Eminent world scientists from both sides of the AIDS debate have been mandated by the Mbeki AIDS panel to undertake historic experiments to attempt to purify, or isolate, the HIV virus; and also examine the current HIV testing methodologies. In the meantime, the panel wants all HIV testing to be suspended. "It's a worthless distraction," says one panel member. Huw Christie reports from Johannesburg.

Pusch Commey, reports from Durban, on the good, the bad and the shananagians at the recent 13th International Aids Conference held in that city.

Something is killing Africa and the world. What it is, nobody is sure. But for now the medical establishment believes it is HIV.

Based on this premise, 12,400 delegates and over 1,500 journalists congregated at the Durban International Convention Centre for the 13th International Aids conference (9-14 July) to debate and compare notes on the most insidious scourge in modern times. These were bad times to be a youth. But all was not solidarity.

The run up to the conference itself was characterised by an unrelenting media assault on the person of President Thabo Mbeki. He was variously described as irresponsible, grossly negligent and genocidal. Most thought he had lost his marbles. Columnists suggested that it is perhaps his final solution to the high incidence of poverty and unemployment.

His mortal sin was to have exercised his right to the freedom of expression and enquiry that all Western constitutions hold so dear. He had dared question the unquestionable: the inconclusive theory that Aids is solely caused by a virus called HIV.

He had dared to threaten the very foundation upon which is built a huge Aids edifice that feeds on the virus. Pharmaceutical companies, Aids researchers, the medical establishment, microbiologists, NGOs, entrepreneurs, you name it. And which replicates as fast as the virus itself as sufficient panic is created to force governments and institutions to fork out more and more cash.

The potential catastrophe has been variously described as akin to a nuclear war that will decimate economies and societies, and leave ghost countries or maybe continents in its wake; Africa being the usual suspect.

Durban, the current “epicentre” of the invincible virus, was chosen as the venue of the counter-attack primarily for this reason. So far the body count, according to UNAIDS, is 33 million infected worldwide by the end of 1999, 18 million already dead. Africa’s share was 24 million infections.

South Africa reportedly has the highest number of people living with the virus — 4.2 million. And its neighbour, Botswana, is said to be the worst afflicted, with about 36% of its adult population between the ages of 15 and 49 affected. Delegates echoed a modern day black plague revisited on blacks. They largely blamed African sexuality and gross negligence. It was time to fight back and one huge banner on the highway lamented: “The future is not what it used to be”.

Alternative views not welcome

Break the silence was the chosen theme, partly meant to highlight the “criminal negligence” of governments said to have buried their heads in the sand while the epidemic raged. More importantly it was meant to bring the issue of Aids out into the open.

Ironically, this invitation to transparency did not extend to anybody with a view contrary to the official one — that “HIV is the sole cause of Aids”. Chairman Mao would have been proud of this huge conspiracy to silence dissenting voices.

Legal threats to President Mbeki and a threatened boycott of the conference by anti-Mbeki elements failed to materialise.

Delegates came from over 200 countries and paid $800 each for the privilege to attend. For the duration of the conference, the official website (www.aids2000.co.za) recorded 1.4m hits, with promises of a bigger turnout at the next conference in Barcelona, Spain, in 2002.

Before the commencement, an agenda had already been set with the “Durban Declaration”; a scroll-like document in the form of the Ten Commandments tablet signed by 5,000 medical practitioners declaring HIV to be the sole cause of Aids.

In another manoeuvre, the German drug company, Boehringer Ingelheim, manufacturers of Viramune (also known as Nevirapine) and a major sponsor of the conference, announced without informing the Mbeki government, that it would offer its drug free for five years to prevent South African babies born to HIV-positive mothers being infected.

Preceding that, the South African government had come under intense fire from the press for failing to provide pregnant HIV-positive mothers with drugs that would reduce transmission risks, saying they were too expensive and toxic.

Boehringer’s move, the detail of which was uncertain, was cautiously welcomed by UNAIDS. At best, it was a tactical manoeuvre as well as a Greek gift meant to undermine the Mbeki government’s position on anti-retroviral drugs.

