By David Rasnick

2 March 2000

Dear everyone,

I am now free to divulge this information.

Wednesday, January 19, 2000, Jacques Human in South African President Thabo Mbeki's office faxed me 8 questions that the President sent to Health Minister Manto Tshabalala-Msimang. Mbeki wanted me to respond to the questions and answers. I asked Professor Charles Geshekter, PhD, to join me in responding to those questions. We sent our response to Mbeki's office Thursday, January 20.

Friday, January 21, I talked with President Mbeki for perhaps 10 min on the phone. The President and I had a very nice conversation. He asked me if I would support his efforts regarding AZT and AIDS. I made a personal commitment to support Mbeki and I also committed Rethinking AIDS: the Group for the Scientific Reappraisal, and I committed the International Coalition for Medical Justic (ICMJ) to support his efforts.

Mbeki is good friends with Clinton, the Prime Minister of England, and the German Chancellor. He told me that he is going to write these heads of state and ask them to join his efforts to bring about an international discussion on AIDS and the anti-HIV therapies sometime in the spring, well before the International AIDS Conference in July.

Mbeki wants to provide a public forum where the leading proponents of the HIV hypothesis and its leading critics can present the evidence for and against the following popular beliefs:

1. AIDS is contagious.

2. AIDS is sexually transmitted.

3. HIV causes AIDS.

4. The anti-HIV drugs promote life and health.

(Below is what Charlie Geshekter and I sent to President Mbeki's office.)

Jan. 20, 2000

Dear President Mbeki,

I have asked my friend and colleague Charles Geshekter to join me in responding to the eight specific questions and answers that Jacques Human faxed to me.

Dr. Charles Geshekter (California State University/Chico) met with Dr. Manto Tshabalala-Msimang at the Ministry of Health on December 2nd. Ms. Precious Matsoso (the Registrar of Medicines) and Dr. Lindiwe Makubalo (Director of Health Systems Research) were also in attendance.

Their wide-ranging discussion included 1) the HIV seroprevalance surveys at antenatal clinics and recognized problems with interpreting the accuracy and specificity of the ELISA antibody tests; 2) the way that Western Blot test results are read and interpreted by differential standards from one continent to another; 3) a literature review about the effects of AZT, protease inhibitors and the various combinations of "anti-retroviral" drugs which rely on surrogate markers but fail to establish any clinically demonstrated, life-enhancing benefits; and 4) discussions about the actual definition of an AIDS case in Africa.

Geshekter mentioned the high cost of fees and registration costs for the Durban 2000 conference and how the requirement that these amounts be made in US dollars might restrict efforts to hear dissident voices from throughout South Africa and elsewhere in the world. The cost to register is US $700 by February 1st, US $750 by May 1st, and US $800 after May 1st.

This meeting was frank, open and very cordial. The Minister herself suggested that it seemed the time to assemble a distiguished group of South African and international experts from the fields of medicine, virology, biology, chemistry, epidemiology, and public health to engage in a formal, face-to-face exchange of opinions and viewpoints about all aspects of HIV, AIDS, AZT and related topics BEFORE the Durban conference (July 9-15, 2000).

Geshekter has since sent scientific papers and new information to the Minister and her staff via airmail and emails.

While in South Africa, Geshekter presented a seminar on "Rethinking Core Concepts About HIV and AIDS" at the Pretoria campus of MEDUNSA which allowed for lively educational exchanges amongst the physicians in attendance. The moderator was Dr. Sam Mhlongo, the Head of the Family Medicine Unit, whose clinical experiences and professional judgements should be included in any forthcoming discussions about HIV and AIDS in South Africa.

Returning to the eight questions presented to the Health Minister, they are all clear and straight forward. While the Health Minister's answers faithfully reflect the views of many in the medical establishment, nevertheless, her responses expose many of the problems and contradictions inherent in trying to understand AIDS in Africa. To address these problems and contradictions, we suggest that even more fundamental questions should be asked.

