Global AIDS Talks Sidetracked
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Science taking backseat to politics

By Laurie Garrett

Hoosen Coovadia, Mark Wainberg and Peter Piot are anxious, unhappy men these days, losing sleep and pacing nervously as they watch years of AIDS work slipping through their fingers. They fear their efforts will mutate into a major international fiasco.

For the past five years, their immodest goal has been to stage the 13th biannual International AIDS Conference -- the millennial gathering of 16,000 of the world's AIDS scientists and physicians in Durban, South Africa. The conference, sponsored by the International AIDS Societies and the UNAIDS Programme, has consistently set the agenda and tone of AIDS research and treatment.

Significantly, this is the first time a scientific meeting of such scale has convened in sub-Saharan Africa, where HIV rates are among the world's highest. The conference is intended to put scientists, most of whom work in North America, western Europe or Japan, in the middle of a developing country in which 13 percent of the population is HIV-positive and, in some areas, 40 percent of adults are infected.

Now, as the July meeting nears, a political maelstrom coupled with growing scientific disinterest in the conference threatens to reduce attendance from levels of previous conferences -- a scene that could leave Africa and other poor, AIDS-plagued regions of the world bitter.

The Durban meeting has become a political lightning rod for many: dissidents who believe that HIV is a harmless virus; African political leaders who are angry about the concentration of wealth and science in the Northern Hemisphere; activists who want multinational pharmaceutical companies to bring down prices on AIDS-related drugs; and even protesters who share the anti-World Bank sentiments expressed last week in Washington.

The biannual conference has routinely been highly politicized. And in recent years many laboratory scientists have shunned it, preferring to attend quieter scientific gatherings convened primarily in the United States.

"In choosing Durban, we understood that we would be setting into motion a chain of events that we would not be able to control," Canadian HIV scientist Wainberg, president of the International AIDS Societies, acknowledged. But he said organizers had not envisioned demonstrations staged by an array of political groups, tension with the host country's government and a debate seen as imperiling global cooperative efforts to combat AIDS.

"Globally, this event has to succeed to demonstrate that developing countries can host such a massive event," said Coovadia, the conference chairman.

But as a global sense of political urgency about AIDS has risen in recent weeks -- the World Bank pronounced the AIDS pandemic its "No. 1 priority," and the United Nations Security Council declared Africa's HIV epidemic a "global security issue" -- so have a host of protests. In South Africa, President Thabo Mbeki expressed doubts about whether HIV is, indeed, a harmful virus, even whether AIDS is a bona fide epidemic. He recently wrote to President Bill Clinton, denouncing the "campaign of intellectual intimidation and terrorism" he said was being waged against the dissident view.

South African Deputy President Jacob Zuma expanded on Mbeki's remarks this week, singling out the group ACT UP-San Francisco for praise and comparing its belief that HIV is harmless to Galileo's 17th-Century crusade to prove that the Earth rotates around the sun.

Emboldened by such attention, ACT UP-San Francisco and other dissident groups have stepped up attacks on mainstream AIDS organizations; earlier this week they disrupted a meeting there on HIV drug research developments. ACT UP-San Francisco has vowed to attack drug company representatives who, the group claims, are selling toxic HIV drug cocktails.

In response, the drug industry has scaled back its plans for Durban. Glaxo Wellcome has canceled its customary conference briefing on AIDS drugs. Other drug companies have reduced the numbers of scientists they plan to send.

The South African Congress of Trade Unions earlier this month announced it will turn the meeting "into another Seattle," referring to the riots that broke out in that city in December in protest of the World Trade Organization meeting. The unions' targets are also the drug companies, which, they say, are unfairly pricing their products at unaffordable levels.

Several months ago scientists in the United States and Europe circulated an Internet call to boycott the Durban meeting, to protest the Mbeki government's decision not to provide the drugs AZT or nevirapine to pregnant HIV-positive women in order to prevent viral infection of their babies. Cost was not an issue -- Glaxo reduced the AZT price to South Africa by 75 percent, and humanitarian groups offered the country free nevirapine. That unofficial boycott has broadened in response to Mbeki's recent statements.

The biannual conference has produced significant events. In 1994 in Yokohama, physicians reported that patients were dying despite the then-available drugs. That spurred a vigorous research effort, and at the 1996 conference in Vancouver, British Columbia, it was announced that cocktails of old and new anti-HIV drugs could prolong lives and possibly eradicate the virus.

