AIDS & South Africa A Contrary Conference in Pretoria
In 14 years of AIDS journalism, I've never seen the AIDS leadership writhing in the kind of agony they now find themselves in daily. The prospect of having to debate, defend or quantify their paradigm is melting them down. Since last fall, when the government of South Africa announced that it would suspend AZT use while investigating its toxicity, the country that once symbolized oppression has emerged as a crucible of enlightenment.
Just last week, Mandela came out in support of Mbeki's "controversial" AIDS initiative, which has "AIDS activists" and "AIDS experts" around the world in fits of apoplexy. And this week, with Mbeki visiting Clinton, the stories all revolve around the disturbed emotional states of "AIDS activists" who don't quite know how to express their horror. Project Inform's Martin Delaney told the Times this weekend that "the fear here is that he'll dig in worse if he gets pressured."
The trigger for all this strife was a simple, historic event: After months of deliberations and internal strife, Mbeki and the government of South Africa convened a two-day panel in Pretoria, May 6-7, at which 33 scientists deliberated about the evidence for and against HIV as the single and sufficient cause of AIDS worldwide. They also discussed the drugs used to combat it, and asked themselves whether the drugs have saved lives or ended lives. The AIDS orthodoxy was widely quoted as fuming about Mbeki wasting time on dead scientific questions while they themselves were busy saving lives. But the panel did take place, and I was there.
If you've absorbed the situation thus far from the mainstream press, you've been left with the impression that the story is all about President Mbeki betraying his country, if not losing his mind altogether?Mbeki "trawling" the Internet late at night and "stumbling" across a few "obscure" American scientists who say HIV doesn't cause AIDS. What's consistently absent from reports on this subject is a statement not of conjecture but of fact: Mbeki did not fall under the spell of two American scientists who question HIV's role in AIDS (by which is meant Drs. David Rasnick and Peter Duesberg). The scientific opposition to the mainstream view of HIV and AIDS is in fact longstanding, formidable and far more extensive than two scientists. This opposition was first galvanized around retrovirology pioneer Peter Duesberg, who in 1987 wrote his first deconstruction of the hypothesis. Duesberg mapped the genetic structure of retroviruses, and was widely regarded as one of the leading retrovirologists in the world at the time of his first critique. In subsequent years, hundreds of scientists from around the world have joined the ranks of the dissenters, under the auspices of the Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis, an opposition group that boasts up to 600 signatories, many of whom hold PhDs and two of whom hold Nobel Prizes.
These are the so-called AIDS dissidents, now also labeled "AIDS denialists." On June 6, 1991, the initial signatories drafted a letter that stands as the working definition of an "AIDS dissident." The letter, which no major science journal would publish for years until Science finally relented in 1996, read as follows:
It is widely believed by the general public that a retrovirus called HIV causes the group of diseases called AIDS. Many biochemical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken.
Epidemiological studies? Whoever heard of anything so whacked? We all know HIV causes AIDS. Anybody who doubts it obviously doesn't care about the dead and dying.
Seriously, this simple statement is all that lies at the heart of the maligned and despised AIDS dissident movement. That wish for a "thorough reappraisal" was behind the Pretoria conference in early May. Yet judging from media reports, you'd think that Mbeki had called for AIDS quarantines and tattoos for all HIV-positives.
In fact, Mbeki's heresy consisted of opening up one large room at the Sheraton hotel in Pretoria, and placing along a rectangular table 33 scientists with opposing views on what causes AIDS. About a dozen of them argued that no proof of causation has been established between HIV and AIDS. The others took the opposing, majority view.
There was predictable response from some quarters. "It's irresponsibility that borders on criminality," a South African "medical graduate" and "respected intellectual" was quoted saying in the Sunday Herald of Glasgow. "Mbeki's position defies logic," said Dr. Ashraf Grimwood, the chairman of the South African National AIDS Convention, in the same article. "The suggestion that AIDS is not caused by HIV is totally at odds with what is happening on the ground. South Africans are burying wives, husbands, children, relations and friends every day. People are terrified. No-one has seen anything like it before. This country needs to get its priorities right, or it will hardly be a country at all." (Notice the leap of illogic from the first to the second sentence of that statement.)
People are sick and dying in alarming numbers on the continent of Africa, but what is it that leads us to trace this phenomenon to sexual promiscuity and this particular retrovirus, when other complications abound? Why has AIDS not spread outside the original risk groups in any industrialized nation, yet where poverty is widespread, the virus (and AIDS) spreads like wildfire? The orthodox theory is that this is due to sexual promiscuity among Africans and a penchant for dry sex, rough sex and even sexual rituals involving monkey blood.