1. Is AIDS contagious?

2. Is AIDS sexually transmitted?

3. Does HIV cause AIDS?

4. Do the anti-HIV drugs promote life and health?

5. What is the justification for lumping together the well-known diseases and conditions of poverty, malnutrition, poor sanitation and parasitic diseases that Africans have been suffering from for generations and renaming them as AIDS?

Now to the specific eight questions.

Questions #1:

"What means and methods are used in the Public Health System to test the "HIV status" of individuals?"

Our first reaction to this question is that the HIV antibody tests do not measure HIV at all. Neither does the Western Blot test. These tests also do not test for AIDS.

The instructions that come with the Abbott ELISA test states that: "AIDS and AIDS-related conditions are clinical syndromes and their diagnosis can only be established clinically. EIA testing alone cannot be used to diagnose AIDS, even if the recommended investigation of reactive specimens suggests a high probability that the antibody to HIV-1 is present. ŠThe risk of an assymptomatic person with a repeatedly reactive serum sample developing AIDS or an AIDS-related condition is not known."

The Abbott insert goes on to admit that, "At present there is no recognized standard for establishing the presence and absence of HIV-1 antibody in human blood." The "sensitivity [is] based on an assumed 100% prevalence of HIV-1 antibody in AIDS patients [and] is estimated to be 100%."

The "specificity [is] based on an assumed zero prevalence of HIV-1 antibody in random donors [and] is estimated to be 99.9%". This assumption is contracted in the fourth paragraph on the second page of the same document. There are many known (over 70 published ways) of people having antibodies to HIV who do not have either HIV or AIDS.

In plain language, the sensitivity and specificity of the ELISA test are ASSUMED to be 100% and 99.9%, respectively.

A question we would ask the Health Minister is what evidence is there that people with antibodies to HIV liver shorter, poorer lives than people in the same community who do not have antibodies to HIV? We know of no such evidence.

Furthermore, why are antibodies to HIV a sign of impending disease and death? Antibodies are a sign of immunity, not imminent death? We know of no answer to this question.

The Health Minister says that, "According to WHO recommendations an ELISA is preferred and adequate for surveillanceŠwhere the HIV prevalence rate is estimated to be over 10%."

How is that estimate of 10% arrived at since the only basis for making that estimate is the ELISA test itself? It seems like circular logic.

Question #2:

"What definition is used, again in the public health system, to classify a person as being afflicted with AIDS?"

Interestingly, the Minister's answer does not even mention HIV at all for a diagnosis of AIDS in adults (so why bother with the HIV antibody tests?) and only mentions confirmed maternal HIV infection with regards to AIDS in children.

Childhood AIDS is AIDS by association. A child can be labeled with AIDS because the mother has antibodies to HIV.

Second, none of the AIDS defining diseases in the Health Minister's list is specific to AIDS. In fact, the Health Minister admits that the list of AIDS defining diseases can be caused by things other than HIV: "Presence of at least two major signs and one minor sign IN THE ABSENCE OF ANY OTHER PATHOLOGY THAT MAY BE KNOWN TO CAUSE THESE SIGNS (OR EXCLUSION CRITERIA e.g. MALNUTRITION AND CANCER)".

Third, the Health Minister says that, "This definition is preferred in the African setting including South Africa because this definition does not require the presence of laboratory facilities for a diagnosis to be conducted."

Why are these old diseases that generations of Africans have been suffering from long before AIDS now arbitrarily redefined as AIDS?

Fourth, Mr. President, we would like to know how AIDS physicians can tell the difference between people with AIDS and people suffering from the consequences of malnutrition, poor sanitation, poverty, parasitic diseases, etc. since none of the diseases on the Health Minister's list is specific to AIDS?

Question #3:

"Of the people determined to have died of AIDS, what 'opportunistic disease' was identified as having been the immediate cause of death?"

Mr. President, we would like to know how doctors know the difference between:

1. pneumonia and AIDS pneumonia?

2. tuberculosis and AIDS tuberculosis?

3. intractable diarrhea and AIDS intractable diarrhea?

4. meningitis and AIDS meningitis?

5. generalized septicemia and AIDS generalized septicemia?

6. wasting syndrome and AIDS wasting syndrome?

