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