The big Western drug companies had made major contributions to the sponsorship of the conference and expected returns on their investments. But what drew a lot of interest was the sex workers stand which reported an unprecedented boom in business. As one bystander commented: “The demand for sex has never been known to go down, HIV or no HIV.”

Mbeki’s speech at the opening ceremony met with a roar of anger. Some delegates walked out. But the president, expected to make penance in front of the drug lords, was unyielding. He stuck to the cornerstone of his presidency which seeks to find African solutions for African problems, only too well aware that self-interest is the only guiding principle in the West’s dealings with Africa.

He welcomed the delegates and reminded them: “Perhaps in thinking that your conference will help us to overcome our problems as Africans, we overestimate what the 13th International Aids Conference can do. Nevertheless that over-estimation must also convey a message to you. That message is that we are a country and a continent driven by hope, and not despair and resignation to a cruel fate.”

He stressed that the world could not blame everything on a single virus and that Aids thrives — a partner with poverty, suffering, social disadvantage and inequity. And that the greatest cause of ill health and suffering worldwide, including South Africa, was extreme poverty.

In conclusion, he posed the rhetorical question: “Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour?” He wished that they had all come to Africa because they care.

AZT! AZT!!

The response from subsequent speakers, wildly cheered, was a highlight of a lack of political will. Then a hapless Nkosi Jonson, a 11-year-old boy living with HIV, was put on stage to sorrowful talk about his plight and plead for the government to give pregnant mothers AZT.

The next morning’s headlines were unanimous: “Mbeki fails to break the silence”. Then there was the usual media spin to put his speech out of context by reporting that Mbeki says the cause of Aids is poverty, while the import of his speech for those who cared to apply their minds was simply that conditions of poverty in developing countries, for which the West is a major contributor, has spawned several killer diseases, including Aids, tuberculosis and malaria.

And that to make any impact, the world must attack the conditions that create poverty. Better hygiene, better education, better nutrition, etc, will go a much longer way to arrest Aids rather than merely focusing on drugs. Prevention, which was one of the great themes of the conference, would be virtually impossible if the social condition within which Aids thrives is not addressed.

Drug wars

The conference itself was a superbly organised affair worthy of any standard. On any particular day over 50 papers were presented at seminars with topics like pediatric retroviral therapy, innovative approaches to reach sex workers, and male circumcision.

Fifteen separate satellite link-ups made it a huge affair. And several cultural events took place at the same time to bring awareness to the Aids issue.

However, any scene of intense activity happened to be where new or old drugs were on offer, ranging from AZT and Nevirapine to Zinovidune.

Combination therapy or cocktails, the most popular being the triple combination therapy known as Haart, was also touted as a remedy to reduce viral load to undetectable levels.

The subject of vaccines attracted great interest too, and worthy of note was the work of the International Aids Vaccine Initiative (IAVI), a New York-based NGO, which seeks private and governmental funding to develop free Aids vaccines. Bill Gate’s Foundation has donated $26m to its cause.

Apparently bio-tech companies were unwilling to invest in the development of vaccines for the main reason that those who need it most were poor and could not afford it. A US-based company, Genetec, which tried, found its share price drop dramatically on the stock markets.

The drug wars reached a head on the third day of the conference when a fierce battle ensued on the floors, side rooms and even toilets of the conference centre. The giant pharmaceutical companies were out to get firms offering a no-name brand drugs for Aids sufferers.

Representatives of the large companies were busy on a misinformation campaign to discredit generic drug manufacturers even though it had been shown that some of the drugs made in Brazil and India were more effective than the very expensive brand names.

The infighting got so bad that an international lobby group, Act-Up, called a meeting at the offices of the Durban Chamber of Industries to resolve the matter with government ministers from several countries.

The drug giants had complained that the generic drug manufacturers were trying to cash in on a multi-billion dollar trade. “We are talking billions here,” one representative who did not want to be named said.

With no drug able to claim outright victory over Aids, the strategy shifted to drugs or a combination of drugs that prevent mother to child transmission of HIV. By the end of the week, cost/benefit analyses suggested victory for Nevirapine which claimed to be more effective and less costly. Two single doses to the mother, costing as little as R24 as compared to R1,608 for AZT was said to reduce the risk of mother to child transmission of HIV by 47%. There was also talk about differential pricing which could see a significant reduction in the price of drugs and vaccines when exported to developing countries.

