Presidential AIDS Panel

By Claire Bisseker

Financial Mail (South Africa) 13 April 2001

Report makes a political point but fails to break intellectual deadlock

Widely hailed as a victory for mainstream scientific opinion, the report by the Presidential AIDS Advisory Panel is nothing of the sort. Governments decision to interpret the report as confirming that HIV causes AIDS is not so much a reflection of what the report proves as evidence that political pressure has forced the Presidency to recant.

The panel was supposed to advise government on the best ways to tackle AIDS in a local context. But as a guide to policy, the report is worse than useless. It fails to provide any new answers and doesnt even attempt to provide one clear set of recommendations. Instead, it uncritically reproduces the diametrically opposed recommendations of the dissident and orthodox camps. Government now says consensus was never the aim of the exercise.

In a move to bolster the battered image of President Thabo Mbeki, government is calling it an interim report and stressing that the outcome of further experiments recommended by the panellists will be of groundbreaking international importance an assertion that Medical Research Council president William Makgoba refuses to endorse.

Government has declared that, pending further research, the debates of the panel do not provide grounds for it to deviate from its current AIDS strategy, which is based on the premise that HIV causes AIDS. That is second prize. Since there is little in the report that compels the impartial reader to choose the orthodox view over the dissidents, mainstream scientific opinion has won a political rather than an intellectual victory.

Government has acceded to political pressure from the international and local AIDS community to accept that HIV causes AIDS. Residual doubts, however, could continue to bedevil SAs HIV/AIDS programmes, especially the introduction of antiretroviral therapy on a large scale.

For dissidents like Californian panellists David Rasnick and Prof Peter Duesberg, it means they have failed in their crusade to convince a world leader that AIDS is nothing more than a cruel hoax. But neither will they admit that their window of opportunity has closed.

The exercise was extremely important to the people of SA and the world and it is not over, Rasnick says. It brought together those who support the mainstream view that AIDS is contagious and caused by HIV and those who dispute that assertion. That is a major accomplishment.

Local AIDS experts disagree. They say the R2,5m exercise has put back the introduction of antiretroviral therapy in SA by at least a year and confused young minds.

Once people understand that the report fails to adjudicate between the orthodox and dissident positions, it could cause divisiveness, National AIDS Convention of SA (Nacosa) chairman Dr Ashraf Grimwood predicts. The report has the potential to do a huge disservice to our AIDS strategies, especially with regard to our public education programmes aimed at the youth. High school kids are saying: Were told HIV doesnt cause AIDS, so why should we practise safe sex?

The report does reveal how out of touch the dissidents are with SAs townships and hospitals. They claim there is insufficient evidence of an AIDS epidemic in SA and that people are dying from the same things that have been killing them for generations diseases of poverty. This was contrasted with evidence from King Edward VII Hospital in Durban showing a 60% mortality rate among HIV-positive children who were followed up over two years.

I learnt nothing from talking to the dissidents and its an experience I wouldnt want to repeat, University of Natal professor and panellist Jerry Coovadia says. Within minutes, I knew we would learn nothing from them. We were talking past each other. It was as absurd as talking between people who believe in God and those who dont.

Duesberg was equally unmoved. He says the orthodox camp failed to provide any scientific evidence to convince him to change any of his views.

Some of reports recommendations include those by Rasnick that SA stop screening donated blood for HIV and that AIDS will disappear if HIV testing is outlawed.

Orthodox panellists argue that it is vital to develop strategies and protocols for the wider use of antiretrovirals in SA, while the dissidents decry their use as totally unjustifiable. Instead, the latter call for the investigation of immune-boosting medications such as ginseng, Chinese cucumber and garlic and for the consideration of interventions that will encourage the detoxification of the body such as massage, yoga, and music and light therapy.

The only consensus reached was on the need to obtain better statistics on AIDS in SA and that factors such as poor nutrition and sanitation intensify the disease.

Though Makgoba says the exercise generated no new insights, the experiments undertaken to determine the quality of HIV testing in SA were valuable. They showed only a 0,1% difference in the results of HIV tests carried out in local as against US laboratories. He also says further experiments to establish the robustness of HIV tests and to introduce molecular beacon technology to SA will prove useful. This technology will help scientists monitor viral loads and virus mutability, which will become important as more people use antiretroviral drugs.