Controversy Overshadows 13th AIDS Conference

D U R B A N, South Africa, July 7, 2000 -- The first time they convened, the 33 scientists who are attempting to give South African President Thabo Mbeki the definitive answer on AIDS could not bear to stay inthe same room together.

The panel, made up of roughly even numbers of AIDS“dissidents,” who question the link between HIV and AIDS, andmainstream scientists, who say it has been proved beyond doubt,had to break out into separate sessions.

Now, just days ahead of the 13th International AIDSConference, to be held in Durban, South Africa, mainstreamscientists are struggling to find a way to make Mbeki happywithout giving into the hated dissidents — and without lettingthe controversy overshadow the conference.

They are furious that the first AIDS conference to be heldin a developing country is being hijacked by what they considerto be an inane debate over well-established facts, when it shouldbe an opportunity to highlight the disaster that AIDS has becomein Africa.

Stark Fundamental Differences

“When we met as a panel, we all spent the first day and ahalf working through as much as we could together, but it cameto a point where we were not able to make sufficient progressbecause the fundamental differences were too stark,” Dr. SalimAbdool-Karim, head of the HIV/AIDS Research Unit at SouthAfrica’s Medical Research Council, said in a telephoneinterview.

“There had to be two different groups. The kinds ofsuggestions and recommendations that you make if you don’taccept that HIV causes AIDS are so dramatically different thatthere is no gray area. It is all black and white.”

When Mbeki first started questioning the link between HIVand AIDS, disbelieving scientists turned to their main link —the Internet.

Messages flew fast and furious between South Africa,Britain, the United States and elsewhere. One South Africanresearcher called Mbeki’s questioning attitude “idiotic.”

An outraged John Moore, formerly of the Aaron Diamond AIDSResearch Center at New York’s Rockefeller University and now ofCornell University, sent out lists of Mbeki’s new 33-member AIDSadvisory panel, which included virtually every known“dissident” who disputed the link between HIV and AIDS.

Challenging Orthodoxy Online

Ironically, it was the Internet that first gave Mbeki theidea that he could challenge scientific orthodoxy. Known for hisfondness for “surfing the Web,” he had come upon the pagesposted by Peter Duesberg of the University of California atBerkeley, David Rasnick, a California-based molecularpharmacologist, and research editor Harvey Bialy of New York.

The three men are members of the Group for the Reappraisalof the HIV/AIDS Hypothesis, which argues that HIV does notalways cause AIDS and HIV drugs may do more harm than good.

Mbeki appointed them to his panel, along with some of theworld’s leading mainstream AIDS researchers, including Karim, Dr.Luc Montagnier, who co-discovered HIV, and Dr. HeleneGayle, who heads the AIDS center at the U.S. Centers for DiseaseControl and Prevention in Atlanta.

They are trying to be diplomatic while, at the same time,make their point. One member of the panel, who asked not to benamed, said it was difficult because of strong pressure fromMbeki’s office.

“The absurdity of this panel is without question but thepolitical ramifications are serious,” the panelist said. “Thepresident [Mbeki] wants to know that we came to an agreement.”

Some researchers say it is possible that Mbeki is acting outof desperation.

Devastating Impact

The latest report by the United Nations Program onHIV/AIDS (UNAIDS) says that nearly 20 percent of adult SouthAfricans are infected with the AIDS virus, predicting that halfof all 15-year-olds will eventually die of it. The impact onSouth Africa’s already struggling economy will be disastrous.

Up to one in four adults in central Johannesburg areinfected, according to the city’s Southern Metropolitan LocalCouncil.

The expensive cocktails of drugs that keep so many HIVpatients alive and well in rich countries are unavailable to thevast majority of Africans.

Even if they were to become freely available tomorrow, thefacilities do not exist to test people for the virus, determinewhich drugs they should take and then monitor their progress tomake sure the drugs, which require a complex dosing regimen, areworking properly.

Faced with the collapse of his country’s economy and theloss of millions of lives, Mbeki’s best hope may be that thereis some answer other than that an incurable and highlyinfectious virus is causing the devastation.

Some of the dissidents propose that so-called co-factors,such as tuberculosis and malnutrition are in fact the cause ofAIDS, and it is easier to feed someone or give them the antibioticsthat will cure TB than to treat them for HIV.

Durban Declaration

Earlier this week, more than 5,000 prominent scientists anddoctors decided to disabuse Mbeki of this notion.

“The evidence that AIDS is caused by HIV-1 or HIV-2 isclear cut, exhaustive and unambiguous, meeting the higheststandards of science,” the scientists wrote in a letter, calledthe Durban Declaration, and published in the scientific journalNature.

“It is unfortunate that a few vocal people continue to denythe evidence. This position will cost countless lives.”

In case the point does not get across, on Sunday, when theconference officially opens, scientists backing the AmericanFoundation for AIDS Research (AmFAR), including former Dr. HaroldVarmus, former director of the U.S. National Institutes ofHealth, will publish a full-page advertisement reasserting thisin The New York Times.

Mbeki’s spokesman, Parks Mankahlana, is not happy. Hedenounced the “Durban Declaration” and said he hoped theconference would not descend into “Mbeki-bashing.”

“If the drafters of the declaration expect to give it tothe president, or the government, it will find its comfortableplace among the dustbins of the office,” he said.

Is Test Accurate?

Mbeki’s advisory panel held a second and final meeting inPretoria this week. Members said they had come up with acompromise meant to save face for both sides.

“We do have a consensus agreement on treatment,” onepanelist said. It was to be presented to Mbeki on Wednesday.And a committee of the panel agreed that “co-factors” such asTB and poor nourishment must be taken care of.

A committee will also investigate whether the widely usedELISA test, an enzyme-linked test used to check bodily fluidsfor HIV, is, in fact, accurate.

Gayle was diplomatic in telling reporters about thedecision. “People in South Africa are concerned about whetheror not tests used in HIV are accurate and valid,” she said.“We want to start at the first step which is the very basis ofthe data collected to clarify the scope of the problem.”

Karim suggested he did not expect much more.

“I am not expecting to convince anybody that my viewpointis the correct view point,” he said.

Karim, who chairs the scientific committee of the AIDSConference, said he was unhappy at the idea of debating thecauses of AIDS.

“Matters of scientific fact are not determined by panelsvoting and so on,” he said. “If that were the case, we wouldhave voted on whether the Earth was flat. It doesn’t work likethat. Issues of scientific fact are those that stand the test oftime.”