Sunday Times, South Africa - July 9, 2000
Laurice Taitz

THE QUESTION THAT CAUSED ALL THE TROUBLE:

At the first meeting of the AIDS advisory panel in May, President Thabo Mbeki asked scientists to explain how the disease had come to blight Africa.

He said AIDS had developed from one that infected predominantly homosexual men, intravenous drug users and haemophiliacs in the US and Western Europe in the '80s to one that affected a vast African heterosexual population less than a decade later.

"This is not an idle question for us because it bears directly on the question of how we should respond if this change is for reasons we cannot explain," he said.

WHAT MOST SCIENTISTS SAY:

So-called orthodox scientists from bodies like the local Medical Research Council, the Centres for Disease Control in the US and organisations such as the World Health Organisation and UNAIDS say that AIDS is caused by the human immunodeficiency virus that is spread by unprotected sex, by sharing needles with an HIV-infected person and by infected pregnant women to their babies.

They say the evidence that HIV causes AIDS is overwhelming. First, evidence of HIV infection is easily found in patients with AIDS; second, the virus has been isolated and grown in pure culture from people with the disease; and, finally, studies of AIDS cases resulting from blood transfusions have documented the transmission of HIV to previously uninfected people who have subsequently developed the disease.

They say tests for HIV are reliable and that anti-retroviral drugs can be used to slow down the pace of infection and cut down transmission of the virus from mother to child.

WHAT THE 'DISSIDENTS' SAY:

The so-called AIDS dissidents believe that HIV is not the cause of AIDS. They acknowledge that people are dying and that AIDS is caused by a breakdown of the immune system. But they say the disease has been caused in Europe and the US by recreational and anti-retroviral drugs, and in the developing world by poverty, malnutrition and poor living standards. They say the statistics cited to demonstrate an AIDS pandemic are not trustworthy and that the "shoddy" tests used to detect HIV can cross-react with endemic microbes such as malaria.

WHAT MBEKI'S AIDS PANEL DECIDED THIS WEEK:

Despite protracted discussion among panellists, little has emerged to suggest that the HIV/AIDS issue has to be radically re-evaluated. However the Minister of Health, Manto Tshabalala-Msimang, mentioned concern among local health officials about the accuracy of HIV tests.

This comes a week after the release of figures by UNAIDS that say South Africa has the highest number of people in the world infected with HIV - an estimated 4,2-million.

A project to evaluate the reliability of the tests used to diagnose HIV/AIDS will be carried out over the next few months by Dr Helene Gayle, of the Centre for Disease Control, Dr William Makgoba, president of the Medical Research Council, and the dissident scientist Dr Harvey Bialy of the Autonomous National University of Mexico. The project should be completed by the end of the year.

But orthodox scientists including Gayle and Makgoba say they are in no doubt that HIV tests are accurate and the Director-General of the Department of Health, Dr Ayanda Ntsaluba, said after the meeting: "The department is proceeding with its programmes on the basis that HIV is the cause of AIDS. So far, there is nothing to suggest we should be doing otherwise."

WHO'S WHO IN THE DISSIDENT CAMP:

Dr Peter Duesberg: A molecular biologist at the University of Berkeley, California, Duesberg has disputed conventional wisdom on AIDS since the viral cause was first proposed in 1983.

One of his more memorable statements is: "They have hyped up HIV into this superrapist, but in reality the damn thing can hardly get an erection."

Dr David Rasnick: He was contacted in January by the President's office and asked to answer some questions posed by Mbeki on HIV and AIDS. Two days later he had a 10-minute conversation with Mbeki. In a letter posted on the dissidents' web site, Rasnick said: "The President and I had a very nice conversation. He asked me if I would support his efforts regarding AZT and AIDS. Mbeki wants to provide a public forum where the leading proponents of the HIV hypothesis and its leading critics can present the evidence for and against the following popular beliefs: AIDS is contagious; AIDS is sexually transmitted; HIV causes AIDS; and anti-HIV drugs promote life and health."

Dr Harvey Bialy: A molecular biologist based at the Autonomous National University of Mexico, Bialy has been quoted as saying: "HIV is an ordinary retrovirus. There is nothing about this virus that is unique. Everything that is discovered about HIV has an analogue in other retroviruses that don't cause AIDS. HIV only contains a very small piece of genetic information. There's no way it can do all these elaborate things they say it does."

Dr Sam Mhlongo: Head of the department of family medicine and primary health care at the Medical University of South Africa, Mhlongo is the only South African member of the President's advisory panel who holds the dissident view.

Asked by US journalist Celia Farber how there could be so many media reports about the millions dying of AIDS in Africa, he was quoted as saying: "Look, there are no death certificates whatsoever. I am so-called bourgeois, and I don't see any of this among the middle class. It's the poverty-stricken, unemployed, black South Africans who are dying . . . of diseases related to poverty."

How people with the virus manage to go on living

MILLIONS of South Africans have HIV. Three of them tell how they cope:

FAGHMEDA MILLER:

"Coming back home after the doctor told me I was positive, I asked myself what I was going to do, could I tell my people because I know that in the Muslim community it's a big sin to have AIDS. . .

