We may be past the days when medicines junked in the West are exported to the Third World, but South Africa is aggressively defending its right to import junked science. Even as his government confirmed this week that at least one in every 10 South Africans is HIV-positive, President Thabo Mbeki lashed out at critics of his government's flirtation with self-styled "dissident" AIDS scientists who believe the disease isn't caused by the HIV virus. Mbeki even put a nationalist spin on his angry retort to those who criticized him for giving credence to discredited science. Distinguishing AIDS in Africa as a primarily heterosexual phenomenon that is destined to slash average life expectancy in his region to 47, Mbeki insisted that "as Africans we have to deal with this uniquely African catastrophe" and that simply accepting Western conventional wisdom on AIDS would be "absurd and illogical." Mbeki's remarks, in letter to President Clinton which administration officials considered so unfortunate that they tried to avoid releasing it to the media even likened those warning against the views of dissident AIDS scientists to the repressive apartheid regime and book-burning religious fanatics.
Mbeki's position has been privately greeted as something of a disaster by Clinton administration officials, who will receive the South African president on a state visit next month. In their official comments they avoided criticism of Mbeki so as not to prompt a further backlash, but the controversy is almost certain to provoke protests from U.S. AIDS activists and cast a cloud over Washington's relationship with its favorite new-generation African leader.
The controversy also threatens to disrupt a major international AIDS conference to be held in South Africa in July, with a growing number of key experts threatening to stay away if Mbeki's government insists on indulging the views of dissident academics whose views were debated and discounted a decade ago in the U.S. To the consternation of South Africa's own medical and AIDS-activist community, Mbeki has invited Berkeley molecular biologist Peter Duesberg and his colleague David Resnick who maintain that the HIV virus is harmless and not the cause of AIDS to serve on a panel advising the government over whether to make AZT available to pregnant HIV carriers. Duesberg and Resnick argue that the high incidence of AIDS in Africa is based less on unprotected sex than on such poverty-related conditions as undernourishment.
"Duesberg has been so thoroughly discredited among AIDS researchers in the U.S. that this is equivalent to South Africa trying to import out-of-date medicines," says TIME medical correspondent Christine Gorman. "If South Africa approaches this question in good faith they'll find out what everybody else has figured out, which is that HIV causes AIDS but in the meantime hundreds of thousands, if not millions, of people will suffer because of some misplaced distrust of medical authority."
With AIDS threatening to wipe out a full 25 percent of South Africa's population by the year 2010, the current debate has arisen over the government's responsibilities in treating the disease. Despite growing pressure from the South African medical and AIDS activist communities, the government refuses to make available the drugs AZT or Nevirapine to rape victims and pregnant women. Some 22 percent of pregnant women in South Africa are HIV-positive, and AZT and Nevirapine have been successful in preventing mother-to-child transmission of the virus. "AZT has been shown to prevent transmission of the virus to unborn children," says Gorman. "There's always a chance that HIV won't transmit and that some of those being treated might now have contracted HIV anyway, but even if women aren't compelled to take it there's no excuse not to make it available."
But the South African government maintains the drugs are too expensive and potentially harmful. As the protests escalated, Mbeki and his aides have invoked Duesberg's theories and his claim that AZT does more harm than good, and have accused their critics of promoting profiteering pharmaceutical corporations. And the president has rationalized his stance by invoking Duesberg. While proclaiming himself undecided on Duesberg's arguments, Mbeki insists that they ought to be debated and instructed his AIDS advisory panel to consider questions ranging from the merits of treatments such as AZT to "whether there's this thing called AIDS, what it is, whether HIV leads to AIDS, whether there's something called HIV," according to his spokesman Parks Mankahlana. But South African critics see dabbling in Duesberg's ideas as a dangerous distraction that ducks the government's treatment responsibilities, which could also critically undermine the government's own safe-sex education efforts.
The work of the HIV-AIDS naysayers passed into obscurity with the success of anti-retroviral cocktail treatments, which were developed on the premise that HIV causes AIDS. Of course, treatments that cost some $10,000 per patient each year are way beyond the reach of the overwhelming majority of South Africa's HIV sufferers and of their government, which would have to spend its entire medical budget on providing the drug cocktails. But AZT is a lot more within their reach. And scientists fear that attempting to resurrect the credibility of skeptics such as Duesberg sends a message that could prove disastrous to education efforts to stop the spread of the virus in South Africa. "If the problem with supplying people with AZT is financial, that needs to be said up front," says Gorman. "But for a government to be seen questioning whether HIV actually causes AIDS is extremely dangerous, because it twists people's minds."
Mbeki's position reportedly derived from reading Duesberg's ideas while trawling the Internet for information on HIV. And as a proud intellectual and instinctive contrarian, he won't easily be cowed by the howls of protest. In the end, though, Mbeki's flirtation with weird science may prove to be an embarrassment to a government that hopes to lead a continent-wide African renaissance. But that embarrassment will be nothing compared with the human suffering that could result from challenging the fundamentals of AIDS science in a country with one of the world's highest incidences of HIV.