The Mail & Guardian (SA) 14 March 2000

Johannesburg -- The opportunity to institute a constructive policy to deal with the HIV/AIDS epidemic is slipping out of reach as politicians and scientists argue over who knows best.

Minister of Health Manto Tshabalala-Msimang confirmed two weeks ago that her department is busy setting up a panel of approximately 30 local and international experts "to explore all aspects of the challenge of developing prevention and treatment strategies [for HIV/AIDS] that are appropriate to the African reality".

The announcement of names of panel members is eagerly awaited, in the context of widespread scepticism about the government's motives in setting it up.

Tshabalala-Msimang's statement followed an earlier report, based on an interview given by her special adviser, Dr Ian Roberts. The report, from Sapa, speculated that the panel would be asked to evaluate the claim by California biochemist Peter Duesberg and other AIDS dissidents that HIV is not the cause of AIDS.

The minister dodged the question of whether Duesberg had been approached to serve on the panel, but commented that her "personal view is that those with more extreme views are unlikely to participate because we are looking for a consensus view". She also stated that she would welcome suggestions for panellists.

She said the panel would convene as soon as possible to agree on their terms of reference in consultation with her department. They would be encouraged to publish their views, which would be available on the Internet, over a period of six to eight weeks. There would then be an attempt to "thrash out a consensus recommendation to the department".

Some of the issues which she would encourage the panel to review included the treatment of HIV/AIDS and opportunistic infections; general prevention of the disease; prevention of mother-to-child infections; prevention of HIV infection following rape or "needle-stick" injuries; and local evidence regarding the causes and diagnosis of AIDS and opportunistic infections.

On whether the government would revisit its refusal to supply anti-retroviral drugs to pregnant women with HIV/AIDS, Tshabalala-Msimang replied that if the panel came to a different conclusion, she would give it serious consideration -- although an ingenious solution to the funding challenges would be required.

But she defended the government's decision, saying that it had been taken "in the light of the best available evidence and the special social and economic circumstances in our country".

"I still think it's the right decision", she said.

Asked whether the panel would be free to come to its own conclusions, Tshabalala-Msimang replied: "I can't imagine that top scientists will accept anything else." She added, however, that it was the prerogative of the government to make a final decision about their recommendations.

Tshabalala-Msimang denied accusations by the Treatment Action Campaign (TAC), following Roberts's initial announcement about the panel, that it was "a justification for the immoral, unscientific and unlawful decision to withhold AZT or Nevirapine from pregnant women".

"I hope that the work of the panel will demonstrate that we have no hidden agendas", she countered.

It is difficult to see how the government could benefit from any further advice on the issue of using anti-retroviral drugs to prevent mother-to-child transmission of HIV. It has rejected two reports from the Medicines Control Council, and has not yet officially reacted to a third report from the same body -- none of which it is prepared to make public.

It also has in its possession additional reports from the Medical Research Council and the World Health Organisation. All of these reports are believed to support treatment using anti-retroviral drugs, but they are based upon the premise that HIV causes AIDS.

The TAC also challenged both the minister of health and Roberts to state whether or not they support the Duesberg claim that HIV is not the cause of AIDS, noting that it has been discredited by the international scientific community. Roberts has subsequently issued a statement confirming that he does not support the dissident view but, interestingly, Tshabalala-Msimang appears to have ignored this challenge.

She is known to have met prominent AIDS dissident Charles Geshekter of California State University, during a visit he made to South Africa in December.

According to Sapa, yet another prominent AIDS dissident, David Rasnick, claims to have been contacted by President Thabo Mbeki in January for advice. Mbeki's office has refused to verify or deny this claim.