Dissident promises to shut up once proof is provided

President Thabo Mbeki may yet emerge from the controversy surrounding the creation of his Aids advisory panel with his credibility intact - not because the dissidents' view will prevail, but because they have been co-opted into a process that may quash their views once and for all.

This is the outcome desired by Medical Research Council (MRC) president Malegapuru Makgoba, whose idea it was to create a subgroup of the 36-member panel to establish conclusively the link between HIV and Aids. It is made up of Makgoba and Dr Helene Gayle, director of the National Center for HIV/Aids and TB Prevention at the Center for Disease Control (CDC) in Atlanta on the one hand, and arch-dissident Californian molecular biologist, Prof Peter Duesberg, and self-proclaimed Aids heretic Prof Harvey Bialy, a former editor of the US magazine Bio/technology, on the other.

Malegapuru Makgoba . . . joint research important for science Aids dissidents comprise a small but vocal minority who don't believe that HIV causes Aids. Thus, they don't believe in anti-retrovirals - a fact that may explain the strange appeal they hold for Mbeki, who is under pressure to provide pregnant HIV-positive women with free AZT.

Makgoba, an ardent defender of Aids orthodoxy, says the subgroup will embark on a series of joint projects that will enable it to understand the nature of the epidemic in SA .

"We're not going to be looking at whether malnutrition or TB causes Aids or any of those things that come from the dissidents," he says. "We're undertaking a series of projects to try to understand the peculiarities of the disease in SA."

The group will design a series of studies centred on the MRC and carried out by top local scientists with the CDC providing technical support. For starters it will prove that all SA's diagnosed Aids cases are also HIV-positive. "Duesberg has promised that if we prove that HIV causes Aids he'll shut up," says Makgoba who has no doubt that they will arrive at this conclusion. "The findings will allow us to put this matter to rest once and for all and we will have done it together, which will be important for science."

If this happens the R2m that the Department of Arts, Culture, Science & Technology (DACST) will be shelling out over the next two months on hotel and travel bills for the 30 international panellists may not be money down the drain. And if it clears up policy confusion in government about the right way to tackle the epidemic, it will be cheap at the price.

But not everyone is sure that the panel - of which about a third are extreme dissidents - will resolve in a matter of weeks an issue that has had orthodox scientists and dissidents tearing at each others throats for 15 years.

"You're not going to convince the other side," says panellist Prof Salim Abdool-Karim, director of HIV prevention and vaccine research at the MRC. "It can't be done because they've been convinced (of the correctness of their views) for years."

In the mid-Eighties, mainstream science considered Duesberg a challenge, but his outdated theories have since been buried under masses of solid scientific evidence. At the 1992 International Aids Conference in Amsterdam delegates sported badges stating: "It's the virus, you idiot!" in reference to Duesberg's views. Then he was the butt of jokes; now SA is, with the creation of a panel which threatened to derail Mbeki's upcoming US visit.

The Clinton administration is not amused by Mbeki's forays into science and at the last minute sent three African-Americans who specialise in infectious diseases and hold orthodox views on Aids to join the panel discussions.

The discussion, though heated at times, was generally cordial. At one point it verged on the bizarre when some dissidents, faced with the scorn of a room full of African clinicians, dropped their argument that Aids is caused by malnutrition and concocted a new theory: that Aids in Africa is caused by environmental pollutants and other unspecified chemicals. It was given short shrift.

The panel must recommend to Mbeki how to counter Aids in an SA context, including an affordable drug-based response. But how a divided panel can be expected to produce credible guidelines for its treatment and prevention, is anybody's guess. And what will happen to the government's prevention campaigns and vaccine initiatives if the panel fails to satisfy Duesberg that HIV causes Aids?

Former WHO consultant, Dr Gordon Stewart, a panellist who believes that lifestyle factors are a dominant cause of Aids, backs Mbeki: "The main reason for the President's genuine concern is because existing policy approaches in the UK and US have been unsuccessful (here) and that calls for a radical new approach".

Over the next six weeks as they conduct an Internet debate over the best course of action for SA, the panellists - few of whom actually treat Aids patients - would do well to remember the ordinary South Africans who are dying of Aids without access to drugs or proper care. The panel must leave Mbeki with no more room for doubt; the lives of thousands are at stake.

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