside the South African Government's Controversial AIDS Panel


JOHANNESBURG, SOUTH AFRICA—The most surreal moment happened right on the first day.

South African president Thabo Mbeki convened a panel of scientists to advise him on how to handle his country's surging AIDS epidemic, and it met on July 3 and 4 in Johannesburg. This panel has sparked a firestorm of criticism, because many of the invited scientists, who met for a first round in May, are so-called "dissidents" who cling to the fringe view that HIV does not cause AIDS and that AIDS in Africa does not exist but is instead just a new name for the old diseases of poverty and lack of hygiene. The meeting, attended by the South African minister of health, was closed to the press except for a handful of invited observers, including this reporter.

On the first day, prominent dissident David Rasnick—a California biochemist whose advice President Mbeki had sought out earlier this year—made the proposal that all HIV testing be banned. Stunned, South African scientists on the panel asked if Rasnick meant banning the test even to screen the nation's blood supply. "If I had the power to outlaw the HIV antibody test," said Rasnick, "I would do it across the board."

Rasnick also denied that he had seen "any evidence" of an AIDS catastrophe, despite the testimony of African physicians about the drastic change AIDS has caused in their clinics and hospitals. More evidence emerged from South African mortality records, showing a shocking rise in deaths among adults in the prime of their life. In 1990, 48 percent of deaths among men occurred in the 15–49 age group, but by 1999–2000, that age group accounted for 87 percent of the deaths. For women, the rise has been just as alarming, from 27 percent to 68 percent.

Publicly, the ministry of health applauded the robust debate—and, indeed, the most extreme dissidents, like Rasnick, may have discredited themselves. In private, health department officials veered between amazement and ridicule of Rasnick's proposals, and Peter Duesberg, the most famous AIDS dissident, gave a presentation so removed from African medical reality that it left several local doctors shaking their heads.

But while the vast majority of South African AIDS researchers know that HIV causes AIDS—and certainly know the disease is ravaging their country—this panel was not for them. It was for their president, who desperately needs a way to save face for giving credence to people who deny the very existence of the worst danger facing his country, and for Africans who may be hearing the dissident ideas for the first time and need to know the evidence for and against ["Proof Positive" and NIAID Web Site]. Winstone Zulu, a prominent HIV-positive activist on the panel, welcomed the discussion because it gave him hope. "For 10 years I've lived with HIV," he told the Voice, "and for 10 years I've preached the main line. To hear that I could be wrong is good news. If you were in my shoes, you could understand." Indeed, Zulu comes from Zambia, where people are so poor that the costly drugs that have reduced the AIDS death rate in rich nations amount to a cruel mockery. Yes, people must "face reality," Zulu said, but added, "Ideas from the other side will find very fertile ground in Africa because the conventional thinking hasn't been of much use."

That's one reason why Joseph Sonnabend, a South African–trained doctor practicing in New York, was so angry about the strategy adopted by most mainstream panelists toward the Internet debate set up by the South African government. They decided not to contest every dissident point—partly because they have been exhaustively debated among scientists for more than 10 years—but instead to prepare broad responses to questions posed by the president and the panel moderators. Sonnabend, one of the few mainstream members to participate wholeheartedly in the Internet discussion, called the limited involvement by his peers "unconscionable." The minister of health, Manto Tshabalala-Msimang, went further, saying her government felt "betrayed" by unnamed South African scientists for discouraging foreign panelists from joining the debate—a charge South African researchers flatly denied.

Yet, in the end, there was something to show for it all: research proposals put together by both sides. Ministry of health official Khotso Mokhele hyped the planned studies, which he said he expected to be completed by the end of the year, as so rigorous a test of the hypothesis that HIV causes AIDS that afterwards one side might "shut up once and for all."

"He was a bit overexcited and overspoke," said Harvey Bialy, Duesberg's biographer and the dissident scientist who worked hardest on designing the study. What Bialy hammered out with Helene Gayle, head of the AIDS program at the American Centers for Disease Control, and Malegapuru Makgoba, president of the South African Medical Research Council, is a broad proposal on how to test the test—specifically, to see whether the standard antibody test concords with other HIV tests, including isolation of the virus, a laborious and expensive process that is usually done only for research purposes. Obviously, this study will not determine if HIV causes AIDS, but it could give fresh credence to a test that the dissidents have steadily tried to undermine.

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