7. Kaposi's sarcoma and AIDS Kaposi's sarcoma?

8. cardiomyopathy and AIDS cardiomyopathy?

9. multi-system failure and AIDS multi-system failure?

Physicians have told me that the symptoms of all the non-AIDS diseases above are identical with the same diseases in AIDS patients. So why are these old diseases thought to be different in AIDS patients? Why is it necessary to propose that HIV causes these diseases when it is well known that all of these diseases can be caused by the conditions of poverty that are unfortunately common in Africa?

Question #4:

"Would there be any record of the treatment that such people would have received for these diseases, including the health profiles of such people at the point they started experiencing continuous bouts of diarrhea, coughing, weight loss, etc?"

The fax contained only the first paragraph of the Minister's answer. However, the top of the next page contained this important admission:

"Patients are often from economically stressed environments, with poor nutritional status. There is thus a link between socio-economic status and HIV prevalence."

We suggest that the link to HIV is irrelevant but the link between AIDS and socio-economic status is truly the underlying basis of AIDS in Africa. The HIV/AIDS establishment is blaming the consequences of poverty, malnutrition, poor sanitation, parasitic diseases etc. on a harmless virus. There are billions of dollars available for AZT and condoms but hardly a penny for food, schools, education, clean water, and jobs.

The only blessing of poverty is that it may protect poor Africans from the highly toxic anti-HIV drugs that have already killed thousands, perhaps tens of thousands of Americans.

Question #5:

"Has any research been done on the health profiles of the populations where allegedly it has been found that there are large numbers of 'HIV positive people' (e.g. In KZN)?"

The Minister's comments capture the state of public health very well. But it is important to point out that the word AIDS is not mentioned even once in the response to this question. We respectively urge that the emphasis be on AIDS. As discussed above, even the definition of AIDS in adults in Africa does not even mention HIV, and AIDS in children does not require their being infected with HIV, only that their mothers have antibodies to HIV.

Hlabisa is located in a rural area of Maputaland (a district in remote northern KwaZulu-Natal) which seems to typify one of the poorest and most destitute areas of KZN. The figures for migrancy and labor mobility and other descriptions provided in the Minister's reply offer ample testimony to the deep structural nature of deprivation and poverty which preclude local,opportunities for gainful employment among its inhabitants.

Maputaland is acknowledged to be one of the most under-developed regions of South Africa with 80% of its people receiving no income. One in three people have only primary education, or no education at all. This once forgotten region has recently become the target of development initiatives.

Into a situation of natural wealth and human poverty has come a transnational development plan, the Lubombo Spatial Development Initiative (LSDI). Because of its natural beauty and ample wildlife, the former apartheid government cordoned off large tracts of land in Maputaland as conservation areas which they managed in a protectionist manner.

Thus, the local Tembe-Thonga ("Tembay-Tonga") people lost an estimated 70% of their arable land without compensation. Hlabisa is located a few miles from the northern border of Hluhluwe Game Reserve. About 15 miles southeast of that Game Reserve is the small town of Mtubatuba which is a major HIV/AIDS research station (linked to Hlabisa) and funded heavily by Glaxo-Wellcome.

The LSDI has embarked on a R40-million programme (approximately US $6.5 million) to significantly reduce the incidence of malaria as a major obstacle to development.

The area is very sandy, its soil completely different from the stony grounds common in parts of Zululand that Geshekter saw in December 1999. It's very hard to grow anything and the staple food seems to be nuts. It is exquisitely beautiful, but shockingly underdeveloped.

Basic facilities like roads and water are missing. In a visit to one of the hospitals in the region, one sees many people suffering already from kwashiorkor, malnutrition and tuberculosis that mainly affect very young kids and elderly people.

Here's where all the slander about "truck drivers," wandering male workers away from home seeking prostitutes, women who themselves become prostitutes and kids who must fend for themselves all fuses together to become the HIV/AIDS viral epidemic caused by sexual promiscuity.

