By Belinda Beresford

Mail & Guardian (South Africa) 28 March 2002

The unrelenting drip of debate about HIV, AIDS and anti-retroviral drugs is corroding South Africa's medical and scientific world, with top scientists and institutions coming under private and public attack.

A document being circulated within the African National Congress with at least tacit top-level approval contains venomous attacks on leading South African scientists, including world-renowned researcher Glenda Gray.

Gray, who recently jointly won the Nelson Mandela Award for Health and Human Rights, is accused in the document of experimenting with toxic drugs on a black pregnant woman who then died. Gray's research includes preventing HIV-positive pregnant women from passing the virus on to their children.

Entitled Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics, the 114-page document was discussed at the ANC's national executive committee meeting in mid-March and is being distributed to some ANC branches. It goes beyond named attacks, effectively calling many South African scientists "cats and geese" - the cats are Africans too proud of associating with whites, while the geese are academics stuffed with the money of their sponsors.

"We have our own geese, posing as writers, thinkers and scientists To justify their feed, they work hard to build repression from within our ranks. It would be good if we could assist them to return to their ponds as quickly as possible, taking their good brains with them."

The report also criticises the independence of the Medical Research Council (MRC), although this is one of the reasons the institution is internationally recognised.

And a top academic who has refused on ethical grounds to cooperate with a forensic audit into the leak of an MRC document has been effectively told that he will be considered guilty until proven innocent.

Meanwhile prominent members of the health world - including at least one in the government - have been told to ask journalists for letters clearing them of leaking the report.

Sunday Times journalist Laurice Taitz last year broke a story on MRC research showing rising HIV-infection levels and mortality. She is one of the journalists who got hold of a copy of the report ahead of its official release, and who have been asked to write letters clearing certain individuals of handing over the document.

Taitz was asked to confirm that neither MRC head Malegapuru Makgoba nor other researchers at the institution gave her the document.

The government was furious about the early publication of the report, especially since there were allegations that it was delaying the release because it was so damning.

Minister of Health Manto Tshabalala-Msimang wrote to the board of the MRC, asking it to conduct an investigation into whether the document had been leaked from there.

An MRC insider has suggested that the institution's compliance in the forensic audit is an attempt to protect its independence. The laws relating to the MRC and other research institutions are going to be reviewed and there are fears that this could lead to a curb on their independence. Some believe the audit is part of a campaign to oust Makgoba who has been publicly critical of the government on HIV/AIDS.

Questions have also been raised as to how there can be a government investigation into the leaking of a report by an independent organisation.

As one academic put it, the government seems to lack an understanding of academic freedom: "The bureaucrats think if the Cabinet wants something it must get it."

The MRC initially identified four individuals with whom it intended to work closely in the future, and asked them to cooperate with the investigators "for the good name of the MRC and its associates".

The list has been extended and up to 10 individuals have been asked to take part. A full probe has been ruled out on the grounds of cost.

Louis Strydom, a director of the firm Triumvirate that is conducting the audit, said the purpose is to clear the name of the MRC and those individuals with whom it would work in future.

One of those asked to participate is Professor Rob Dorrington of the University of Cape Town's (UCT) department of actuarial science, and one of the researchers who initiated the mortality study. It was not originally commissioned by the government.

He says ethical issues of academic freedom led him to "respectfully decline" to take part in the exercise.

"I do not see the need for a forensic audit over a piece of self-initiated research fairly widely distributed in the months leading up to the release."

He also said he felt an audit was "extremely dangerous" in terms of academic freedom, and did not wish to participate. In this he is backed by UCT senior deputy vice-chancellor, Professor Wieland Gevers, who said that the institution fully supports Dorrington's stance on this matter.

The MRC said participation is "entirely voluntary". However last week Strydom wrote to Dorrington telling him that the interim report of the investigation was close to completion.

"Regrettably, as you have chosen not to participate in our investigation and as our primary objective was to clear all key players in the MRC involved in the process, we are unable to clear yourself in our interim report."

But while the pressure on top scientists may be hitting the headlines, academics and doctors are concerned about the insidious effects on science and medicine.

"As a scientist involved in AIDS research [the debate] is extremely belittling," said Professor Greg Hussey, the head of paediatric infectious diseases at UCT. He said the politicisation of HIV/AIDS "sits at the back of your mind and it complicates the way you react with the health department. It is extremely wearying and is upsetting to have to contend with what the minister, what the department is going to say. You are wary, especially with international grants, that they [the department] are going to say no."

Hussey is one of the many academics concerned about the impact on future doctors and researchers. Young doctors are increasingly unwilling to practice, especially in specialities where they would be at higher risk of catching HIV from their patients.

Enthusiasm for a medical career, at least in South Africa, is also being curtailed as doctors look at wards full of patients, many infected with HIV, whom they cannot treat properly.

Doctors employed in the public sector are facing an increasing ethical dilemma between their duty to their employer - a government that questions the link between HIV and AIDS - and their responsibilities towards their patients. The most obvious example of this has been the superintendent of Rob Ferreira hospital in Nelspruit, Dr Thys von Mollendorf. He lost his job for allotting a room in the hospital to an NGO that helped rape survivors to get anti-retroviral drugs to cut their chances of catching HIV from their attackers.

Researchers say that government officials seem unwilling to talk to scientists who have publicly stepped into the debate or have produced research that contradicts any aspect of the government's position.

Hoosen Coovadia of the University of Natal is one of the world's top HIV/AIDS doctors and is part of an internationally recognised and quoted team.

Speaking of his own research unit, Coovadia said: "We have been totally isolated. We know more about breastfeeding than probably anyone else in the world, but as researchers we are ignored by government."

In 2000 Coovadia was the chairperson of the International AIDS Conference in Durban. Held every two years, this is the world's most prestigious AIDS-related gathering. Organisers of the event say that the government's hostility towards Coovadia started on the last night of the conference, when he and Professor Salim Abdool Karim refused to allow the minister of health to address the next morning's final plenary session.

The minister felt that South Africa had been unfairly represented, and wanted to put forward the government's position. As one organiser of the conference said, allowing such political interference in the scientific conference would have destroyed Coovadia's reputation.

In a heated exchange, Coovadia and Karim were apparently told they were not loyal South Africans and implicitly threatened with revenge when all the overseas delegates had gone.

Many researchers say that scientific solidarity has been one reason why international funders are still keen to support research in South Africa, which is also regarded as being of an extremely high standard. But there are fears that as the political saga surrounding AIDS continues, such links may drop away.

Dr Ian Sanne of the Wits Health Consortium highlighted one problem of the sensitivity involved in HIV/AIDS research.

"Research is becoming less competitive for international funding because of the government's stance. Scientists recognise that research needs to be conducted in collaboration with the Department of Health. But this needs to be a joint effort. No one in the Department of Health wants to approve a research agenda in a timeous fashion, in part because they are scared for their own careers.

"We are being asked to identify research questions in a resource poor setting, but then we have problems accessing international funding when our government is not going to implement the research."