SOUTH AFRICA TURNS TO RESEARCH
IN THE HOPE OF SETTLING AIDS POLICY

By Michael Cherry

Nature 12 May 2000

The relationship between HIV and AIDS is set to be put to the test in South Africa in a bid to defuse the controversy surrounding comments made by President Thabo Mbeki. He has often stated that he maintains an open mind on whether HIV is the cause of AIDS (see Nature 404, 911; 2000).

The inaugural meeting of an international panel, set up by Mbeki to advise on South African AIDS policy, announced the proposals last weekend. South Africa's Medical Research Council (MRC) will team up with the Centres for Disease Control (CDC) in Atlanta, Georgia, together with two prominent AIDS 'dissidents', who dispute that HIV causes AIDS, to devise a series of surveys to investigate the relationship between the disease and the virus.

According to MRC president Malegapuru Makgoba, the surveys could involve the clinical identification of a sample of AIDS sufferers, who would be tested for HIV. Another possibility is an epidemiological study correlating HIV-positive children with the HIV status of their parents.

A task force made up of Makgoba, Helene Gayle of the CDC - which has placed its database at the team's disposal - and two prominent dissidents, Berkeley biochemist Peter Duesberg and biotechnologist Harvey Bialy, has been appointed to conceptualize exactly what research needs to be done. Makgoba told Nature that the establishment of a national register for HIV/AIDS in South Africa - in which the CDC could presumably assist - is also on the cards.

Khotso Mokhele, president of the National Research Foundation and one of three facilitators on the international panel, said after the meeting that funding would be sought from the South African government and other bodies once the agenda had been clarified. He emphasized that existing knowledge, based on completed studies, should provide the basis for any new work.

In opening the two-day meeting, Mbeki emphasized the high level of heterosexual AIDS transmission in South Africa. He referred to the first South African paper on AIDS, published in 1985, which predicted that the disease would remain largely confined to male homosexuals. The panel's task would be to try to explain why this situation had not changed in the West, but had in South Africa, he said, adding that the conclusions would have a direct bearing on the government's response to the problem.

But the composition of the 36-member panel is itself controversial, as just under half of its members are dissidents. "The panel has pretty well everyone on it who believes that HIV is not the cause of AIDS, and about 0.0001 per cent of those who oppose this view," comments AIDS researcher John Moore of Weill Cornell Medical College.

Announcing the panel last week, health minister Manto Tshabalala-Msimang said that it would consider the causes of the immune deficiency leading to AIDS, and the best response to the pandemic in a local context. It would also investigate why HIV/AIDS was heterosexually transmitted in southern Africa, and assess drug-based responses, including strategies to prevent mother-to-child transmission, she said.

Panel members include the French discoverer of the AIDS virus, Luc Montagnier, and Clifford Lane of the US National Institutes of Health. Twelve of the panel are US-based, and ten are African, including seven South Africans and representatives from Uganda, Malawi and Senegal. There are also members from Cuba, Mexico and India.

Significantly, with the exception of Sam Mhlongo of the Medical University of South Africa, none of the African representatives belong to the dissident camp. But several prominent South African AIDS researchers, all of whom have been outspokenly critical of the dissident movement, were not included. These include Jerry Coovadia of Natal University (convenor of the World AIDS Congress to be held in Durban in July), James McIntyre of the University of the Witwatersrand, immunologist Johnny Sachs, Gary Maartens of the University of Cape Town, and epidemiologist Bryan Williams of the Council for Scientific and Industrial Research.

"Although it's very important to determine innovative strategies for combating AIDS, engaging with fringe groups is not the way forward," says Glenda Gray, director of the perinatal HIV research unit at Johannesburg's Baragwanath hospital, who was also excluded from the panel. "These people should never have been given a platform." Although Tshabalala-Msimang described the meeting as a "wonderful experience", it is said to have been very acrimonious, with the dissidents finding themselves in a minority in each of three groups appointed to discuss the causes, prevention and treatment of AIDS. Instead of a final round-table discussion, the meeting is understood to have divided into groups representing the orthodox and dissident views. The panel's chief facilitator, lawyer Stephen Owen of the Institute for Dispute Resolution at the University of Victoria in Canada, said at the press conference following the meeting that reaching consensus had not been the objective. "Divergent points of view remain, in very stark terms," he said.

The panel will enter into a "closed Internet debate" over the next four to six weeks, before reconvening in South Africa for a four-day discussion before the start of the World AIDS Congress on 9 July. The task force is widely interpreted as a face-saving device for Mbeki, who admitted at the meeting's opening that he was "embarrassed to say" that he had "discovered that there had been a controversy about this for some time". Quoting the Irish poet Patrick Henry Pearse, Mbeki pondered whether his having raised the issue was "folly or grace".

There has been some speculation that a last-minute deal to add three extra non-dissident members to the panel - thereby creating an overall majority of non-dissidents - was brokered at a high level between the South African and US governments.

The three additional names had not appeared on the initial list announced last week; neither Tshabalala-Msimang nor Essop Pahad, cabinet minister in the President's office, were prepared to confirm this at the press conference.

Some South African AIDS researchers feel that if the proposed surveys counter the claims of the dissident movement, they will have done a useful service.