Aids letter ill-informed and inopportune, say top researchers

Husband and wife Salim and Quarraisha Abdool Karim are at the forefront of research to find an HIV/Aids vaccine and based at the Centre for the Aids Programme of Research in SA. They respond to the former president

ALMOST 16 years ago, in July 2000, President Mbeki shocked the world at the opening of the 13th International Aids conference in Durban with his dissident views on Aids in the midst of a country ravaged by the HIV epidemic.

Those attending the conference rose to the challenge and scaled-up their advocacy for global access to life-saving antiretroviral medications.

Activists, health care workers, scientists and students at the conference organised and hosted several Aids-related activities, including marches, concerts, prayer evenings, panel discussions, petitions, declarations and candlelighting ceremonies at venues across the city. Durban was abuzz, reverberating with the clarion call for affordable Aids treatment from every quarter.

Then Minister of Health, Manto Tshabalala-Msimang was, however, an exception. She sat glumly in the conference, irritated that nutrition, garlic, lemons and potatoes were not being promoted with similar enthusiasm as antiretroviral drugs.

At the conference’s closing ceremony, former President Nelson Mandela captured this spirit in his ovation-studded presentation, galvanising the attendees to rise even further to the challenge of affordable access to Aids medication.

In about a hundred days from now, in July, the International Aids Conference will again be hosted in Durban, this time in the midst of a truly impressive South African Aids response. And Mbeki is back. This time, he is peddling his unique brand of “I am still right after 16 years” Aids denialism through the online publication of a letter this week titled, “A brief commentary on the question of HIV and Aids.”

Mbeki’s letter, published online on March 7 summarises his views on Aids and confirms that he remains firmly an Aids dissident.

The letter also confirms a longheld suspicion that he authored the document titled, “Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics”, a report on Aids that is as incoherent as its title.

In the letter, Mbeki meticulously ensures he does not say that “HIV does cause Aids”, instead he claims that he did not say that “HIV does not cause Aids”.

He rationalises this with the belief that “a virus cannot cause a syndrome”.

With this argument he is simply ill-informed and/or deliberately attempting to obfuscate the facts. The fact is that viruses can and do cause syndromes.

Chickenpox virus causes Ramsay Hunt syndrome, an ear canal rash with facial neuropathy. “Slapped cheek syndrome”, which is a red rash on the cheeks of children, is caused by Parvo-virus 19.

In Aids, a range of clinical features emanating from some cancers, certain types of pneumonias, TB and other opportunistic diseases is collectively referred to as a syndrome, and this syndrome is caused by a virus known as HIV.

Mbeki claims there is no explanation for the differences in the HIV epidemic progression with gay men in the US/Europe compared to the rapid spread in the general heterosexual population in Africa.

This was explained at the Mbeki Presidential Aids Panel. Genetic sequencing shows that the HIV epidemic in gay men, both in Africa and in the US/Europe, is mainly due to subtype B of the virus while a different subtype (subtype C) predominates in the heterosexual population in Africa.

Socio-behavioural and viral genetic studies indicate that a major contributor to the rapid spread of HIV in the general heterosexual population in southern Africa is the region’s colonial heritage and mining that affected stable family life to support migrant labour.

In the letter, Mbeki aligns himself with Luc Montagnier’s belief that a good immune system, emanating from good nutrition, can cure a person of their HIV infection. This belief has no factual basis – it is simply wrong. Despite extensive research on immunity against HIV, not one person has been cured of HIV infection naturally or with drug treatments. There is no cure for Aids.

He quotes a 2006 Stats SA report that Aids is the ninth most common cause of death in South Africa, questioning why everyone is making a fuss about the ninth cause and not about the first cause, which is TB.

His reliance on death certificates to accurately reflect all the causes of death ignores the well-known problem of the underreporting of stigmatising diseases on death certificates.

The latest World Health Organisation figures from 2013 confirm TB and HIV as the number one and two causes of death in South Africa.

Since TB is the main cause of death in patients with HIV, with 70 percent of TB cases in South Africa associated with HIV, the most important cause of death is, in fact, HIV.

However, deaths due to HIV are now starting to decrease with the scale-up of antiretroviral therapy, despite the initial delays during the Mbeki administration.

Finally, he argues that those promoting HIV as the cause of Aids do so to support drugcompany profiteering through sales of antiretroviral drugs. However, much of the scientific evidence on HIV causing Aids comes from researchers, locally and abroad, who are themselves against the profiteering by drug companies from the plight of the poor.

Mbeki’s conspiracy theory insults all treatment advocates and people living with HIV, who in the interests of their communities, family members and friends challenged drug companies to make Aids medication affordable, in some instances compromising their own survival.

Fortunately, Mbeki’s widely discredited views will probably have little or no impact on South Africa’s Aids response.

His views are likely to fall on deaf ears as South Africa has moved on since 2000 and is looking forward to hosting the International Aids Conference in Durban.