Two years ago, the Geneva meeting took a sober shift, with physicians reporting that the miracle drugs touted in Vancouver were more dangerous than previously thought. Further, scientists acknowledged that the new drugs were not eradicating HIV from patients' bodies. Research shifted to a search for a vaccine and ways to improve the treatment cocktails or boost patients' immune responses.

Scientifically, then, the Durban gathering was shaping up to be a pragmatic, but grim, affair. This week, for example, European researchers reported in The Lancet that the first round of anti-AIDS cocktails is not succeeding in half of all HIV patients in Europe, and for those on their third round, the failure rate is 80 percent.

Coovadia, Wainberg and Piot agree that recent developments have put science distinctly in the back seat at Durban.

"We've been pushing to move AIDS into the political arena and now, here we are," Piot, director of the United Nations AIDS Programme, based in Geneva, said in an interview. "Now how do we translate this into something useful?" "We are equally angry," Coovadia said, noting that "no one in South Africa has been more vocal about opposition to the government's position than the organizers of this meeting ... This will amount to a boycott of fellow scientists and not the government." Coovadia hasn't released details on conference registration, but sources close to the meeting say the numbers of scientists and physicians enrolled are far below those at this point two years ago.

A telephone and e-mail survey of dozens of scientists who attended previous conferences found that, except for those scheduled to give speeches, they do not plan to attend. Most said it was too costly and time-consuming to travel to South Africa, particularly given the likelihood that political protest would overwhelm the science.

"If scientists in the U.S. and Europe cannot inconvenience themselves, however trivially given the first-rate infrastructure in South Africa, then it seems to me we will establish and consolidate two cultures," Coovadia said.

"Science for the rich, and science for the poor."

Auch das "Wissenschafts"magazin "Nature" hat sich mit Mbekis Forderungen auseinandergesetzt, und kommt natürlich zu einem vernichtenden Urteil. Den nachfolgenden Artikel sollte daher nur lesen, wer eine geballte Ladung Pseudowissenschaft ertragen kann. Zur Krönung dann noch (anschließend) ein Brief von "Nature" an Mbeki, den dieser hoffentlich als aufgeblasene Scheinheiligkeit durchschaut.

Nature, 27 April 2000, Volume 404, Page 911
Letter fuels South Africa's AIDS furore
MICHAEL CHERRY

International controversy over the South African president Thabo Mbeki's views on the nature of AIDS deepened last week, when the text of an outspoken letter sent earlier this month to US President Bill Clinton, UN secretary-general Kofi Annan and the heads of state of Germany, France and the United Kingdom became public.

In the letter, Mbeki gives the strongest evidence yet of his sympathies for those who argue that AIDS may not be caused by HIV.

Ironically, earlier in the week James Wolfensohn, president of the World Bank, had promised that there would be "no limit" to the funds available for combating AIDS in the developing world. In his statement, delivered during the annual World Bank meeting in Washington, Wolfensohn singled out sub-Saharan Africa as being in particular need.

The publication of the letter coincided with the release of South Africa's AIDS statistics for 1999, which confirm that nearly ten per cent of its population — about 4.2 million people — is infected with HIV.

Mbeki's letter was passed to The Washington Post by a senior US official, following a meeting in Atlanta the previous week between South Africa's health minister Manto Tshabalala-Msimang, its ambassador to the United States, Makate Sisulu, and Sandra Thurman, director of the White House office of national AIDS policy.

In the letter, Mbeki states that he is "convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of AIDS in the West."

Referring to 'dissident' AIDS researchers who believe that HIV does not cause AIDS, he continues: "The scientists we are supposed to put into scientific quarantine include Nobel prizewinners, members of academies of science and emeritus professors of various disciplines of medicine!"

In the South African parliament last Wednesday, Jacob Zuma, deputy president and chairman of the National AIDS Council, denied that Mbeki had at any stage said that he challenges the view that HIV causes AIDS or the contrary.

"During the last decade and a half and more, a heated debate amongst scientists and others relating to this question, has been going on," said Zuma. Rallying to the president's position, he continued: "We should not, and we will not, leave any stone unturned, even if this means including the views of the so-called 'dissidents'."

