Chapter 10

Chapter 1 of this report set the scene to explain the events that led to the constitution of the Presidential Advisory Panel on AIDS. The Terms of Reference for the panel included very specific questions that the panel had to deliberate on and generate possible answers to. The Presidential Advisory Panel on AIDS was quite deliberately constituted in such a manner as to bring together individuals who were expert and/or had experience in a broad diversity of areas that are relevant to the understanding of the AIDS issue. This diversity of expertise and experience also included diametrically contrasting views on several key questions pertaining to AIDS. The assumption, therefore, was that members of the panel would unpack the merits and de-merits of particular scientific, public policy and health policy viewpoints in a dispassionate manner and generate the best possible collective advice to the South African government. This lofty ideal usually underpins the constitution of advisory panels. A possible alternative of constituting panels according to common belief systems of the members would necessarily generate advice that is biased in favour of those particular belief systems.

It would have been quite clear to the reader of this report that the recommendations to the South African government that emanated from the panel deliberations are presented in the main according to the viewpoints of the panel members on the cause of AIDS. Such a presentation reflected a painful reality of the deliberations. The panel split quite early on in the process on the basis of what the cause of AIDS was. That primary split on aetiology generated consequential splits of views on the treatment and prevention of AIDS. The depth of the cleft on the aetiology of AIDS was such that the commonalities of views on health policy and public policy were by and large swallowed up.

The central basis of the split was, in the opinion of the author of this report, not based on deeply entrenched ideological positions or blind passion. The split was instead based on fundamental disagreement on the interpretation of the scientific and clinical data and evidence on the cause and progression of AIDS. It was also apparent during the deliberations that there were many legitimate scientific questions to which scientific research has not yet generated answers. In the latter case, no amount of debate between adversaries can manufacture an answer. The only way of generating the answers is to carry out proper scientific investigations. An example of such a question is by what specific mechanism does the HIV induce the depletion of CD4 cells?

The implications of this situation for public policy is should not underestimated. On the one hand, it could be argued that since there is no known mechanism by which retroviruses kill host cells and, as some panellists have argued, that the evidence that HIV is a retrovirus belonging to the lentivirus family of RNA viruses is not compelling, it should therefore be concluded that HIV cannot be the primary cause of AIDS. Such a conclusion would lead public policy in a particular direction. On the other hand, it could equally be argued that we may not yet know the mechanisms by which HIV leads to the depletion of CD4 cells, but there is sufficient evidence to establish a primary causal link between HIV and AIDS. This conclusion would drive public policy in another particular direction.

Results of scientific research and scientific investigations are key drivers of public policy. The Presidential Advisory Panel on AIDS was constituted ostensibly to interrogate available scientific and clinical data and evidence and to make recommendations to inform and advise the South African government as to the most appropriate measures to take in combating AIDS. Such a step was taken in direct recognition of the fact that science does not necessarily have to provide exhaustive, irrefutable and non-controversial evidence before public policy can be developed. More often than not, public policy is developed on the basis of the best possible interpretation and understanding of the data and information available at the time. These policies may be adapted or abandoned as more data, information and evidence are continuously generated by, inter alia, scientific research and investigation and experience.

The nature and format of the deliberations of the panel could not allow the in-depth scientific argumentation that is necessary to resolve many of the differences over scientific issues of a fundamental nature. An inevitable consequence of this reality was different sets of recommendations made from the varying perspectives of what is perceived to be the 'real' cause of AIDS.

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