Mbeki’s AIDS Panel Issues Report, Remains Divided on Cause, Treatment

The AIDS panel created by South African President Thabo Mbeki last year to examine the HIV/AIDS epidemic issued a "sharply divided" 134-page report yesterday, with panel members failing to reach consensus on such issues as the causal link between HIV and AIDS and the benefits of antiretroviral therapy, the AP/Philadelphia Inquirer reports (Cohen, AP/Philadelphia Inquirer, 4/5). The London Guardian reports that the panel was composed of a variety of international scientists, including "mainstream" scientists who believe that HIV is the cause of AIDS and "dissident[s]" who state that AIDS "is the result of social factors" such as drug use, malnutrition and poverty. Among the panel members were the "controversial" American scientists Peter Duesberg and David Rasnick, both of whom are "at the forefront of the AIDS dissident movement." Also on the committee was Luc Montagnier, co-discoverer of HIV (McGreal, Guardian, 4/5).

Disagreements
Panel discussions over AIDS issues such as antiretroviral treatment, HIV testing and the link between HIV and AIDS were "wracked with disagreements" between the two groups of scientists, the AP/Philadelphia Inquirer reports. The dissident group of scientists called for the suspension of all HIV testing and said that antiretroviral drugs should "no longer be prescribed" (AP/Philadelphia Inquirer, 4/5). They also recommended that the government and other groups take steps to "end the 'hysteria'" surrounding AIDS by suspending "the dissemination of the psychologically destructive and false message that HIV infection is invariably fatal" (Guardian, 4/5). In addition, the dissidents stated that the government should devote its resources to wiping out malaria, tuberculosis and other "prominent AIDS defining diseases." The mainstream scientists, however, recommended HIV testing, the use of antiretroviral drugs and sex education as essential components of a comprehensive AIDS strategy (AP/Philadelphia Inquirer, 4/5).

Report Conclusions
South African Health Minister Dr. Manto Tshabalala-Msimang issued an interim report yesterday outlining the panel's findings. She said that in light of the report, the government does not plan to change its "basic approach" to fighting AIDS (Agence France-Presse, 4/5). In a report summary, Tshabalala-Mismang stated, "Pending the outcome of further research, the debates of the panel have not provided grounds for [the] government to depart from its current approach to the HIV/AIDS problem, which is rooted in the premise that HIV causes AIDS." The panel's conclusions included:

• Social Factors: The panel weighed the "signficant impact of developmental issues," such as poverty, literacy, gender relations and nutrition, "in a much more far-reaching way than hitherto," the summary states. The panel "concurred" that "factors like malnutrition and the presence of other infectious diseases ... impacted on the progression of HIV/AIDS." While the panel did not agree on whether intervening to prevent these factors was a "sufficient response" to HIV/AIDS, they recommended "vigorou[s]" management of them.
• Surveillance and Data Collection: Panel members "generally agreed" that "a robust system for collecting data was essential to understand and manage the epidemic."
• Prevention: Panelists reached a "surface agreement" on several "useful interventions," including information, education and life skills programs, condom promotion, effective treatment of STDs, "good management of TB and communicable diseases" and "interventions to relieve poverty and improve quality of life."
• Antiretroviral Treatment: Panelists held "sharply divergent" views on this subject, with dissidents stating that AIDS drugs are "totally unjustifiable" ( Report summary, 4/4). The dissident scientists stated, "These drugs inevitably require significant amounts of compensatory medicine and are claimed to produce, at best, only short term benefits in seriously sick patients" (AP/Las Vegas Sun, 4/4). Dissidents instead urged staving off AIDS through body massages and detoxification therapies, yoga, music therapy and the use of herbal supplements such as ginseng, Chinese cucumber, aloe vera and echinacea (AP/Philadelphia Inquirer, 4/5). Mainstream scientists disagreed, however, stating that "more research is needed" to determine correct administration of AIDS drugs. "Given the demonstrated benefits of antiretroviral drugs in the treatment of HIV/AIDS, the usage of that accumulated knowledge to the benefit of South Africans living with HIV infection was critical," they stated (AP/Las Vegas Sun, 4/4). Some panelists "cautioned" against dispensing antiretrovirals "in the absence of effective monitoring systems" and others recommended drug therapy for use in preventing vertical transmission.
• Future Research: Panelists found a "critical need" for research on social and behavioral factors affecting the virus, including an investigation of "risk-taking and health-seeking" behaviors. In addition, panel members recommended investigating the "stark contrast" between the patterns of AIDS in the developed world and Africa, and how "genetic factors" could play a role in these differences (Report summary, 4/4).

Reaction
The Guardian reports that the scientists' "lack of consensus ... neither embarrasses Mbeki by concluding he was wrong to question the cause of AIDS, nor does it say he was right when his government quietly reversed its original policy" (Guardian, 4/5). However, some AIDS activists have disagreed with some of the report's findings and Mbeki's views. Judge Edwin Cameron, "[o]ne of South Africa's most prominent carriers of the AIDS virus" and a "vociferous critic" of Mbeki's views on AIDS, said that it was "demeaning, insulting and disempowering" for panel scientists to recommend "denying" antiretroviral drugs to South Africans "on the basis that African health services are poor." Cameron criticized "proponents of First World privilege" for "suggest[ing]" that "in view of lack of infrastructure, lower prices (of pharmaceuticals) will, in any case, make no difference in Africa and the poor world" (Smith, London Independent, 4/5). One of the country's "leading" AIDS researchers, however, said that it was "important" that one of the report's main effects was a consensus by the government that HIV causes AIDS. "If that is so, I have a sense of relief and delight, and a sense of hope that at last that part of the problem is over," Hoosen Coovadia, a professor at the Nelson Mandela School of Medicine at the University of Natal, said (Agence France-Presse, 4/5). To read a summary of the report, go to http://www.polity.org.za/govdocs/pr/2001/pr0404d.html.