In the paragraphs just before her sub-section on "AIDS Orphans" in Section #6, Manto mentions some other small areas that were unknown to Geshekter but alludes to surveys or research done there as well. It concerns health profiles of local people. The material already there is ample enough to confirm that impoverished, unsanitary, malnourished and disease-ridden conditions give rise to any or all of the "clinical symptoms" of an AIDS diagnosis.

If person presents those symptoms to a nurse or doctor, someone will immediately call for an HIV test (or do it surreptitiously) to determine if the person "has the virus that causes AIDS." You know how the rest of that tale unfolds......

In an interview with Dr. Geshekter in Durban, a member of the Medical Research Council indicated that "the most common specific presenting illness for HIV infected patients was pulmonary tuberculosis followed by pneumonia, gastroenteritis and meningitis." But he added that "tuberculosis and pneumonia were also the commonest two diseases among patients not infected with HIV." The Health Minister's numerous references to socio-economic status, poverty, malnutrition, tuberculosis, diarrhea, respiratory infections, malaria and other parasitic infections are the real causes of AIDS in Africa.

Here are some short notes on the areas mentioned by the Health Minister.

(1) Khayelitsha is a township outside Cape Town, mostly for Xhosa speaking* people, from the Eastern Cape and Transkei. Historically, Xhosa speaking people from the Transkei flocked to Khayelitsha (and 2 other townships) in search of employment. A bit like Alexandra-thousands of people living in miserable squalid conditions, poor infrastructure, lots of squatters, high unemployment, and hardly any home grown vegetables.

(2) Mitchells Plain is a mixed-race area in CapeTown. Housing and general conditions are much better than in townships like Alexandra (outside Johannesburg). Yet while people have water and better sanitation, many live in overcrowded conditions.

The main problems in Mitchells Plain are social - the area is rife with violence as gangs, drug traffic, rape, and child abuse or partner violence are widespread. No vegetables are grown since people have no land. Most folks live in blocks of municipal flats (low cost housing projects) that evidently resemble US 'inner city' projects in Chicago, Bronx or East St. Louis. Grim places. Lots of single mothers on government grants and many men in prison. The urban face of "AIDS" in South Africa.

(3) Amatikulu is a little town about 10 miles from the Indian Ocean in north coastal KZN. It refers to an area, not a specific town, and resembles much of rural Zululand with its conical homesteads amidst rolling hills and gentle valleys.

(4) We have no information about Agincourt.

The technical basis for the health estimates needs to be addressed. The estimates of antibodies to HIV is primarily based on tests in pregnant women. The numbers derived from these women are then indiscriminately used to project the AIDS prevalence in Africa.

Pregnant women, or women who have ever been pregnant, are known to be a high source of false positive antibodies to HIV. For example, the instructions for using Abbott's ELISA test for antibodies to HIV says in the fourth paragraph on the second page: "non-specific reactions may be seen in samples from some people who, for example, due to prior pregnancy, blood transfusion, or other exposure, have antibodies to the human cells or media in which the HIV-1 is grown for manufacture of the EIA." A similar warning appears in the instructions for the Western Blot test.

The Health Minister's answer leans heavily on AIDS being sexually transmitted. The simple fact is that this is merely a very popular assumption. All the scientific studies that have tried to measure the sexual transmission of HIV have repeatedly shown that it is virtually impossible to transmitt HIV sexually or by any other means.

It would take an American woman over 270,000 random sexual contacts with men to become antibody positive to HIV. It would take an American man 7-8 times that number of random sexual contacts with women to become antibody positive to HIV. The most recent study that supports these numbers is by Padian, N. S., Shiboski, S. C., Glass, S. O., and Vittinghoff, E. "Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: results from a ten-year study, American. J. Epidemiology vol 146: pages 350-357, 1997.

However, the Padian et al. study only addresses the sexual acquisition of antibodies to HIV. It was not designed to determine if AIDS is sexually transmitted. We know of no study that shows that AIDS is sexually transmitted. Furthermore, we know of no study that shows that AIDS is contagious at all. All of the evidence, on the contrary, shows that AIDS is no more transmissible than alcoholism-which means that it is not transmissible from person to person.

