Suspend All HIV Testing - Mbeki Expert Panel
New African September 2000
Suspend All HIV Testing Mbeki Expert Panel Recommends
By Huw Christie
Eminent world scientists from both sides of the AIDS debate have been mandated by the Mbeki AIDS panel to undertake historic experiments to attempt to purify, or isolate, the HIV virus; and also examine the current HIV testing methodologies. In the meantime, the panel wants all HIV testing to be suspended. "It's a worthless distraction," says one panel member. Huw Christie reports from Johannesburg.
Amidst scientific debate and political revelations, senior members of the South African Presidential Panel of Inquiry into HIV/AIDS have called for the suspension of all HIV testing. The full panel of some 33 scientists convened for the second and final time in Johannesburg on 3-4 July, at the large Crowne Court Hotel in upmarket Sandton, in the attentive presence of South African minister of health Manto Tshabalala-Msimang (a medical doctor herself).
During sometimes turbulent proceedings, Dr. Valendar Turner on behalf of the Perth Group of scientists in Western Australia, Prof. Sam Mhlongo, head of Family Medicine and Primary Care at the Medical University of South Africa, and Dr. David Rasnick of UCLA, California, amongst others, appealed for the cessation of HIV testing.
The Perth Group and Prof. Mhlongo stressed that the accuracy of all HIV tests is so questionable, there is no cause for continuing to use them unless their specificity can be determined.
They say there are too many common African illnesses which create "false positive" results on HIV tests, and that no HIV test has ever been validated against the one necessary scientific "gold standard" -- virus isolation. This reality is recognised by the manufacturers of such tests who typically warn: "At present there is no recognised standard for establishing the presence or absence of antibodies to HIV-1 and HIV-2 in human blood." (Axsym System, Abbott Laboratories.)
Dr. Rasnick stressed that since there was no proof of an HIV causing AIDS, testing for it was, in his view, a worthless distraction. He also disputed the use of the term AIDS at all, in a continent where the presenting illnesses of people diagnosed with AIDS are all long-known conditions, usually associated with malnutrition and other consequences of poverty.
By the end of the two-day session, a smaller working group of HIV testing had been structured which will now continue through at least Christmas to report, in President Mbeki's words, on "the reliability of, and the information communicated by, our current HIV tests and the improvement of our disease surveillance system."
The working party -- led by Prof. Mhlongo, and including Australian biophysicist Eleni Eleopulos and her colleague Dr. Valendar Turner, Dr. Harvey Bialy, with Dr. Helene Gayle of the U.S. Centers for Disease Control, and Prof. William Makgoba of the South African Medical Research Council and other panelists willing to continue working -- has accepted responsibility for historic experiments to attempt to purify, or isolate, HIV, and to examine the consequential issue of the accuracy of all so-called HIV testing methodologies.
Virus isolation is the thorn in the foot of the HIV/AIDS marching machine -- it has never been achieved by conventional standards. Until the mid-1970s, virus isolation used to mean separating virus particles from everything in the cell culture that is not virus, and producing an electromicrograph of the resulting purified particles. It is then not very difficult for virologists to analyse the particles' proteins and genetic material, and to test for infectivity.
It is a careful process, however, because all experts agree that there are abundant particles in nature and in cell cultures that in many respects resemble viruses but are not. Only once these steps are successfully completed can any other tests be evaluated for accuracy.
Government confidential website
The two-day meeting had begun on a sharp note. The South African health minister, Manto Tshabalala-Msimang, in her opening address noted that the six weeks since the first meeting in Pretoria had seen little exchange between the panelists of differing scientific and medical views via the confidential South African government website established for the purpose.
Noting that some scientists had nonetheless made extensive contributions, which had mostly gone unanswered, Tshabalala-Msimang commented that those who had worked tirelessly "will not be betrayed." The scientific website contributions of Eleni Eleopulos' Perth Group, of Dr. Roberto Giraldo, of Prof. Etiennne de Harven and Prof. Gordon Stewart, and various other "AIDS dissidents" were implied. Plans were announced to make the contents of the web discourses public in due course.
