By Smuts Ngonyama

Business Day (SA) 4 Oct. 2000

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.