Zuma said that an international panel being set up by the South African government to advise on an appropriate national policy on AIDS included "all points of view in the debate and is constituted of the most eminent world scientists who can help to ensure that we understand HIV/AIDS correctly and therefore respond to it correctly".

But the decision to set up the panel, and the way it is being done, has itself come under criticism. Although the panel is due to meet for the first time in South Africa next week, its members have not yet been announced. Two medical researchers, both linked to the dissident movement, are the only people who have confirmed their participation.

One is Gordon Stewart, professor emeritus of public health at the University of Glasgow, who became well known in the 1970s for his opposition to whooping-cough vaccine. The other is Sam Mhlongo, professor of family health at the Medical University of South Africa, north of Pretoria.

In 1997, Stewart co-authored an article with Eleni Papadopulos-Eleopulos of the Royal Perth Hospital, Australia, and other 'dissidents' in the journal Current Medical Research and Opinion. A later article in the same journal by Papadopulos-Eleopulos and others on the pharmacology of AZT, which claimed that the drug was unacceptably toxic, appeared to be a major influence in Mbeki's refusal to sanction state provision of this drug to prevent mother-to-child transmission of HIV (see Nature 402, 3; 1999).

During the debate in parliament last week, Mike Ellis, a member of the Democratic Party, said that Mbeki seemed so defensive about AIDS that he was placing sound judgement and rational thinking at risk. Kobus Gous, health spokesman for the New National Party, accused the president, through his contact with the dissidents, of having "given a podium to discredited scientists, false hope to AIDS sufferers and created doubt in the public mind".

But support for Mbeki's stance came from an unusual quarter when the right-wing Boerestaat Party applauded the president's efforts to "investigate the biggest hoax in the twentieth century".
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Nature, 27 April 2000, Volume 404

Dear Mr Mbeki ...

An open letter to the president of South Africa.

We are writing in response to your recent letter to world leaders, including US president Bill Clinton and United Nations secretary general Kofi Annan, expressing your concern about the horrific situation that your country faces over the spread of AIDS, and your desire to see the situation approached in the most rigorously scientific way possible (see page 911). We share this goal; AIDS will not be defeated or contained without access to the best treatment that modern science has to offer. But we are also concerned that, in your admirable enthusiasm to ensure that a wide spectrum of scientific views is heard, you appear tempted to give greater weight to some voices than the scientific process justifies.

No one who has been impressed by your success in what many claimed impossible the peaceful transition to democracy in South Africa following the long struggle against the iniquities of apartheid will reject the argument that there are times when the voice of those challenging the existing order must be heard. Your own colleagues have referred to the astronomer Galileo in this context. But this does not mean that all dissidents and 'heretics' can claim equal legitimacy merely on the basis of their persecution; democratically endorsed procedures exist through which their ideas can be put to the test, and viable heresies separated from those that, after close scrutiny, deserve to be placed aside.

Politics has developed one set of such procedures: the ballot box, parliamentary debate and constitutional law. Science has developed its own, very different, set. Contrary to the impression given by your letter, science thrives on the ideas of heretics. But heretical hypotheses only become widely accepted in science if they prove useful and effective in understanding and interacting with the natural world. The peer-review system is little more than a way of speeding up the process of sorting out those ideas which have a greater chance than others of surviving intellectual scrutiny and testing through experiment.

One hypothesis that has survived this process is that the idea that there is a direct, causal relationship between infection with the human immunodeficiency virus (HIV) and the onset of AIDS. We are well aware of the arguments of those who challenge such a direct relationship. Our columns have been and remain open to anyone offering evidence to the contrary, but on one simple condition: that their evidence passes the same rigorous tests of scientific robustness that are applied to any scientific paper that we receive. So far this has not happened. Those who have experienced rejection may choose to castigate this as 'censorship', but the vast majority of authors of the scientific papers that we reject on technical grounds accept the process as valid and necessary for the health of science.

You yourself admit in your letter to President Clinton and the other world leaders that your comments about the treatment being given to heretical ideas on the nature of AIDS may be "extravagant"; you justify this on the grounds that in the recent past you have had, in your own words, "to fix our eyes on the very face of tyranny". But as Koïchiro Matsuura, the new head of Unesco, said at a meeting in Nigeria this week: "Without a scientific capacity of its own, Africa will not be able to tackle and overcome its endemic diseases".

