ADDED FOE IN AIDS WAR: SKEPTICS
By Laurie Garrett
Newsday 29 March 2000
The leader of the most influential African nation has opened debate in recent
months on whether or not HIV causes AIDS, has issued a blistering attack
against the international pharmaceutical industry and has ordered formation
of a commission that will review all of the primary assumptions about the
global AIDS epidemic including whether it even exists.
South African President Thabo Mbeki leads a country that estimates 10 percent
of its population is infected with HIV.
Mbeki has revved up his commentary in recent days. His office issued a
statement last week condemning drug companies that "propagate fear to
increase profits; the profit takers who are benefiting from the scourge of
HIV/AIDS will disappear to the affluent beaches of the world to enjoy wealth
accumulated from a humankind ravaged by a dreaded disease."
Then on Friday his office issued an angry, lengthy statement denying that
Mbeki had ever stated that HIV was not the cause of AIDS.
His comments have raised red flags in Washington and at the United Nations
AIDS Program in Geneva. Officials are concerned that American fringe elements
that dispute the very existence of AIDS have gained Mbeki's ear. And they are
discreetly voicing two fears: First, that such notions may spread across
Africa, the continent hardest hit by the pandemic, imperiling public health
efforts. And second, that the World AIDS Conference, scheduled to convene
this July in Durban, South Africa, may be endangered because of resulting
Canada's Dr. Mark Wainberg, president of the International AIDS Societies,
said in a speech in Washington recently, "We often find that the ground is
cut out from under our feet by people who should know better."
Wainberg directly denounced Dr. Peter Duesberg, a professor in the molecular
biology department of the University of California at Berkeley, and his
followers who insist that HIV is a harmless virus and AIDS a nonexistent
disease. Saying that these skeptics are "contributing to the spread of HIV"
by promoting mass denial about the disease, Wainberg suggested that their
actions warrant criminal prosecution.
AIDS vaccine researcher John Moore of the Aaron Diamond AIDS Research Center
in Manhattan goes further, saying that "a charge of genocide would not be
inappropriate ... Their efforts are already having a devastating negative
effect on public health in South Africa, and the problems could well spread
further if other nations are foolish enough to take a lead from the South
Dr. Seth Berkley, head of the New York based International AIDS Vaccine
Initiative, likened the non-belief in HIV "to those that believe that the
Holocaust did not occur."
Worried about exacerbating what is already a diplomatically testy situation,
U.S. health officials and UNAIDS have declined to comment directly in public
on either Mbeki's or Wainberg's statements. But the National Institutes of
Health and UNAIDS both released fact sheets via the Internet last week,
attacking the allegations made by the HIV skeptics. And the U.S. agency, with
the White House, is reconsidering security needs for U.S. scientists who
attend the Durban meeting because of anticipated confrontations.
Neither the allegations nor the scientific community's rebuttals are new;
Duesberg first raised his theory in 1987. But Mbeki's public support for the
skeptics' point of view is the first such action taken by a head of state.
His own nation estimates that 4 million of its 44 million population are
infected with HIV, and rates of infection run as high as 40 percent of young
adults in some regions.
The Mbeki government began its recent campaign on Feb. 28, when South
Africa's minister of health announced that an "expert panel" would convene to
review evidence that HIV causes AIDS and allegations that the AIDS drug AZT
is poisonous. On March 14 the nation's Deputy President Jacob Zuma said on
South African radio that the commission will "look at these issues to get rid
of misinterpretations and misrepresentations or differing opinions. If there
are differing opinions they must be scientifically investigated so we can get
at the truth."
Among those invited to participate in the commission are Duesberg and Dr. Sam
Mhlongo of the Medical University of South Africa, in Capetown. Mhlongo has
said the epidemic was concocted by drug companies to hook South Africa on
costly anti-HIV drugs.
Increasingly, comments reveal a chasm of misunderstanding between the
industrialized world's AIDS community and that of sub-Saharan Africa. In the
United States, those who voice the dissident views haven't found much
support, but their influence is growing in South Africa.
In its Friday statement, Mbeki's office said, "Government is strong in its
resolve that we cannot confine our response to the problem of HIV/AIDS to an
injunction not to speak to HIV skeptics or telling people how to think."
The skeptics come from a broad range of backgrounds and political
affiliations. There are political conservatives who dispute the notion that
HIV is transmitted heterosexually, gay radicals from San Francisco and
heterosexual men who claim that AIDS is a disease caused by being gay. All
share one common article of faith: that HIV is harmless.
Prominent San Francisco AIDS activist Jeff Getty recently circulated an
Internet alert warning that San Francisco's chapter of ACT UP was a militant
skeptics group, "a cult...the axiom here is this 'if I don't believe AIDS
exists, I don't need to take those nasty drugs and more importantly, I don't
need to have safe sex."'
One contingent of AIDS skeptics, which calls itself The Group for the
Scientific Reappraisal of the HIVAIDS Hypothesis, has claimed to have 600
members, including California biochemist David Rasnick and historian Charles
Geshekter. It was to these men that Mbeki turned for advice in January, after
a series of AIDS related public episodes.
First, in a 1997 cabinet meeting Mbeki, then deputy president, promoted a
substance called Virodene, an alleged cure for AIDS. The chemical turned out
to be an industrial solvent. Shortly thereafter, South Africa's government
and its pharmaceutical industry clashed over the pricing and importation of
Last spring, in hopes of easing such tensions, the Bristol Myers Squibb Co.
offered the South African government a $ 100million, five year grant for AIDS
education and clinical research. After an initial rebuff, the country
accepted the funds. Some skeptics used the grant as evidence of a
pharmaceutical conspiracy directed to Africa.
