A virus cannot cause a syndrome
Smuts Ngonyama
MANY people in our country do not understand the issues that President Thabo Mbeki has been raising about AIDS. Part of the reason for this is that the general level of knowledge about AIDS is abysmally low. This is clearly illustrated by the views of your correspondent Wyndham Hartley. I refer to his article titled Robbie helped govt sidestep consequences of HIV notion (September 14, 2000) He says "President Thabo Mbeki (is) questioning whether the virus causes the syndrome". I would have expected that, as a senior journalist, Hartley would know the difference between a disease and a syndrome. A virus cannot cause a syndrome. As represented by the letter "S" in AIDS, the syndrome includes a collection of diseases, according to the US Centres for Disease Control and others. Among these diseases are TB, some pneumonias, certain cancers, diarrhoea, herpes and others. It is because of this that it is said that "opportunistic diseases" cause the death of people living with AIDS. This is also why even some scientists who are convinced that HIV causes AIDS also argue that this virus negatively affects the immune system only when it acts together with other co-factors. There are established treatments for each one of the diseases that together constitute the syndrome, based on contemporary scientific understanding of the causes and progression specific to each disease. It is therefore absurd for Hartley to suggest that all these diseases can be caused by a single, common virus HIV. Had he checked what "syndrome" means, he would have found that, according to the Oxford English Dictionary, the word means "a set of concurrent things". It is in this sense that the word "syndrome" is used in the acronym AIDS. It signifies a set of different, concurrent diseases. Hartley should read President Mbeki's speech at the Durban international AIDS conference and his comments in the recent issue of Time magazine. He will see that, among other things, what the president is challenging is the assertion that AID AIDS without "S" is the exclusive fault of a single virus. He is saying that he does not believe that immune deficiency can be acquired the "A" in AIDS from a single cause, the HI virus. To substantiate his opinion, Hartley must produce evidence that HIV is the sole cause of AIDS. It is neither sufficient nor responsible for him merely to argue that all he is doing it to state "conventional wisdom". After all, the controversy has arisen essentially because the president has asked that science must answer the questions posed by eminent ("dissident") scientists who question this conventional wisdom. The president's international advisory panel on AIDS is working precisely to consider the divergent scientific opinions on this matter. Some journalists base their offensive against President Mbeki on an argument supposedly in favour of the integrity of science and scientists. They argue correctly that the president is a politician and not a medical scientist. Yet they do not concede the importance of the panel. The scientists agree that the various factions must expose their views to scientific scrutiny. On the contrary, the same journalists who pretend to defend the independence and integrity of science argue that there exists an established dogma that everybody must accept and not subject to scientific scrutiny. Hartley argues that pressure must be put on government to admit "unequivocally the link between HIV and AIDS". He says that it is necessary to do this "simply because it is far safer for SA's youth to believe in the link and to take precautions". In this context he pours scorn on Education Minister Kader Asmal's call to our "adolescents" to use condoms to avoid teenage pregnancies. Hartley seems unaware of the importance of the social problem of teenage pregnancies. Abstinence and the use of condoms must be some of our responses to this serious social problem, as Asmal correctly said. The minister might also have mentioned the critically important issue of sexually transmitted diseases, such as syphilis. These diseases are of the greatest importance with regard to a more comprehensive and accurate understanding of how immune deficiency is acquired. Safe sex and the use of condoms are a vital part of the struggle we have to wage to reduce the incidence of sexually transmitted diseases. SA's youth must take precautions for all these reasons, including the stopping of any other viruses that might be sexually transmitted. As long as Hartley, and many others, refuse to take the trouble seriously to study all issues that pertain to HIV/AIDS, so long will it take us to have a rational discussion of this challenge. Hartley writes that "the question whether HIV causes AIDS" must be answered. The question he must answer for himself is why this question is posed at all. It is patently irrational and absurd to ask a question about whether anybody believes that more than two dozen well-known diseases are caused by one virus. Our country, and much of our continent, face a serious health crisis to which all of us must respond, not only government. This crisis includes AIDS, but is not merely made up of AIDS. We continue to pray that everybody in our country will understand these fundamental truths. This will enable all of us to respond appropriately to the real health crisis that confronts us. All those among us who take the trouble to think must refuse to be driven to act on the basis of belief and strident propaganda, rather than scientific and medical truths. Ngonyama is head of the African National Congress president's office.
