Financial Gazette (South Africa) 5 Oct. '00

Harare -- Some Zimbabwean scientists have started questioning whether the human immuno deficiency virus (HIV) is the sole cause of AIDS, opening a debate that has been raging in South Africa and which pitted President Thabo Mbeki against some of the most eminent scientists in the world.

Mbeki, who has assembled a team of international scientists of his own, says poverty rather than HIV alone is more responsible for the AIDS pandemic in southern Africa, the area hardest hit by the disease.

Eminent clinical pharmacologist Norman Nyazema said this week that Zimbabwe had long recognised that AIDS was not just a health issue, hence the multisectoral approach encouraged by the government when dealing with the disease.

"Why are we saying AIDS needs a multi-sectoral approach if it is just a viral problem? There is nothing that requires a multi-sectoral approach more in this country than poverty reduction," said Nyazema, a lecturer at the University of Zimbabwe's medical school.

Nyazema, who has researched extensively on the disease in Zimbabwe, said it was clear that many AIDS sufferers were dying from what are called "opportunistic infections".

These are diseases such as skin cancers and tuberculosis (TB) which take advantage of the weak immune system in AIDS patients.

"A good example is TB. If you say what causes TB, a social scientist will say it is because of the living conditions," he said.

Nyazema said it had been proven that TB would recur even if completely treated if the patient went back to the same living conditions that he was subjected to before treatment.

It had also been recently found that malnutrition was now one of the major contributors to the deaths of AIDS patients in Zimbabwe, he said, noting that people suffering from AIDS were now known to be easily affected by malaria.

"There is now an argument which links malaria with HIV and more people are now dying from malaria than before," said Nyazema, a senior member of the Medicines Control Authority of Zimbabwe.

Nyazema lamented that there was no culture of debate among Zimbabwean scientists on crucial issues such as the AIDS pandemic and also criticised the government for not providing leadership on the management of the disease.

Recent statistics from the World Health Organisation show that sub-Saharan Africa has the highest number of AIDS sufferers in the world and that Zimbabwe, South Africa and Botswana are the hardest hit.

The disease is also said to be growing fastest in the poorer communities of Africa and Asia compared with anywhere else in the globe.

Mbeki has been heavily criticised in the West by some leading AIDS experts who say his scepticism on the origins of the disease is likely to undermine efforts to curtail the spread of AIDS in southern Africa.

Mbeki says he will not accept the casual link between HIV and AIDS unless this is proven anew. He says the West is more influenced by gain than helping AIDS sufferers in Africa.

"Let's start the debate here," Nyazema said. "Anti-retroviral drugs are not the main answer to AIDS in this country."

Supporters of Mbeki say the West is putting pressure on the South African leader to accept that HIV is the sole cause of AIDS so that their manufacturers can cash in on the flooding of the region with anti-retroviral drugs (ARVs) where they are most needed.

ARVs do not cure AIDS but can slow the spread of HIV and sometimes wipe it out from the blood. The virus however remains hidden in areas such as lymph nodes.

To avoid the re-multiplication of the virus, patients on ARVs are forced to take the medicines for the rest of their lives.

ARVs are extremely expensive and many southern African countries have even turned down World Bank loans to purchase the drugs, fearing the creation of more debt because of their perennial debt-servicing problems.

In Zimbabwe, a monthly subscription of the popular ARVs such as Combivir - a combination of a drug called AZT and another known as 3CT - costs as much as $20 000. The main manufacturers of ARVs are American and European multinational companies such as Glaxo-Welcome, producers of Combivir.

Stephen Chandiwana, the Zimbabwean scientist who is the chairman of the Medical Research Council of Zimbabwe, could not be reached for comment. He was said to be out of the country.

Chandiwana is the only Zimbabwean on Mbeki's council of experts on AIDS.

Meanwhile, South African doctors this week came out against Mbeki on the origins of AIDS, saying it was scientifically proven that HIV causes AIDS.

"Whether HIV causes AIDS or not is not a matter of speculation, it's a question of scientific fact. As professionals and scientists, we want to make that statement very clear. It's our responsibility to do so," South African Medical Association chairman Zolile Mlisana said in Johannesburg.