Question # 6:

"Has any research been done on 'HIV positive' infants, children and orphans with regard to their health profiles, those of their mothers and families, as well as the lifestyles and socio-economic circumstances of the mothers and families?"

We would have phrased the question this way: Has any research shown that HIV positive infants, children and orphans live shorter or poorer quality lives as compared to HIV negative infants, children and orphans in the same community? In other words, do antibodies to HIV matter at all? To the best of my knowledge, this question has neither been asked nor answered in the mainstream scientific and medical literature.

The studies referred to by the Health Minister looked only at HIV positive children. As discussed above, all the AIDS defining diseases can be found in HIV negative people as well. We know of no study that has shown that AIDS-defining diseases in HIV negative adults or children are different from AIDS-defining diseases in HIV positive adults or children.

Tellingly, the Minister's answer again stated that, "malnutrition and immunodeficiency in the HIV infected children was evident."

The fax only had the first paragraph of the Minister's answer about the AIDS orphans.

Nevertheless, that paragraph is pure speculation about the future, in particular, the year 2005.

Question #7:

"On what do we base the statistics we publish occasionally on the incidence of HIV and AIDS, and how do we arrive at the projections?"

According to the Summary Report (*1998 National HIV Sero-prevalence Survey of Women Attending Public Antenatal Clinics in South Africa*, Department of Health, February 1999), estimates of HIV prevalence across the country and within the nine provinces were based on 15,301 blood samples.

This is the only existing national surveillance activity for determining HIV prevalence in South Africa. Furthermore, there is no national surveillance system for determining other sexually transmitted diseases, e.g., syphilis, gonorrhea and chlamydia, in South Africa. Suggestions that a syphilis surveillance system might be "piggybacked" onto the antenatal HIV survey warrant careful review and great caution to avoid further confusion of these two separate and distinct issues.

For instance, recent research reported the results of a large clinical trial in a Ugandan population. The findings in *The Lancet* showed that despite a reduction in sexually transmitted diseases, there was no difference in HIV-antibody incidence between the treated and untreated populations or among pregnant women.

Among the 15,127 participants in the study in Rakai District (Uganda), the "incidence rates of HIV-1 did not differ between intervention and control subgroups based on age, sex or marital status, among partners in HIV-1 discordant or HIV-1 concordant relationships, or among individuals reporting single or multiple partners."

Moreover, the findings suggested that while "the mass-treatment strategy [consisting of azithromycin, ciproflaxacin and metronidazole] significantly decreased the rate of maternal cervical and vaginal infections during pregnancy, [there was] no concomitant reduction in incidence of HIV-1 infection either during pregnancy or after delivery." [Maria J. Wawer, et. al., "Control of Sexually Transmitted Disease for AIDS Prevention in Uganda: A Randomized Community Trial," The Lancet, Vol. 353 (February 13, 1999), pp. 530-35.]

STDs should be diagnosed and treated according to established protocol, based on clinically diagnosed symptoms. When conflated with the misleading and often flawed results of an HIV-antibody test, however, patients who could receive inexpensive and effective treatment may avoid it altogether, fearing they have "AIDS."

None of the literature produced by the Medical Research Council or its affiliates acknowledges the serious implications about the possibility that HIV tests, especially a single ELISA, one which is the basis for the above report, may be unreliable. See the discussion of the ELISA test in questions 1 & 5.

Problems of cross-contamination, poor levels of specificity and sensitivity, the fact that any of more than 70 diseases can give rise to a falsely positive test, demonstrated cross-contamination when using the polymerase chain reaction test [PCR], or the fact that pregnancy itself can trigger a misleading result are critical dimensions that are unacknowledged in the sentinel surveys but upon which important public health policy decisions are based and citizens given life-altering "news."

For an excellent review of these issues with ample source citations, see Rosalind Harrison, M.D. and Kevin Corbett, "Screening of Pregnant Women for HIV: The Case Against," published in *The Practising Widwife*, Vol. 2, #7 (July/August 1999), pp. 24-29.

The United Nations Programme on HIV/AIDS produced a *Report on the Global HIV/AIDS Epidemic* (June 1998) that was updated in December 1998.