Mr. Ngonyama was writing in response to the following article. Robbie helped govt sidestep consequences of HIV notion
Wyndham Hartley
THERE has been a sense of unreality surrounding the HIV/AIDS debate for some time now. Not only because of President Thabo Mbeki questioning whether the virus causes the syndrome, but because of the way the consequences of being wrong have been ignored by government. That unreality was stepped up a gear last week as a result of John Robbie and his now infamous interview with Health Minister Manto Tshabalala-Msimang. Robbie has done the world of journalism no favours. I suppose talk show hosts maintain their popularity in different ways. One of those is to be outrageous so that listeners return to find out what outlandish thing the host is going to say next. Robbie's forthrightness might be acceptable when discussing the performance of the Springboks after their latest test match, but it does not translate well in the context of interviewing a cabinet minister who was his invited guest. That he should have aggressively and vigorously interrogated Tshabalala-Msimang on the issue of what causes AIDS, and whether it just might have something to do with the human immunodeficiency virus, was correct. But to have been rude, behaving like the "baas" talking to the "maid" was the start of the disservice, particularly for an industry fighting a rearguard action against charges of being subliminally racist. It was at best insensitive, at worst arrogant. The rudeness effectively allowed Tshabalala-Msimang off the hook. When she complained that she did not want him to call her Manto on air he should have heeded her. By ignoring the request she was allowed to escape the question by citing his rudeness. All people will remember is the personal conflict between the two, not the fact that a minister who once upon a time returned from Uganda filled with enthusiasm for new ways of combating the HIV/AIDS pandemic is now hiding behind a strategy document to avoid conceding that she does believe that HIV causes AIDS. The African National Congress (ANC), with great alacrity, attacked Robbie for his rudeness and demanded he should be fired. The demand was outrageous and, thankfully, has been roundly rejected. But it was clever, because suddenly the debate was not about whether the health minister in a democratic SA believes HIV causes AIDS, but about press freedom. Indeed, the way a notice of motion was introduced in the National Assembly on Tuesday congratulating Primedia (the owner of Radio 702) for its apology to the minister and further castigating Robbie for his failure to apologise, shows they are playing it for all it is worth. The demand has been toned down a tacit admission that the earlier calls for Robbie to be sacked were undue interference in press freedom to a call for an apology. The smoke screen around the minister's failure to answer the question has expanded. Robbie's rudeness has effectively allowed the ruling party to take the focus off Mbeki's and TshabalalaMsimang's position on HIV/AIDS and turn it into a discussion on the "despicable and disrespectful" behaviour of the media. This could mean that the question of whether HIV causes AIDS and is poised to kill millions of South Africans will continue to go unanswered. It was clear from the reactions of Education Minister Kader Asmal at a press briefing on Tuesday that all cabinet ministers are walking on eggshells over the HIV/AIDS question. Asmal, when asked about the connection between HIV and AIDS, with particular reference to education programmes in the schools under his control, simply obfuscated. Suddenly adolescents were being encouraged to use condoms for the sake of avoiding pregnancies rather than to avoid a potential death threat. In a further amazing reply, Asmal said there was a connection between the virus and the syndrome as far as gay men were concerned. He concluded by saying he would not be pushed into a corner on the issue. Clearly neither he nor TshabalalaMsimang are prepared to repudiate the president. Nor is Minister Essop Pahad, who evaded the question by reading the president's ambiguous replies to questions in a Time magazine interview. The only minister willing to state unequivocally the link between HIV and AIDS was Labour Minister Membathisi Mdladlana, although he added the proviso poverty also damages the immune system. Just in case the conventional wisdom on HIV/AIDS is correct, the pressure must be kept up. Cabinet ministers should repeatedly be asked to take a stand on the issue simply because it is far safer for SA's youth to believe in the link and to take precautions. But, for heaven's sake, let it be done politely.
 TORONTO
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