Mr Mbeki, we ask you, in the spirit of Matsuura's comment, not to ignore the advice of your own leading scientific and medical experts, nor to reject those aspects of science that offer your country the greatest hope for the future. A respect for vigorous scientific debate is one of these aspects that we endorse. Giving excessive credence to populist hypotheses that fly in the face of established evidence and fail to survive rigorous peer review is not.

Makgoba meint, Mbeki würde sein Verhalten später bereuen (?):

Science, April 28, 2000

SOUTH AFRICA:
AIDS Researchers Decry Mbeki's Views on HIV

Jon Cohen

Most governments that face a serious AIDS epidemic have taken a long time to acknowledge the fact. In South Africa, one of the hardest hit countries in the world, this pattern has a bizarre twist: President Thabo Mbeki has acknowledged that his country has an AIDS epidemic, but he has questioned whether HIV is to blame.

Not only is Mbeki publicly flirting with scientifically discredited ideas about the cause of AIDS, but a leading skeptic of HIV's role in the disease has been invited to serve on a panel to discuss how South Africa should deal with the crisis. These moves are drawing international attention--and increasingly sharp attacks from AIDS researchers inside and outside South Africa, where the virus has infected one out of every 10 adults.

Mbeki's questioning of the scientific evidence that HIV causes AIDS became front-page news around the world last week when The Washington Post revealed that he recently sent a letter about his views to President Bill Clinton, other heads of state, and U.N. Secretary Kofi Annan. In the letter, Mbeki decries the "orchestrated campaign of condemnation" that has been directed at him for seeking out the views of so-called AIDS "dissidents," such as the University of California, Berkeley's, Peter Duesberg, who in 1987 began challenging the widely accepted scientific conclusion that HIV causes AIDS (Science, 9 December 1994, p. 1642). "We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited," wrote Mbeki in his 3 April letter. "The day may not be far off when we will, once again, see books burnt and their authors immolated by fire by those who believe that they have a duty to conduct a holy crusade against the infidels."

"I think the letter was emotional and irrational," says Malegapuru William Makgoba, an Oxford-trained immunologist who in July became the first black head of South Africa's Medical Research Council. "This man will regret this in his later years. He displays things he doesn't understand."

Makgoba says Mbeki told him and others earlier this year that he became intrigued by the dissidents' views after reading about them on the Internet. In January, Makgoba says Mbeki sent him about 1500 pages of documents that question the so-called "HIV/AIDS hypothesis." "It's pure rubbish," says Makgoba. "They never provided any data and, at the same time, they are taking things out of context." He told Mbeki as much in a letter that also offered detailed counterarguments. "His credibility as an African leader may suffer from this," says Makgoba, who recently edited a book called African Renaissance, which has an introduction written by Mbeki.

Parks Mankahlana, Mbeki's spokesperson, stresses that Mbeki has never said that he does not believe that HIV causes AIDS. "We've gone through all of his speeches," says Mankahlana, who points out that Mbeki has increased support for AIDS research, encourages the use of condoms, and always wears an AIDS ribbon on his lapel. Mbeki, says Mankahlana, is simply exploring a range of views on the role that HIV plays in the disease. "The problem that the scientific world has is this: It has to do with human arrogance."

The dissidents' views are expected to be included in a panel of about 30 AIDS "experts" that South Africa's Department of Health is convening to discuss how to address the country's epidemic. Duesberg says he has been invited and may well attend the panel's meeting next month. "I think after this letter, I have to go," says Duesberg. "It's getting hot again, just like in the old days, thanks to Mbeki. I'm surprised that there's a place left on this planet where you can ask commonsensical questions."

In part because of Mbeki's stance, some AIDS researchers have threatened to boycott the international AIDS conference scheduled to be held in Durban this July. But Salim Abdool Karim, a leading South African AIDS researcher who chairs the scientific committee for the meeting, says he does not expect Mbeki's views to depress attendance. "In fact, it has encouraged some people to say, 'I will attend the conference,' " Karim says. Karim, who conspicuously was not invited to sit on the health department's panel, hopes Mbeki will quickly declare that he believes HIV causes AIDS. "This should be resolved urgently, rather than making it an international issue," says Karim.