South Africa in a Furor Over Advice
(New York Times- 03/19/00)
By RACHEL L. SWARNS
JOHANNESBURG, March 18 -- President Thabo Mbeki's decision to seek advice from two Americans who argue that H.I.V. does not cause AIDS has touched off an outcry at home and abroad and raised fears that South Africa's already soaring infection rate will climb still further.
News that Mr. Mbeki recently consulted the Americans, a scientist and a professor of African history, leaked out this month, and is the latest of several disputes over how to treat AIDS in a country of 44 million people with one of the highest H.I.V. infection rates in the world.
Mr. Mbeki and his officials spoke with David Rasnick, a biochemist, and Charles Geshekter, a professor of African history at California State University, Chico, as the president was considering strategies to combat the virus, which has infected 12.9 percent of the nation's adults. He plans to convene international AIDS experts later this year, and telephoned the scientists to assess various AIDS treatments and to reappraise the evidence that concludes that H.I.V. causes AIDS.
"The president speaks to all scientists and to everyone who believes he's got something to contribute," said Parks Mankahlana, the president's spokesman. "Until all the questions that keep cropping up are answered, we are not going to be able to say to a person who disagrees with the conventional thinking, 'You are wrong or right.' Mbeki has never said H.I.V. doesn't lead to AIDS," Mr. Mankahlana said.
Mr. Rasnick argues that H.I.V. does not cause AIDS, a view shared by Peter Duesburg, a professor of biochemistry and molecular biology at the University of California at Berkeley. The United Nations AIDS program, the World Health Organization and most scientists say the causal link between H.I.V. and AIDS is already well established.
"At first, we were thinking we would just ignore it, but now we think this confusion can really undermine all the efforts people have made to prevent this disease," Dr. Awa Coll-Seck, the director of the United Nations' Department of Aids Policy in Geneva, said in a telephone interview of Mr. Mbeki's move.
"People will reassure themselves, perhaps, that they can continue risky behavior because H.I.V. is not the real cause of AIDS," Dr. Coll-Seck said. "It's becoming a real issue."
Earlier this month, government officials scrambled to explain how $6.2 million of the country's $17 million AIDS budget went unspent last year. They said the money would be rolled over into next year's budget.
And five months ago, Mr. Mbeki stunned health experts by questioning the safety of the standard anti-AIDS drug AZT. This week, Health Minister Manto Tshabalala-Msimang said the government had decided the drug should not be distributed in public hospitals.
"There is not enough information for me as the minister of health to expose women to a drug that we do not know about," Ms.
Concerns about AZT, particularly for children, have been raised in the United States. One study found that pregnant mice treated with AZT gave birth to babies with tumors. But after reviewing the mouse study and others like it, the National Institutes of Health determined in 1997 that the benefits of the drug far outweighed the potential side effects.
One two-year study found that a short course of AZT treatment for women who did not breast-feed their babies reduced transmission of the virus by 50 percent.
But Mr. Mankahlana says South Africa cannot afford to accept the West's conventional wisdom about AIDS without investigating carefully since Western scientists have yet to discover a cure for the disease.
"The fact of the matter is, there is so much that is still unknown about H.I.V. and AIDS," said Mr. Mankahlana, who added that the government would spend an additional $11 million this year on research.
Mr. Rasnick said he received a telephone call from Mr. Mbeki after he replied to faxed questions from the president about AIDS. Mr. Rasnick and his colleagues say AIDS is typically caused by recreational drug use and malnutrition.
Prominent scientists say this thesis, which is most prominently advanced by Mr. Duesberg, relies mostly on the data of other scientists and that those scientists disagree with this interpretation of their work. But on Jan.21, Mr. Mbeki called Mr. Rasnick directly, to hear for himself.
"He wanted our views, and we gave them to him," said Mr. Rasnick in a telephone interview from his home in Saratoga, Calif. "He had read everything we had written, everything that was available on the Internet. He knows there are some serious questions out there."
"I think he's courageous," Mr. Rasnick said. "You start looking like a lunatic if you question the AIDS axioms. Knowing this in advance, he put his neck out there anyway. He wants to have a free and public hearing about all things related to AIDS."