The Report admits that its global estimates of AIDS cases, HIV seroprevalence, and AIDS deaths are "provisional" and are derived indirectly from mathematical models based in turn on HIV prevalence rates. As with the South African data, the prevalence estimates depend entirely on statistics from "sentinel sites" that obtain data almost entirely from pregnant African women.

A key problem facing South Africa, like other African countries, is the absence of reliable, local data on mortality, morbidity and comparative death rates over the past 10 or 15 years.

While medically certified information is available for less than 30% of the estimated 51 million deaths that occur each year worldwide, the *Global Burden of Disease Study* (Harvard University Press, 1996) found that sub-Saharan Africa had the greatest uncertainty for the causes of mortality and morbidity since its vital registration figures were the lowest of any region in the world - a microscopic 1.1%.

Because post-mortems or autopsies are seldom performed to determine the actual cause of death in Africa, "verbal autopsies" are widely used to ascertain the cause of death since death certificates are rarely issued.

It is nearly impossible to distinguish the common symptoms attributable to HIV disease or AIDS from those of malaria, tuberculosis or malnutrition. Since 1994, tuberculosis itself has been considered an AIDS-indicator disease. When collapsed into acronyms like HIV/AIDS, HIV/TB or HIV/STD/AIDS, one realizes how a variety of old sicknesses have been reconfigured to form a newly defined "emerging disease."

On the other hand, the World Health Organization attempts to compile AIDS statistics for its official *Weekly Epidemiological Record*. The latest issue is dated 26 November 1999. Page 401 lists the total cumulative cases of AIDS reported for all the countries of Africa since 1982.

That cumulative total for the entire continent of 650 million people, over the past 17 years stands at 794,444. That is roughly 2/10 of 1 percent of the African continent. If anyone wants to dispute that number, they must provide better, more reliable statistics. Thus far, no one has.

Some sample WHO numbers of cumulative AIDS cases are as follows: Zimbabwe (74,783); Swaziland (3,528), and Zambia (44,942).

But when the *UN Report* tabulates "estimated number of people living with HIV/AIDS, end of 1997)" it arrived at these figures for the same three countries: Zimbabwe (1,500,000); Swaziland (84,000); and Zambia (770,000). These represent statistics that are 10 to 20 times greater, yet provide no evidence whatsoever, beyond computerized models and projections, as to how those numbers can be verified.

Question #8:

"Are there any anti-HIV/AIDS drugs that are dispensed by the public health system on a regular basis, including to medical workers who might be exposed to needle pricks?"

The CDC reports in a footnote in the latest HIV/AIDS Surveillance Report year end edition that there has been a total of 25 healthcare workers in the USA who have contracted AIDS on the job in over 18 years of AIDS. However, this claim is not referenced as to where the CDC got this information or what other risk factors those 25 individuals may have had.

Even if the CDC's 25 occupationally acquired AIDS cases over the past 18 years is true, how does that constitute a raging health hazard to healthcare workers? The 1 million needle-stick injuries among healthcare workers in the USA each year results in about 1000 cases of hepatitis among healthcare workers annually. That means that in the 18 years of AIDS, healthcare workers contracted 18,000 cases of hepatitis and 25 cases of AIDS.

Mr. President, we respectfully suggest that you add a ninth question to your list for the Health Minister to answer. What are the scientific or medical papers that show that the anti-HIV drugs prolong the lives of HIV positive people as compared to a similar group of people from the same communities [with the same diseases] who do not have antibodies to HIV? We would love to see that study. We have not been able to find it.

Mr. President, we are well aware that your investigations into AIDS and the anti-HIV drugs is not popular among some of your fellow countrymen and certainly not popular with the world HIV/AIDS establishment and the drug companies. There must be tremendous pressure on you personally and on your administration to stop your investigation. We know the courage it takes to do the right thing in the face of such pressure. You have our support and admiration for what you are doing. You also have the support and admiration of the members of The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis and the International Coalition for Medical Justice.

Good luck, Mr. President.

Dave & Charlie