Sunday Times (Johannesburg) - April 8, 2001
Mike Cherry

The report contains few surprises and has dual (and dichotomous) sets of recommendations, depending on acceptance of the premise that HIV causes AIDS.

The panellists met in May and again in July last year to consider the causes of the immune deficiency leading to AIDS, and the best response to the pandemic in a local context.

But the controversial inclusion on the panel of prominent AIDS "dissidents" who believe that HIV is not the causal agent of AIDS precluded the possibility of consensus.

This was conceded by the Minister of Health, Manto Tshabalala-Msimang, last week. The government's response, she said, would be to continue with its AIDS programme based on the premise that HIV is the cause of the disease, while supporting the research programme proposed by the panel.

"We will have to await the outcome of further research before we see whether public policy should be adjusted," confirmed Essop Pahad, the Minister in the office of the Presidency.

The corollary to this is that scientific discourse is seldom conclusive - matters usually boil down to how convincing an argument is, based on the weight of evidence.

The two most persuasive items of evidence presented to the panel were reported in this newspaper at the time.

The first related to changes in patterns of mortality in South Africa over the past decade being mirrored by rising levels of HIV infection, and the second to a study of babies born to HIV-positive mothers in Soweto who were not treated with anti-retroviral drugs. Infant mortality rates after one year were 17/1 000 in babies who were HIV-negative after delivery, compared with 326/1 000 in those who were HIV-positive.

Pahad also downplayed the importance of the panel's recommendations. "I don't know whether we had raised anybody's expectations except in that we wanted an indication from the scientists on issues up for discussion," he declared.

This contrasts with the responses that the President has given in answer to questions on the issue over the past year, indicating that government policy might be predicated upon the panel's recommendations.

The dissidents appear to be at least partially satisfied, as it leaves the door open for further experiments proposed by them at the July meeting and listed in the report. However, protocols for these experiments have yet to be agreed upon.

The report's author, panel facilitator Khotso Mokhele, president of the National Research Foundation, recommended at the press conference this week that yet another committee be established to consider the merits of the proposals.

The reality is that, after almost a year of paralysis resulting from Mbeki's flirtation with the dissident movement, the Department of Health mercifully decided not to wait for the panel's report. Its director-general, Ayanda Ntsaluba, declared publicly in October last year that he believed HIV causes AIDS, and began with the implementation of a pilot programme using anti-retroviral drugs to prevent mother-to-child transmission of the disease.

Mbeki had already announced he was withdrawing from personal involvement in the debate.

The costs of a year's delay are being felt. The long delay in the arrival of the report has also been the subject of speculation. Initially due at the end of last year, it was handed to Tshabalala-Msimang on January 18 but was returned to the panel's secretariat to deal with what she described as "changes of a non-scientific nature".

Although offering no resolution on the issue, the report serves the dual purpose of offering both an escape route for the President, and a justification for the Health Department's (belated) "business as usual" approach to the AIDS problem.

Michael Cherry lectures in zoology at the University of Stellenbosch and is a contributing correspondent for the international science journal Nature. In this capacity, he was one of two journalists permitted to attend the panel's second meeting in Johannesburg last year. The views expressed here are his own

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