"It isn't the facts that are in dispute," says African historian Charles Geshekter of California State University at Chico, who took part in advising Mbeki prior to the panel formation. "It's the theoretical construct behind the facts. Yes, there is a measurable decline in African health and increases in African mortality. What is in dispute is whether the symptoms of such illnesses are caused by extraordinary patterns of sexual behavior or whether the signs reflect the deterioration of life on the continent over the past 20 years. The breakdown and decline of public health and medical treatment across Africa is due largely if not entirely to domestic civil war, impossible levels of indebtedness and sharp declines in the prices paid for commodities produced by Africans. This is standard World Bank and IMF micro- and macro-analysis. Where's the mystery?"
The statistics ubiquitously cited to demonstrate a plague of AIDS sweeping Africa are untrustworthy in the extreme, as virtually no statistics are kept on either rates of infection, numbers of deaths or causes of death on the whole continent. In addition, the shoddy test used there can cross-react with microbes endemic to the region, such as malaria. The "Bangui definition" of AIDS was published in Science in 1986; the diagnosis is AIDS if a patient has a persistent cough and two of three other conditions: "prolonged fevers (a month or more), weight loss of 10 percent or greater and prolonged diarrhea." In other words, people were diagnosed with AIDS without being given HIV tests.
"According to the Global Burden of Disease Study (GBD), which is a WHO-sponsored project," says Geshekter, "Africa maintains the lowest percentage of vital statistics for cause of death of any continent in the world." The GBD estimates that statistics can be considered accurate on the continent for a microscopic 1.1 percent of all deaths.
One of the South African dissidents on Mbeki's Pretoria panel, Dr. Sam Mhlongo, arrived at his own skepticism while working at a hospital in London in the mid-1980s. There he came across a group of patients from Uganda who, he was told, were all HIV-positive (on the ELISA test). After retesting them using more rigorous tests, he found that every one of them was in fact HIV-negative. "That's when I knew something was very, very wrong," he told me.
The countries where AIDS supposedly rages in Africa are also afflicted by dire poverty and malnutrition. But the "massive effort" to combat AIDS that Mbeki is supposedly undermining with his skepticism amounts to widespread condom education and distribution, and the dumping of failed, toxic drugs onto a population that does not, in many cases, have access to food or clean water. AIDS advocates seem curiously unmoved by the practice of driving around to desperately poor villages in Africa and preaching condom use to people who don't have water. They also don't seem bothered by the fact that poor Africans are used in shoddy drug trials, pressured to sign consent forms they don't understand, manipulated by AIDS terror and told they will "probably die of HIV anyway." In one Nevarapine trial in South Africa, five pregnant women were recently killed by the drug, a protease inhibitor; others suffered debilitating side effects.
Thabo Mbeki was a central figure in the worldwide anti-apartheid movement, as was his father, Govan Mbeki. He led the ANC delegation that finally negotiated the release of Mandela and other political prisoners, and managed to negotiate a peaceful end to apartheid. "The Mbeki family is like the royal family here in South Africa," a South African journalist told me.
Mbeki is renowned for his intellect, decency and sense of honor. He is a rapacious reader. He was sent abroad by the ANC as a young man to spare him from prison and ensure that he got a good education. At the University of Sussex, where Mbeki obtained his degree in economics, the theme of his education, according to biographical notes, was "the notion that the students had to know enough to be able to question whether what they knew was, in fact, knowledge."
Mbeki was literate from a very early age, and it fell upon him to read the letters written to the illiterate wives of the husbands who had gone off to work in the coal, gold and diamond mines. When the miners began dying from coughing up blood, lore had it that they died because they had been kicked in the chest by the killer-birds of witches (impundulu). In fact, they died of phthisis, brought on by mine dust.
Is it surprising, then, that now as president of South Africa, he looks at AIDS and questions its causes? Twenty years of crisis. An estimated 50 billion research dollars expended by the U.S. government. But a head of state can't invite 33 scientists into a room to discuss the actual data underlying the AIDS edifice without triggering international outrage.
This is the Thabo Mbeki described in The Washington Post as "thin-skinned" because when "a reporter asked if he could afford such a cautious, studied approach to treating AIDS when activists estimate that 1,500 to 1,700 South Africans are becoming infected with HIV daily, Mbeki retorted skeptically: 'How is that figure derived? Do you know? I don't know."'
A better question might be why "AIDS activists" are put in charge of estimating HIV infections on a continent that keeps no such figures. Mbeki's "I don't know" is by itself a revolutionary statement. When discussing AIDS, rule number one is: Don't ever admit you don't know something. Rule number two: Statistics, especially in Africa, are always beyond dispute, spiraling toward the skies, getting worse and worse and worse.
