Proof Positive

How African Science Has Demonstrated That HIV Causes AIDS

BITOKE BISALILE, UGANDA—It had to be witchcraft. For more than a year, Matia Katongole just kept getting thinner. His stepmother remembers his feet: As the bones showed through ever more sharply, they seemed to elongate.

Matia's family decided, with rising terror, that the hex had come from Tan-zania. Matia was a trader in beans, rope, pots, and anything else he thought might turn a profit, and he conducted much of his business with Tanzanians across the nearby border. Matia had once bought some goods on credit but failed to fully pay back the loan. Now, he was too weak to make amends and lift the curse, so his father sent one of Matia's busi-ness partners back across the border with a goat, copious quantities of local banana wine, and 80,000 shillings—far more than the original goods had been worth.

It didn't work. Less than a month later, Matia's father was holding his son, trying to give him a little tea. "Matia vomited," his father recalls, "and died in my lap."

That was 1980, before villagers here in Uganda's Rakai District had seen enough patients like Matia to coin their own term for the new disease, Slim, and before enough trickled into clinics for medical authorities to suspect that they had an epidemic on their hands. Not until five years after Matia's death was Slim proven to be AIDS. This week, after an estimated 14 million Africans have followed Matia's fate, the first World AIDS Conference ever held on African soil opens, bringing about 10,000 doctors, researchers, and activists to Durban, South Africa.

Past World AIDS Conferences have often slighted the contributions of African science. At the last one, held two years ago in Geneva, the editor of the British medical journal The Lancetnoted that whenever third-world speakers rose to present their findings, "seats emptied and the hall began to bleed delegates." But this conference, chaired by South African doctors, offers a chance to showcase research conducted on the continent where HIV almost certainly originated and where the epidemic is far worse than anywhere else.

But earlier this year, African science got snubbed by a most unlikely source: South African president Thabo Mbeki. Apparently after surfing the Web, Mbeki resurrected the notions of a small group of self-styled "AIDS dissidents," the most prominent of whom is University of California virologist Peter Duesberg. These AIDS deniers—who have conducted almost no original scientific AIDS research, let alone on the African continent—argue that HIV does not cause AIDS and that the disease does not exist at all in Africa. The estimated 12 million African children orphaned by AIDS have simply lost their parents to the old, endemic diseases of poverty and inadequate sanitation. The full quarter of the adult population thought to be infected with HIV in some African countries carry only a harmless "passenger virus."

Mbeki recently convened a scientific panel split almost evenly between mainstream researchers and people who espouse such fringe views, catapulting their notions to center stage. Mainstream scientists—at first reluctant to believe that anyone could fall for a theory with hardly more scientific support than Matia's ideas of witchcraft—are now circulating a sign-on statement declaring that HIV causes AIDS. The prestigious journal Natureplans to publish it.

Mbeki—who along with Nelson Mandela is scheduled to speak at the World AIDS Conference—has seemingly backpedaled. Yet there is no doubt that he seriously entertained the denialist ideas. His office solicited the advice of Duesberg colleague David Rasnick, who responded with a letter coauthored by Charles Geshekter, a professor of African history at California State University, Chico, who often takes the lead in arguing that AIDS in Africa doesn't exist. After their surreal letter to Mbeki was made public, inciting a storm of criticism, the South African president penned his own letter to Bill Clinton, comparing the AIDS deniers to antiapartheid activists and medieval heretics burnt at the stake. U.S. diplomats were reportedly so shocked they checked to make sure the letter wasn't a hoax.

What makes this all so extraordinary is that Mbeki—who constantly speaks of leading an "African renaissance" in economics, culture, and science, and who says he consulted the dissidents to help avert a "superimposition of Western experience on African reality"—apparently chose to slight African science in his search for an African solution. Instead, he gave disproportionate credence to a group of mostly Western theorists who seem especially ignorant—indeed, almost contemptuous—of science conducted in Africa and the clinical experience of African physicians.

Yet African research has provided crucial information to the world's understanding of AIDS, proving, for example, that HIV is not spread by mosquitoes. And now, as the astronomical cost of medication is finally becoming a headline issue, African science is showing that the drugs work every bit as well in African patients as they do in Westerners.

In Uganda, many of the scientists who helped discover the epidemic are still studying it. Their story epitomizes the research of a continent.

David Serwadda's first inkling was the four patients with Kaposi's sarcoma. That cancer, called KS, is endemic in Uganda, but largely confined to older men who usually get easily treatable lesions on their arms and legs. From late 1983 through '84, when Serwadda was doing his residency in Kampala's Mulago Hospital, four patients—all younger than 45, all from Uganda's rural Rakai District—presented with an unusual form of the cancer that raged throughout the body. One 26-year-old woman originally came in with the lesions on her head and torso, which was unusual enough. But an autopsy revealed that the cancer had invaded her tonsils, stomach, liver, spleen, heart, and lungs.

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