Apparently of little consequence to these “First World” drug wars were traditional healers. Representatives of traditional healers at the conference seethed at the lack of respect shown them even though they claimed that 90% of people in the most affected areas saw traditional healers. Their holistic methods, they said, was far superior to Western remedies and yet they were shunned even by their own governments.

In addition, “bio-piracy”, a situation where Western drug companies steal African remedies and pass them off as theirs, is rife and unremedied. Incidentally, the two “most successful” African countries in dealing with the Aids crisis happened to be those which had a programme of close collaboration between traditional and Western therapies — Senegal and Uganda. ä

Dissident voices

So where were the so-called Aids dissidents? Obviously the party was organised by a very rich gentleman who goes by the initials HIV, and since dissidents had not acknowledged his status and power, they were non-guests at his feast. They were not on the agenda and had to resort to guerrilla warfare, unofficially taking on anyone who dared to debate.

They took their case to the corridors as nobody would provide them with a forum for a settled issue. Absent was the dissident guru, Peter Duesberg, but another prominent dissident, Christine Maggiore, made it to print.

She reiterated her position mooted in her book, What if everything you thought you knew about Aids was wrong. She was tested HIV positive and negative and positive on numerous occasions, and fed on AZT that made her sick, until she repudiated the HIV theory and refused any treatment.

She has lived a healthy life for eight years since her first diagnosis, and has even given birth to a healthy baby. She called on everybody to reject the HIV-Aids link and shun the so-called anti-retrovirals like AZT which she describes as toxic.

Judgement day

At the end of it all, the focus had shifted from prevention and drugs to hopes for a vaccine. Regrettably, sex was too powerful a force to prevent. An African vaccine initiative between Kenya and South Africa, with financial assistance from IAVI was going to be tested at Hlabisa, one of the worst afflicted areas in the region of KwaZulu-Natal.

Nelson Mandela had the final word. He addressed the closing ceremony to rapturous applause. Touching on the HIV-Aids dispute, he said: “I am old enough and have gone through sufficient conflicts and disputes in my lifetime to know that in all disputes a point is arrived at where no party, no matter how right or wrong it might have been at the start of that dispute, will any longer be totally in the right or totally in the wrong. Such a point, I believe, has been reached in this debate.”

He defended both the position of Mbeki and the integrity of the scientific community and admonished all to put the primacy of politics or science on the backburner and proceed to address the needs and concerns of those suffering and dying. It can only be done in partnership. History was going to judge them harshly if they did not. It was vintage Mandela at his diplomatic best.

The aftermath

Long after the conference, media knives were still out for Mbeki — this time on his refusal to supply anti-retroviral drugs to pregnant women on the grounds of expense.

Economists have calculated the highest cost of saving a child’s life from an HIV-infected mother at R2,968 (£1 = R10 approximately), using the cocktail of AZT and Nevirapine. Formula feeding instead of breastfeeding would put the cost at R5,243.48, significantly less than the R18,966.70 that every HIV positive child costs the state. The government seemed to be listening.

Also significant was a U-turn done by Judge Edwin Cameron, a renowned white South African high court judge, who had publicly declared his HIV positive status. He had, earlier on during the conference, slammed the Mbeki government for its assertion that poverty was the root cause of the rapid spread of the disease.

A week later, after the conference, he agreed with the government that poverty played a crucial role in the pandemic. He laid onto “the fundamental moral iniquities” of pharmaceutical companies who inflate the prices of anti-retroviral drugs, which should cost little more than aspirin, condemning millions of Africans who had Aids.

He openly apologised to the government, saying: “The government has the right legal framework in place to combat HIV-Aids.” It was some about-turn!

His strident condemnation of the government and his sudden repentance have sent government critics scurrying for cover, and muttering about Mbeki wanting to use the Aids issue as a weapon to redress colonial economic and political wrongs.

If that was so, then it is a noble pursuit. And Africa can indeed be proud of a political grandmaster who has thought 20 moves into the global chess game of richman/poorman, plunderer/victim. If Aids cannot, then nothing can move the “greedy” North to cancel Africa’s debts and give a new Africa a fighting chance to survive and triumph over adversity.