The Great AIDS Debate
South Africa is coming alive with discussion and hopes for the government's "Expert Panel of Inquiry" into the assumptions about the causes of AIDS, how to properly diagnose it, and which treatments are genuinely helpful.
The inquiry (made up of international experts) has been called by President Thabo Mbeki, and is being co-ordinated by health minister Dr Manto Tshabalala-Msimang and her advisor Dr Ian Roberts.
Indications are that the "International Panel" which is to include scientists challenging the HIV-causes-AIDS theory that the world has become so used to, could begin in early May, though the health department is progressing cautiously. There is some friction reported between the President's office and the health department over the goals of the initiative.
In South Africa's chattering classes and beyond, these developments are proving controversial - sections of the media support Mbeki, others ridicule him. On the whole the medical and pharmaceutical establishments have been seriously critical, as the foundations for their professional status and market penetration are rattled.
As an analysis in early April of money transfers into Africa showed an exceptionally high capital transfer from strong Western Aids institutions to African NGOs, it seems that various international interests may even be intent on weakening South Africa's sense of purpose and confounding its regional reputation.
But I have spoken to South Africans with open minds, supportive of Mbeki's call to look at the range of scientific views available - ie, Is HIV testing accurate? Is AZT more toxic than beneficial - and how can one truly respond to the epidemics of malaria, TB and poverty that are being counted as Aids in this country? Up to 60% of Aids in South Africa is TB-related.
Though the agendas defending the familiar HIV/AIDS paradigm are strong, so is the political will to allow new experts and information into the process of producing solutions.
Says President Mbeki: "I am taken aback by the determination of many people in our country to sacrifice all intellectual integrity to act as salespersons of the product of one pharmaceutical company [AZT manufacturer, Glaxo Welllcome].
"I am also amazed at how many people, who claim to be scientists, are determined that scientific discourse and inquiry should cease, because 'most of the world' is of one mind. The debate we need is not with me, who is not a scientist, or my office, but [with] the scientists who present 'scientific' arguments contrary to the scientific view expressed by 'most of the world'. By resorting to the use of the modern magic wand at the disposal of modern propaganda machines, an entire regiment of eminent 'dissident' scientists is wiped out from the public view, leaving a solitary Peter Duesberg alone on the battlefield, insanely tilting at the windmills."
Mbeki's press officer, Parks Mankhalana wrote recently: "A disturbing trend in the current debate has been the intolerance by the media to different viewpoints. One commentator branded the president a criminal because he spoke to [the Californian protease drug designer, Dr David] Rasnick and dared to think beyond accepted wisdom. All efforts to prescribe how other people should think have failed. Dictatorships and fascism failed to suppress the freedom of the mind to wander in search of solutions."
Indicative of the mood was a one-and-a-half hour South Africa-wide radio phone-in in early April on SAFM's Tim Modise Show, with the British independent TV producer Joan Shenton and this reporter, fielding several irate calls from hardworking doctors. One said her blood was boiling, and that this sort of questioning must cease.
On the following week's first anniversary show, about half of Modesi's callers were spontaneously congratulating him on the HIV/AIDS discussion, and Modise expressed a commitment to pursue open debate on this and all issues that are of interest to the nation.
The local and international press have oddly overlooked referring to any potential panel participants other than Rasnick and his senior colleague, Prof. Peter Duesberg, in the so far mostly secret line-up for the panel.
There has been independent confirmation from two senior British scientists that they have accepted invitations to participate. Said Prof. Gordon Stewart, a professor of public health at Glasgow University and a former WHO consultant on HIV/AIDS: "The initiative is unprecedented and wonderful. It is very timely and the reaction from some parts of the AIDS orthodoxy shows how necessary it is to have President Mbeki's questions answered without further delay."
The head of drugs monitoring at the Cochrane Institute, Dr Andrew Herxheimer commented: "It is a worthwhile effort to clarify what the important unknowns are and what needs to be done to resolve the uncertainties that are blocking the path. President Mbeki's initiative is the most rational."
Says South Africa's chief family practitioner and head of the department of family medicine at the Medical University of South Africa, Prof. Sam Mhlongo: "My own view is that the case for a link between HIV and AIDS is not proven and I have questions over the diagnosis of AIDS itself." He is another of the confirmed participants in the International Panel.
International scientists, activists and NGOs are waiting with baited breath to see whether the panel, when announced, will include the Australian biophysicist, Eleni Eleopulos, leader of the group of AIDS researchers based at the Royal Perth Hospital, without whom many feel the Inquiry would not be complete.
In early April, the Johannesburg Mail and Guardian, a white middle class daily newspaper, ran with a fearful headline that 60% of the armed forces in South Africa may have HIV/AIDS - a threatening statistic based on ongoing but problematic Elisa-type testing of soldiers in often high malaria and tuberculosis regions.
However, the newspaper failed to report that scientists and test manufacturers agree that malaria and TB antibodies can turn so-called HIV antibody tests positive.
Apart from creating a climate of national insecurity at home, these results affect the international peacekeeping capabilities of the South African military, since HIV-test positive soldiers are forbidden to be part of peacekeeping units.
In fact, there are said to be some four million South Africans with HIV - a figure arrived at by extrapolating from the results of testing for HIV at antenatal clinics - despite the test manufacturers' warnings that pregnancy itself can cause unknown numbers of non-specific results.
In early April, South Africa's health minister, Tshabalala-Msimang told parliament that five South African women had died during an "ongoing clinical trial" of the anti-Aids drug, Nevirapine. Two of the deaths were caused by hepatitis, while a link between Nevirapine and the other three deaths was "probable", said the minister. A total of 150 pregnant women are taking part in the trial.
She told parliament that the results of the trial so far showed that "there is a death rate of 1% and a liver toxicity profile of 11%." The deaths, she said, underscored the need for caution.
The growing mood in the AIDS-weary South African population seems to be that fresh insights and productive inquiry into fundamental issues surrounding HIV/AIDS, could be the watershed people have been waiting for. Signally absent from the discourse so far is the women's movement, representing so many of those directly affected by the uncertainty of HIV testing.
For potentially far reaching developments in the next months in terms of public health policy, South Africa is the place to watch.
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