Last June, following Mbeki's election to the presidency, Manto Tshabalala
Msimang was named minister of health. UNAIDS then brokered a deal with
British pharmaceutical company Glaxo Wellcome for cut rate AZT to be used in
Africa to reduce the spread of HIV from infected mothers to their babies.
Such AZT interventions reduced the number of HIV positive babies born in the
United States to just 32 last year.
But skeptics argue that AZT is a poison; AIDS, they insist, is actually
caused by the drug used in its treatment. South African skeptic Anthony Brink
of Pietermartizburg, an attorney, insisted that "no one has ever been cured
by AZT, but it sells like hotcakes all the same...and it reaps profits
counted in billions."
On Nov. 5, Mbeki addressed the South African Parliament, noting that the
United States, UNAIDS and other outside interests were pressuring his
government to provide AZT to prevent an epidemic of HIV positive babies.
Mbeki cited Internet sources that, he said, indicated "the toxicity of this
drug is such that it is in fact a danger to health."
Mbeki instructed Tshabalala to investigate further, to be "certain of where
the truth lies."
At that point the government took seemingly contradictory stances. Mbeki said
AZT might be too dangerous. On the other hand, Tshabalala said, it was too
expensive, and drug companies ought to lower their prices.
Further, such U.S.-based groups as the Elizabeth Glaser Pediatric AIDS
Foundation and the Global Strategies for HIV Prevention had offered free
Nevirapine to South Africa, a safer alternative to AZT that also blocks HIV
transmission to newborns. That offer, too, was rebuffed because Dr. Ian
Roberts, special adviser to Tshabalala, said, "We are not satisfied that it
is proven safe. We must test its safety, by South African standards."
(Ironically, when Deputy President Zuma's wife was raped in South Africa last
summer she was immediately put on Nevirapine in hopes of blocking HIV
Late on the night of Jan. 19 Mbeki fired off a fax to skeptic Rasnick, asking
what evidence existed that:
"1. AIDS is contagious.
"2. AIDS is sexually transmitted.
"3. HIV causes AIDS.
"4. The anti-HIV drugs promote life and health."
Rasnick and Geshekter swiftly crafted their response. In December Geshekter
had briefed Tshabalala and toured the rural regions of the nation.
Geshekter, a professor at California State University in Chico, said in an
interview he disputes the estimates of HIV and AIDS rates in South Africa.
"I think it's important to me personally because my training is as a scholar
concerned about numbers, statistics...and Africa. When I see those kinds of
numbers I say, 'Put your statistics on the table."'
UNAIDS readily concedes that its AIDS and HIV estimates for Africa involve
extrapolations from spot studies, Peter Piot, UNAIDS executive director, told
Newsday. "The reality is that some African countries have among the best HIV
surveillance systems in the world," Piot said.
Even the United States doesn't have an HIV reporting system and must
approximate rates of infection from mandated reporting of AIDS caseloads.
In South Africa the extrapolations are made from surveys done in pregnancy
clinics, where upwards of 20 percent of tested women now turn up HIV
positive. The test used on these women, a screening procedure known as ELISA,
is not considered adequate in the United States, as it often yields false
positive results. So the United States requires two additional tests. But
South Africa relies on ELISA alone because of insufficient funds.
Geshekter also disputes the use of the system called the Banqui Definition to
make HIV diagnoses. Formulated by the World Health Organization more than a
decade ago, Banqui, commonly used in Africa, offers doctors a list of
symptoms some combination of which must be present to diagnose AIDS.
Geshekter argues that the symptoms including rapid weight loss, diarrhea and
specific types of skin cancers are more likely to be reflections of economic
"I see a real infrastructural deterioration in Africa over the last 20
years," Geshekter argued. "We need to look...very closely at deteriorating
public health facilities, rising malnutrition rates..."
His hypothesis can't account for the HIV rate in successful countries like
Botswana, estimated at a third of its reproductive age adults. Until three
years ago, when it was slammed by what its own government labels an AIDS
epidemic, Botswana was considered a World Bank "economic miracle," with
phenomenal financial growth. Nor can economics explain why the upper classes
of most African societies have the highest AIDS death tolls.
Duesberg insists that AIDS in the African context is "nothing more than a new
name for old diseases," which may be taking a greater toll today because of
the sorts of economic factors Geshekter underscores.
The U.S. National Institute of Allergy and Infectious Diseases counters on
its Internet site that three studies from Uganda, Rwanda and Zaire show
soaring epidemic AIDS death rates in Africa.
Nevertheless, argues Tom Bethell of the conservative American Spectator
magazine, "People are not dying of AIDS but of the diseases that have always
afflicted those parts of the globe where water is not clean and sewage is not
properly disposed of."
Where is this all headed?
Last week organizers of the upcoming World Conference on AIDS met in Johannesb
urg and were barraged with questions about the Mbeki government's policies.
Among the most outspoken was Dr. Helene Gayle, who heads up AIDS programs for
the U.S. Centers for Disease Control and Prevention. She denounced the
skeptics and said that "there is no merit in questioning conventional wisdom"
Kenya's Dr. Ruth Nduati, of the University of Nairobi, added that Mbeki's
actions are "taking us backwards...that such discussions may unravel our
significant gains in terms of managing the disease."
The comments drew ire from Mbeki, who convened a cabinet meeting to discuss
his country's continued hosting of the prestigious conference.