"Sometimes I do feel down. After I appeared on television I expected other people to come forward and when no one actually did, I felt that my time was useless. Then I received a call from another Muslim guy who was diagnosed five months previously.

"He said to me that when he saw my programme he was feeling very down and was afraid to go out into the community, knowing that they would reject him. He said when he saw my programme, I gave him the courage to live and, without knowing it, by telling me this he also gave me the courage to carry on again."

JUDGE EDWIN CAMERON

"I'd known for a long time that at some time I would make a public declaration that I was living with AIDS. That became particularly urgent after I fell ill with symptoms of AIDS at the end of 1997. Then it became just a question of when it would happen. . . I felt that from my position of relative privilege and protection I should state my position. . . The response moved me beyond words. It was almost universally affirmative. I had a deluge of loving responses - letters, cards, faxes, e-mails, telephone calls and flowers from many, many hundreds of people."

VALENCIA MOFOKENG

"When I was diagnosed with HIV I was angry, and for the first time in my life I thought of suicide. I thought maybe if I died, things would be better for my son. After a few weeks, I realised I was making a big mistake because my two older daughters also needed me. So I decided it was better to live and teach people how to live with AIDS. Telling people was the hardest thing to do because you don't know whether they are going to accept you or not. It wasn't easy, believe me."

Interviews: Susan Fox. Pictures: Giselle Wulfsohn, courtesy of Beyond Awareness Campaign

Helpline

IF YOU would like more information, call the Department of Health's HIV/AIDS Helpline: 0800-012-322

The AIDS helpline is a 24-hour toll free service run by Life Line. Trained counsellors are able to answer questions on all aspects of HIV/AIDS, sexually transmitted diseases and related issues. They can also provide referrals to resources and services. They offer information in a number of South African languages.

Information from the Department of Health web site: http://www.health.gov.za/

Medicine's artillery in a war on the still incurable

While no cure is on the horizon, medical advances against HIV/AIDS have given hope to those who have the disease.

It is estimated that thousands of South Africans do not know that they are positive because they have never been tested. The encouragement of voluntary testing and counselling will go a long way in helping to destigmatise the disease and to get prevention messages across. Offering treatment could provide an incentive for testing;

While anti-retroviral drugs have improved the quality of life of HIV-infected people, the high prices of antiretroviral drugs and treatments for many AIDSrelated infections have made them inaccessible to most South Africans;

The development of an HIV/AIDS vaccine has been identified as a national priority and Cabinet has approved R200-million over seven years for the South African AIDS Vaccine Initiative. Led by the Medical Research Council, the initiative has already secured funding from a range of international agencies and governments. While there are many international organisations and companies that have set their sights on finding a vaccine, the South African initiative is one of the few projects to research a vaccine candidate for the most prevalent subtype found in Southern Africa - Clade C;

While prevention strategies like encouraging condom use play a key role in reducing the number of infections, they are only helpful if they are consistently pursued and target different age groups with accessible messages;

Successful strategies to prevent mother-to-child transmission using antiretroviral drugs have been adopted by many countries including the US and UK, and are being considered by a number of African governments. In the US, where anti-retroviral therapy is widely used to reduce perinatal transmission, the incidence of AIDS in infants has fallen by 80 percent.

The secret of Uganda's success

THE 10 things Uganda has done to fight AIDS:

* Acknowledged the seriousness of the AIDS epidemic. For 14 years, President Yoweri Museveni has been unwavering in his acknowledgement of the seriousness of AIDS and has used every opportunity to remind Ugandans of the dangers of the disease;

* Developed a simple message that has reached every household: practice your ABCs - A is for abstinence, B is for being faithful to one partner and C is for wearing a condom;

* Boldly declared a policy of openness that has reduced the stigma of AIDS;

* A top Ugandan Army officer, Major Rubaramira Ruranga, who is still in the army 10 years after he was diagnosed as HIV-positive, has declared his status to the country;

* Trained public health workers to counsel children and the bereaved; Set up feeding schemes at major hospitals and projects to economically empower orphans and widows;

* Devolved responsibility for the pandemic down to the smallest unit of society, the household;

* Devised a national project to encourage HIV-positive women to document their life story, thoughts and feelings for the children they leave behind;

* Learned that fear doesn't make people change their behaviour, but encouragement, support and compassion do;

* Recognised the contribution of the country's scientists, community-based initiatives and non-governmental organisations, and welcomed support from other countries and international funders.

What it all means for SA

* South Africa cannot be compared to other industrialised countries because its epidemic is many times larger than that experienced by the worst-hit industrialised countries;

* In other industrialised countries the epidemic is largely under control and AIDS deaths have fallen significantly because of the availability of antiretroviral therapy;

* In terms of percentages per race group, there are many more African people infected than other groups. But there is evidence that AIDS is spreading through all groups in South Africa and is breaching class barriers;

* AIDS is killing people in the economically active age group;

* In homes across the country, AIDS cases are causing untold trauma and are proving to be economically disastrous;

* Nearly one million SA children will lose their mothers to AIDS by 2005, according to the Department of Health.

Source: 'AIDS: The Challenge for South Africa' by Alan Whiteside & Clem Sunter

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