The Panel Secretariat of four civil servants, thrust into the uncharted job of coordinating the workings of the Panel and preparing the report for President Mbeki, was therefore faced with the necessity to stimulate debate in a way which had not occurred so far.
The structure favoured by the Secretariat and implemented by the Canadian, Prof. Owen (again the moderator), allowed for representatives of opposing views to speak for half an hour about their views and data, including on-screen visual material around the issues set down by the Secretariat: (1) aetiology, (2) prevention, (3) treatment, and (4) HIV testing and surveillance.
Who sayeth what
Following each presentation, there would be approximately half an hour allowed for two-minute comments on the presentation from other panelists. To begin, a young South African virologist, Dr. Carolyn Williamson, replaced the South African professor, Hoosen Coovadia, chairman of the Durban AIDS Conference. Williamson opened the proceedings with a standard explanation of the HIV-causes-AIDS theory, without proofs, and distinguished mostly by the puzzling claim that in AIDS "the cause is neither necessary nor sufficient" for the illness.
She appeared at a loss to defend this statement against the question, "How then, is it the cause?", except to say she had been instructed to include the statement. Such are the unfathomable pressures on ambitious young South African scientists, though surely she must have misunderstood the statement.
Prof. Peter Duesberg next reiterated his condemnation of pharmaceutical "anti-HIV" drugs, asserting that in many cases these drugs themselves were responsible for illnesses diagnosed as AIDS.
Dr. Roberto Giraldo, the specialist in infectious diseases from New York, covered several aspects in his presentation, including the invalidity of HIV tests, and the range of stresses that can undermine a person's immune system, such as malnutrition and toxins amongst others. He included in his suggestions for treatment the use of anti-oxidants, a point well noted by the South African health minister, and touched on the role of traditional medicine in African cultures.
Next, Prof. Salim Abdool-Karim, principal AIDS researcher of South Africa's Medical Research Council, stressed his belief that the clinical picture of illness in South Africa had indeed changed in recent years. Dr. Joseph Sonnabend, an AIDS clinician from New York, appeared satisfied with conventional AIDS drugs and clinical practice, though he was heard earlier privately resisting pressure from some senior orthodox scientists to begin his presentation with a sound endorsement of the Highly Active Anti-Retroviral Therapy (HAART) drug combinations.
Dr. David Rasnick, an expert in protease inhibitor design, presented a panorama of the scientific literature from major journals discrediting these "anti-HIV" drugs. It seemed many of the conventional scientists in the room had not seen these data before. Later in the day, Dr. Valendar Turner of the Perth Group, whose Eleni Eleopulos has done so much over the years to keep the questions in HIV/AIDS focused on scientific matters, discussed perhaps the key question, which will now be carried forward: When even Prof. Luc Montagnier, accredited as discoverer of HIV, acknowledges his team was never able to isolate "the virus", why has the presence of such a virus been so universally accepted?
Turner showed a slide of a Western Blot antibody test gel -- the type of test believed throughout most of the world to be the best for HIV -- which by the strictest criteria anywhere would be positive for HIV, before revealing it was in fact positive for leprosy.
Dr. Helene Gayle of the U.S. Centers for Disease Control, who supervises the disbursement of billions of AIDS dollars, appeared to have little new to bring to the Panel, but managed to fill her time with slides of black text and statistics on a navy blue background, which this observer was not alone in finding difficult to decipher.
The second day
On the second day, Prof. William Makgoba, currently head of the South African Medical Research Council, took the floor to present epidemiological data on HIV in South Africa. He was unable, when repeatedly questioned, to give figures for actual AIDS deaths in South Africa, instead showing graphs of projected percentages of national annual mortality that could be attributed to AIDS.
He also insisted that the ELISA antibody testing methodology used in South Africa was in line with British standards, resulting in a "false positivity" rate of 0.1%. He made no attempt to address the absence of any gold standard for "true positivity." Next the Panel heard from Dr. Harvey Bialy on the progress made towards designing the experiments that had been hastily foreshadowed at the press conference at the conclusion of the first meeting six weeks before, which it was hoped would settle some of the areas of scientific disagreement.