The night before I boarded a plane for Johannesburg, my phone rang. It was my friend Noah Bogen, a documentary filmmaker who had for years been telling me he wanted to do something on the HIV debate. "I'm coming with you, Celia," he said. "I've decided I'm ready to die for something important. I've had enough of my pointless mundane existence."
"We're not going to die, Noah," I said. "We're going to the Sheraton hotel in Pretoria."
Two dissident scientists and three orthodox scientists are on the plane with us. Fourteen hours later, we touch down in Johannesburg and unfurl our aching bodies. We are greeted by the coordinator of the panel, and ushered into a diplomatic lounge, where they take our passports, offer us drinks and welcome us. Eventually we are divided into cars and speed off toward Pretoria, half an hour away. On arriving at the hotel, we learn that there will be no press access to the actual proceedings, because the mainstream side objected fiercely to this.
A few hours later, jetlagged, I wander down to the cocktail reception, where hardcore dissidents like Duesberg and Harvey Bialy are conversing happily with officials from the Centers for Disease Control and the NIH. In walks Luc Montagnier, from whose laboratory the entire ball of wax emanated in 1983, when he isolated the virus (or, some dissidents would say, "what passes for the virus").
I look around the room and smile at the very sight of all the orthodox scientists eating salmon snippets from the same tray as people who don't think HIV causes AIDS. A single air strike against this hotel at this moment and you'd wipe out the HIV debate forever after. I greet Duesberg, whom I've known, interviewed and admired since 1987. For years I've been telling him that this day would come. He looks around the room. "I have to admit," he says, "this is unbelievable."
The next morning at 8 a.m., a red carpet runs through the Sheraton, and we take our seats to await President Mbeki, who will address and welcome the panel. When he enters the room, it feels great, standing up to salute somebody you actually want to salute.
He addresses us, his voice melodic and gentle, quoting Irish poetry, asking rhetorically if he might be a fool. "Indeed, when eminent scientists said, 'You have spoken out of turn,' it was difficult to think I was not a fool," he said. "You cannot respond to a catastrophe merely by saying, I will respond in a way that is routine. We must never freeze scientific discourse at a particular point."
He detailed the trajectory of his own skepticism, and said that the data on HIV and AIDS in Africa had confounded him.
(Days later, Rachel Swarns of The New York Times would report that Mbeki said in this address that he "knew that the human immunodeficiency virus causes AIDS." He said no such thing. I called Swarns twice for comment. At print time, she has not responded.)
Around the world, even in South Africa, the media has pilloried Mbeki, depicting him as "unable to sleep" and searching the Internet for conspiracy theories about AIDS. Mbeki has accused his critics of waging a "campaign of intellectual intimidation and terrorism" against him, which he likens to "the racist apartheid tyranny we opposed."
The real story has nothing to do with the Internet. It started with a South African journalist and consultant named Anita Allen, who, having read Nobel laureate/HIV dissident Kary Mullis' book Dancing Naked in the Mind Field, began her own crash course in the dissident critique, and started calling South African scientists and health officials to alert them. After many weeks of polite rejections and assurances that the scientific community of South Africa was quite sure HIV caused AIDS but thanks anyway, Allen finally appealed to the President himself in the form of a letter and a 100-page dossier. Three months later, an astounding thing happened.
"It was close to midnight," Allen recalls, "and the fax machine went off. I thought, 'Who on Earth is faxing me at this hour?'" What came through the fax was a handwritten letter from Mbeki, saying he had read her letter expressing concern about the HIV-AIDS question and that he wanted to meet with her in the morning to discuss it.
Allen met with Mbeki for an hour. She brought with her a dossier of scientific articles for him to read.
"He said to me, 'What exactly do you want me to do?' And I suggested he convene a panel. He said, 'I'm going to be slaughtered, you know.'"
"What other leader in the world would talk to an ordinary citizen like that?" Allen wonders.
She was invited to submit a proposal on whom to invite to the panel and how to structure it. The man placed in charge of dispatching the invitations, Dr. Ian Roberts, was, according to Allen, hostile to the debate and simply didn't send them out. This explains why, in the days leading up to the conference, I was on the phone with dissidents Rasnick, Bialy and others, trying to find out if this was really happening or not, and they didn't know. Many of the panelists only had their flights confirmed in the immediate days before departure.
"What's going on in there?" I continually asked whatever panelist I could snag when they came out of the conference room for their coffee breaks.
