SA’s Aids doubts baffle the experts

Statements questioning the cause of Aids have caused dismay among local and international scientists

Khadija Magardie and David Le Page

Leading international Aids scientists and researchers this week unanimously dismissed the South African government’s suggestion that the link between HIV and Aids be “re- examined”.

Head of the Medical Research Council Professor Malegapuru Makgoba also lashed out at the so-called Aids dissidents, describing them as “failures in their own countries” and warning that South African is becoming “fertile ground for pseudo-science”.

Their statements came as the government’s apparent readiness to overturn the principles behind its own Aids policies began to attract further – disbelieving – international attention. A lengthy story in New York’s influential Village Voice this week is subtitled: “South Africa’s president may become the first world leader to believe that HIV is not the cause of Aids.”

The scientists are in Johannesburg for a preparatory meeting ahead of the International Aids 2000 conference, to be held in Durban in July. The group, comprising influential academics and doctors involved in local and international Aids research, criticised moves by President Thabo Mbeki to consult with United States- based dissident Aids scientists – who believe that Aids is caused not by HIV but by drug use and other risk factors.

HIV discoverer and co-discoverer of Aids, Professor Francoise Barre-Sinoussi of the internationally renowned Pasteur Institute in Paris, said the link between HIV and Aids remains clear, while her colleagues pointed to the considerable supporting evidence that has emerged since her discovery.

“HIV was discovered in 1983, 17 years ago. We have accumulated so much evidence of the link with Aids – it is nonsense to try to separate the virus and the disease,” said Barre-Sinoussi.

“Certainly, people are not killed by the virus itself. But there is no doubt that HIV initiates the process of immune deficiency.”

Dr Helene Gayle, a director at the world- renowned Centers for Disease Control in Atlanta, in the US, expressed concern that failure to resolve the fundamental issue over what actually causes Aids will lose valuable time and resources.

“This virus moves quickly – the damage in prolonged questioning and debating issues that have long ago been discussed and refuted is enormous.”

She said that, given the highly politicised nature of HIV/Aids, it is understandable that policymakers at national level had questions regarding alternatives.

In this case, however, she said there is “no merit in questioning conventional wisdom”.

Regarding the governmental policy on AZT, she said it was unfortunate that the efficacy of the drug, despite well- documented evidence to the contrary, is still being questioned as potentially dangerous to Aids sufferers.

Following the government’s announcement in December last year that there was evidence to suggest that AZT was highly toxic, and carried more risks than benefits, a number of HIV sufferers discontinued their treatment. Gayle said this was damaging, as it “could erode people’s beliefs in things that could greatly reduce their suffering”.

Dr Ruth Nduati, a paediatrician at the University of Nairobi, has been heavily involved in studies on the transmission of HIV/Aids through breast milk, and on the usage of anti-retroviral therapy in preventing mother-to-child transmission.

She described Mbeki’s actions as “unfortunate”.

“It’s taking us backwards, and it is our worry that such discussions may unravel our significant gains in terms of managing the disease.”

She acknowledged that questions like Mbeki’s will constantly surface, and needed to be answered, but she emphasised that science has proven what Mbeki now questions.

“There is no doubts in my mind that HIV causes Aids,” she said.

Nduati cited a number of African and international studies that proved the effectiveness of AZT in preventing mother- to-child transmission.

Last year, the government justified its refusal to provide free AZT to pregnant mothers and rape survivors, adding to the claims of toxicity the suggestion it could even exacerbate the symptoms of Aids.

Nduati said the numbers of AZT users who had severe side effects were extremely minimal, and that there is “no evidence to suggest that the drug had side effects dangerous enough to warrant its discontinuation”.

It is not only the international experts who are alarmed by the government’s actions.

“Patients are saddened and confused,” said Dr Ashraf Grimwood, president of the National Aids Council of South Africa and former chief medical officer for Cape Town. Grimwood said medical personnel already struggle to persuade HIV-positive men in good health to seek treatment.

He pointed out that all the dissidents’ claims have been refuted scientifically. “This threatens any gains we have made in response to the pandemic. The debate is taking us back 15 years. Why are we going into denial?”

Dr James Matjile, senior lecturer and principal specialist in Medunsa’s community health department, commended the efforts the government has made so far to tackle HIV and Aids. “We can only hope that whatever doubt there is will be cleared up fairly quickly,” as it “could have a disastrous effect on programmes intended to change dangerous behaviour”.

Matjile said that inevitably, when a disease is first discovered, scientists don’t have all the answers. “But errors that have been made are continuously being corrected.”

He said there is no doubt malnutrition and poverty play a role in Aids, as suggested by the dissidents, but he dismissed the notion that the virus is not involved in such cases.

Interviewed separately, Makgoba described Mbeki’s actions as “foolish and harmful” and said it was worse, given that Mbeki is “medically and scientifically nave”.

Makgoba said he was confident that nearly “all respectable scientists” stuck to the irrefutable facts about HIV/Aids, and that the dissident scientists are opportunists “out to get famous”.

“One mustn’t mix the established facts with all the debates going on around policy,” he said.

He said he welcomed the establishment of a committee that would examine a way forward for HIV/Aids management, but said it would be “annoying” if, instead, politicians merely focused on revisiting issues that science has already cleared up.

Meanwhile, controversial Pan Africanist Congress national health secretary Dr Costa Gazi intends bringing a class action suit against Minister of Health Manto Tshabalala- Msimang, for refusing to supply the anti- retroviral drug AZT to pregnant HIV-positive women.

Gazi made headlines last year after he was fined for calling for manslaughter charges against former minister of health Nkosazana Zuma over the non-issuing of the drug.

According to Gazi, the right to life of “tens of thousands of pregnant women” and their babies is restricted by the department’s refusal to supply AZT.

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