Shortly into his improvised presentation, a loud disagreement flared up from opposite sides of the room between Prof. Peter Duesberg and Dr. Helene Gayle, ostensibly over some comments about AZT, which saw Duesberg leave the conference hall, pursued by Tshabalala-Msimang who spent tense minutes persuading him to return in the interest of the many people whose lives would be influenced by the successful working of the Panel.
However, thereafter Duesberg absented himself from the working group on experiments, at much the same time that Eleni Eleopulos, who had not been at the Pretoria meeting, became one of its most active members. Indications are that Duesberg continues to be willing to participate as the process moves forward. The Panel split into working groups next, to try to deliver recommendations to the anxious Secretariat that they could use in preparation of their report. The group on experiments confirmed it intention to "test the tests"; there was also a set of conventional recommendations produced from the working group around treatment, and that around "co-factors."
Mbeki, the whipping boy
President Thabo Mbeki has become the liberal media's whipping boy for seeking advice about how applicable to South Africa the received Western wisdoms about HIV/AIDS are.
Scientific journals were asserting in the mid-1980s that HIV was not epidemic in South Africa. Now it is said to be everywhere you look. Mbeki has publicly asked how this can be so. What will the answers mean for policy? And why are these statistics showing AIDS in men and women almost equally? If this is heterosexually spread, why did it not happen in the West, where frankly most people do not use condoms?
Why are there no figures for AIDS mortality in South Africa? Real data, not projected estimated. When can these figures be available? Why are the figures for HIV positivity in South Africa extrapolated from testing in ante-natal clinics with an ELISA test about which its manufacturer warns the principal cause of false-positivity is pregnancy?
When none of the 29 illnesses grouped as AIDS is new, what evidence is there that a "new" microbe is involved in the apparent increase of some of these illnesses?
>From the answers to these questions, the Mbeki government seeks to understand whether there are untried approaches to the problems in the country -- principally TB, which is said to account for 60% of the AIDS-projection figures -- which would be affordable and effective.
By Christmas, one of the biggest questions in AIDS science should have it answer, supervised by top international bodies, at the behest of a president not afraid to test convention and go the extra distance to find the truth: is there such a thing as HIV?
Huw Christie is the editor of Continuum magazine at www.continuummagazine.org
AIDS: Judgement day on the 13th
By Pusch Commey
Pusch Commey, reports from Durban, on the good, the bad and the shenanigans at the recent 13th International AIDS Conference held in that city.
Something is killing Africa and the world. What it is, nobody is sure. But for now the medical establishment believes it is HIV.
Based on this premise, 12,400 delegates and over 1,500 journalists congregated at the Durban International Convention Centre for the 13th International AIDS conference (9-14 July) to debate and compare notes on the most insidious scourge in modern times. These were bad times to be a youth. But all was not solidarity.
The run up to the conference itself was characterised by an unrelenting media assault on the person of President Thabo Mbeki. He was variously described as irresponsible, grossly negligent and genocidal. Most thought he had lost his marbles. Columnists suggested that it is perhaps his final solution to the high incidence of poverty and unemployment.
His mortal sin was to have exercised his right to the freedom of expression and enquiry that all Western constitutions hold so dear. He had dared question the unquestionable: the inconclusive theory that AIDS is solely caused by a virus called HIV.
He had dared to threaten the very foundation upon which is built a huge AIDS edifice that feeds on the virus. Pharmaceutical companies, AIDS researchers, the medical establishment, microbiologists, NGOs, entrepreneurs, you name it. And which replicates as fast as the virus itself as sufficient panic is created to force governments and institutions to fork out more and more cash.
The potential catastrophe has been variously described as akin to a nuclear war that will decimate economies and societies, and leave ghost countries or maybe continents in its wake; Africa being the usual suspect.
Durban, the current "epicentre" of the invincible virus, was chosen as the venue of the counter-attack primarily for this reason. So far the body count, according to UNAIDS, is 33 million infected worldwide by the end of 1999, 18 million already dead. Africa's share was 24 million infections.