"They have nothing, just fairy tales about friends dying, architects dying, all these funerals," says Christian Fiala, a dissident doctor from Austria. "There is an interesting argument in there, that so many millions are dying and we have to act now, and all these people trying to reopen a discussion about the causes of AIDS is stopping this important action. But what they don't keep in mind is that before you start to go in a certain direction, you have to know which direction you're going in, and why. What if it's the wrong direction?"
"It took a head of state to accomplish what scientists couldn't accomplish in 15 years," Rasnick told me. "The event itself was historic, but I would not say that anything was resolved. Everybody just laid out their positions, and nobody really budged from those positions... It was two days of 'You're wrong and I'm right.'"
In a separate meeting, it was decided that Duesberg and Bialy, under the auspices of the CDC and the South African government, will design epidemiological studies that will put the HIV hypothesis to a test (16 years after its birth).
After the first day of the panel, there was a joke going around that Helene Gayle, the very beautiful African-American director of the National Center of HIV/AIDS prevention at the CDC, had invited Duesberg to the CDC for a yearlong sabbatical. Duesberg and Gayle were joking and being flirty, and before long nobody knew if the joke was real or not. By the end of the conference, a version of it had taken root, and it was announced that a subcommittee of four?Gayle, Duesberg, Bialy and Prof. Malegapuru Makgoba, head of South Africa's Medical Research Council?would work together to design and carry out the HIV experiments. This was confirmed by the Health Minister at the closing press conference, and reporters were meekly asking who would pay for the experiments.
"Peter Duesberg was more surprised than anybody on the planet to hear that he's now collaborating with the CDC," said Rasnick. "This is beyond anybody's wildest imagination."
Rasnick also reported that when he said that AZT has "killed a lot of people," no one on the panel disagreed.
"That was quite openly stated and nobody disagreed with it," Rasnick said. "I would put the figure at at least tens of thousands killed, at the doses they were giving people in the early years."
Dr. Klaus Koehnlein, a German AIDS practitioner and dissident on the panel, concurred. "I remember vividly the early years, and seeing those AZT patients, and they just had no bone marrow left and that was it. They think AZT wasn't so good and the new drugs are better, but they have no idea that we killed a whole generation of AIDS patients with AZT. Especially in the early high doses of 1200 and 1500 milligrams. That was just murder."
Dr. Sam Mhlongo, head of the Dept. of Family Medicine and Primary Health Care at the Medical University of South Africa, was the only South African on the panel who holds the dissident position. He speaks to Mbeki on a regular basis. I ask him whether he thinks Mbeki might back down under international pressure.
"There is no way this president will give in to attacks on him, because he is convinced, like he was in the struggle against apartheid, that there needs to be a debate. This is all related to apartheid, because the theories and practices of apartheid were not to be questioned. It was taken for granted.
"I grew up under apartheid," he continued. "There were funerals every week because of the violence and the poverty of apartheid. There are many funerals still today, and I say that there is no evidence whatsoever that these people have died of AIDS."
I ask him what I would see if I went to a local hospital (which I've done in other African countries, but not in South Africa). "If you didn't see poverty and malnutrition as the number-one cause of death in South Africa," he replied, "I am prepared to close my bank account and give you all my money."
I asked him how that was possible?how could there be all these media reports about the millions dying of AIDS in Africa? It can't be a wholesale fabrication, can it? Don't they say that AIDS affects the middle and upper classes, not just the poor?
"Look, there are no death certificates whatsoever," he said. "We have no references for anything. All you have is the media. Television, radio and newspapers agreeing on this. That stuff about the upper classes is really rubbish. 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, because of diseases related to poverty."
Political earthquakes sometimes begin as flukes, or oversights?like the "opening" of the Berlin Wall, which the East German government did not intend at all.
The panel is being followed up by a six-week Internet discussion with all the panelists, and then another meeting in Pretoria in early July, where conclusions will be drawn and recommendations will be drafted for the South African government's AIDS policies.
A strange thing happened on the last day. Apparently, Clinton called and spoke to Mbeki just as the panel was convening, and asked if he could dispatch four (African-American) AIDS specialists from the White House to sit in on the panel. Mbeki agreed, and the four suddenly appeared on the last day, but evidently didn't say much.
"It seemed like they were there to observe," said Rasnick.
"That's the United States AIDS forces coming in," quipped Duesberg.
When I collared people from the CDC in the halls and asked them for comment, they would say diplomatically that this conference was "important" and that many of the dissident arguments could be helpful in the "fight against AIDS."
It felt a little like the period around the time of the Velvet Revolution, when former authoritarian socialists suddenly started talking about the importance of "socialism with a human face."