AIDS FORUM IN SOUTH AFRICA OPENS KNOTTED IN DISPUTES
By Rachel Swarns & Lawrence Altman
The New York Times 9 July 2000
Durban -- Opening the first international conference on AIDS held in a developing
country, President Thabo Mbeki today singled out extreme poverty, rather than
the disease ravaging his country and continent, as the leading killer both here
and across Africa.
South Africa is the country with the largest number of people infected with
H.I.V., the virus that causes AIDS 4.2 million. And its president, who has
become embroiled in an international dispute over the disease, pledged to
intensify his response to the AIDS epidemic. But he dashed the hopes of
thousands of participants, and noisy protesters, who wanted to hear him state
clearly that H.I.V. causes AIDS.
Instead, President Mbeki skirted the discussion that has arisen because he
has questioned the use of certain drugs in treating H.I.V. and has even
questioned whether the virus causes AIDS.
Among the many researchers he has contacted in his quest to understand the
epidemic are two American biochemists, Peter Duesberg and David Rasnick, who
argue that poverty and malnutrition, not H.I.V., cause AIDS. When word of this
consultation became public, international consternation arose.
As Mr. Mbeki described his attempts to understand how one of the worst
epidemics in history had enveloped his country just as it had freed itself from
apartheid, he reflected on AIDS and a long list of other diseases afflicting
"As I listened and heard the whole story told about our own country, it
seemed to me that we could not blame everything on a single virus," Mr. Mbeki
The 13th international conference on AIDS is being held here as United
Nations officials have been intensifying the alarm about H.I.V., which infects
34.3 million people in the world, mostly in Africa.
Minutes after Mr. Mbeki finished, Dr. Peter Piot, the head of Unaids, a
United Nations program that monitors the spread of AIDS, said it would require
at least $3 billion a year to take basic measures in Africa to deal with the
disease and tens of billions of dollars more each year to provide in Africa the
standard drugs used in developed countries.
The $3 billion figure is 10 times what is now being spent in Africa, Dr.
Piot said. Unaids estimates that 90 percent of people with H.I.V. do not know
that they are infected.
"We need billions, not millions, to fight AIDS in the world," Dr. Piot said,
and "we can't fight an epidemic of this magnitude with peanuts."
In news conferences and interviews, Dr. Piot said he welcomed a pledge of
$500 million from the World Bank this weekend as a positive step. The rest, he
said, needs to come from the affected African countries and the developed
He urged developed countries to cancel the $15 billion in debt repayments
that African countries owe each year, so the countries could use the money for
health care and social services for AIDS and other diseases.
But political will is as important as money in stopping the AIDS epidemic,
In the last six years, scientists and AIDS activists have repeatedly accused
South African leaders of a lack of leadership in combating the AIDS epidemic.
In 1993, H.I.V. infected 4 percent of South Africa's adult population. Now, the
figure is 20 percent.
Tonight, as those taking part in the conference drifted out of the cricket
grounds where Mr. Mbeki spoke, many left feeling disappointed.
"We, the majority of South African scientists, would have liked a clear,
unequivocal statement about the relationship between H.I.V. and AIDS rather
than the hints he made," said Alan Whiteside, who heads the AIDS research
program at the University of Natal in Durban.
Mr. Whiteside and others said they were encouraged by Mr. Mbeki's pledge to
intensify his recently announced program to encourage safer sex practices and
to sponsor additional research into drug therapy and a possible vaccine.
Thousands of people held a protest rally at City Hall before the meeting
opened, with Winnie MadikizelaMandela and others in the crowd berating the
government for failing to speak frankly about the link between H.I.V. and AIDS
and lagging in its efforts to fight the epidemic.
"AIDS exists," said Mrs. MadikizelaMandela, the exwife of former President
Nelson Mandela and a political leader in her own right. "H.I.V. causes AIDS. We
cannot proclaim this century the African century and then ignore the AIDS
pandemic as some political leaders are."
Mr. Mbeki did speak about the heavy toll that H.I.V. and AIDS take on young
people. He also spoke about the toll from malaria, cholera, syphilis and "other
illnesses with complicated Latin names," along with vitamin A deficiency, which
he said were among the diseases of poverty.
The text of Mr. Mbeki's remarks released in advance of his speech said: "The
world's biggest killer and the greatest cause of ill health and suffering
across the globe, including South Africa, is extreme poverty."
He omitted that passage when he spoke but cited a 1995 report by the World
Health Organization that described poverty as the world's largest killer. "Five
years later," he added, "the essential elements of this story have not
A strong hint that Mr. Mbeki would disappoint most of those taking part in
the AIDS conference in not saying that H.I.V. causes AIDS came earlier in the
day when scientists canceled a news conference because of what they said was
pressure from the South African government.
The news conference had been scheduled to discuss a statement signed by
5,000 scientists around the world, known as the Durban Declaration. It affirmed
that scientific evidence supporting the link between H.I.V. and AIDS was
"clearcut, exhaustive and unambiguous" and was published in the July 6 issue of
the scientific journal Nature after review by scientific peers.
But the news conference was unexpectedly canceled minutes before it was to
have begun. The reason was that "the South African government put pressure on
us" and threatened to dismiss any signer who worked for the government, said
Dr. Charles van der Horst, a professor of medicine at the University of North
Carolina who signed the declaration.
In an interview, Dr. van der Horst declined to name the government official
who had made the call and said the South African scientist who had received it
was a signer of the declaration. Dr. van der Horst said he had been told that
the official had spoken on behalf of Mr. Mbeki.
Tasneem Carrima, a spokeswoman for Mr. Mbeki, denied knowledge of any such
threat. "We certainly would not threaten anybody," she said.
The declaration came in response to Mr. Mbeki's decision to appoint a panel
to review the claims of dissidents who do not believe that H.I.V. causes AIDS,
Dr. van der Horst said. The panel included such dissidents as well as signers
of the declaration.
"We thought no one would give the denialists credence, and we were wrong,"
Dr. van der Horst said.
He criticized the scientific community for not having published a summary
statement earlier of all of the scientific evidence that H.I.V. causes AIDS.
Now, by giving a platform to a small group of dissidents, Mr. Mbeki has helped
to divert efforts to fight AIDS, Dr. van der Horst said.
Several scientists say that becoming embroiled in new arguments over the
causes of AIDS diverts attention and resources from finding a solution.
The declaration was intended as a scientific statement, Dr. van der Horst
said. But he said the South African government viewed it as a political
statement. After the declaration was released last week, a spokesman for the
president, Parks Mankahlana, said it should be thrown in the dustbin.
This week, Mr. Mbeki's government tempered its stringent criticism of
anti-H.I.V. drug therapy by announcing that it had reversed its view about AZT,
a drug it had deemed unsafe for pregnant women.
In discussing his administration's plan to battle AIDS and responding to
critics, Mr. Mbeki said that "there is no substance to the allegation that
there is any hesitation on the part of our government to confront the challenge
Dr. Piot said developing countries, though poor, would have to spend more on
AIDS, because "it is about the survival of the nation."
Mr. Mbeki and Dr. Piot are leaving the conference early to attend a meeting
of the Organization of African Unity in Lome, Togo, at which AIDS is to be