South Africa reportedly has the highest number of people living with the virus -- 4.2 million. And its neighbour, Botswana, is said to be the worst afflicted, with about 36% of its adult population between the ages of 15 and 49 affected. Delegates echoed a modern day black plague revisited on blacks. They largely blamed African sexuality and gross negligence. It was time to fight back and one huge banner on the highway lamented: "The future is not what it used to be."
Alternative views not welcome
Break the silence was the chosen theme, partly meant to highlight the "criminal negligence" of governments said to have buried their heads in the sand while the epidemic raged. More importantly it was meant to bring the issue of AIDS out into the open.
Ironically, this invitation to transparency did not extend to anybody with a view contrary to the official one -- that "HIV is the sole cause of AIDS." Chairman Mao would have been proud of this huge conspiracy to silence dissenting voices.
Legal threats to President Mbeki and a threatened boycott of the conference by anti-Mbeki elements failed to materialise.
Delegates came from over 200 countries and paid $800 each for the privilege to attend. For the duration of the conference, the official website (www.aids2000.co.za) recorded 1.4 million hits, with promises of a bigger turnout at the next conference in Barcelona, Spain, in 2002.
Before the commencement, an agenda had already been set with the "Durban Declaration"; a scroll-like document in the form of the Ten Commandments tablet signed by 5,000 medical practitioners declaring HIV to be the sole cause of AIDS.
In another manoeuvre, the German drug company, Boehringer Ingelheim, manufacturers of Viramune (also known as Nevirapine) and a major sponsor of the conference, announced without informing the Mbeki government, that it would offer its drug free for five years to prevent South African babies born to HIV-positive mothers being infected.
Preceding that, the South African government had come under intense fire from the press for failing to provide pregnant HIV-positive mothers with drugs that would reduce transmission risks, saying they were too expensive and toxic.
Boehringer's move, the detail of which was uncertain, was cautiously welcomed by UNAIDS. At best, it was a tactical manoeuvre as well as a Greek gift meant to undermine the Mbeki government's position on anti-retroviral drugs.
The big Western drug companies had made major contributions to the sponsorship of the conference and expected returns on their investments. But what drew a lot of interest was the sex workers stand which reported an unprecedented boom in business. As one bystander commented: "The demand for sex has never been known to go down, HIV or no HIV."
Mbeki's speech at the opening ceremony met with a roar of anger. Some delegates walked out. But the president, expected to make penance in front of the drug lords, was unyielding. He stuck to the cornerstone of his presidency which seeks to find African solutions for African problems, only too well aware that self-interest is the only guiding principle in the West's dealings with Africa.
He welcomed the delegates and reminded them: "Perhaps in thinking that your conference will help us to overcome our problems as Africans, we overestimate what the 13th International AIDS Conference can do. Nevertheless that over-estimation must also convey a message to you. That message is that we are a country and a continent driven by hope, and not despair and resignation to a cruel fate."
He stressed that the world could not blame everything on a single virus and that AIDS thrives -- a partner with poverty, suffering, social disadvantage and inequity. And that the greatest cause of ill health and suffering worldwide, including South Africa, was extreme poverty.
In conclusion, he posed the rhetorical question: "Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour?" He wished that they had all come to Africa because they care.
The response from subsequent speakers, wildly cheered, was a highlight of a lack of political will. Then a hapless Nkosi Jonson, a 11-year-old boy living with HIV, was put on stage to sorrowful talk about his plight and plead for the government to give pregnant mothers AZT.
The next morning's headlines were unanimous: "Mbeki fails to break the silence." Then there was the usual media spin to put his speech out of context by reporting that Mbeki says the cause of AIDS is poverty, while the import of his speech for those who cared to apply their minds was simply that conditions of poverty in developing countries, for which the West is a major contributor, has spawned several killer diseases, including AIDS, tuberculosis and malaria.
And that to make any impact, the world must attack the conditions that create poverty. Better hygiene, better education, better nutrition, etc, will go a much longer way to arrest AIDS rather than merely focusing on drugs. Prevention, which was one of the great themes of the conference, would be virtually impossible if the social condition within which AIDS thrives is not addressed.
The conference itself was a superbly organised affair worthy of any standard. On any particular day over 50 papers were presented at seminars with topics like pediatric retroviral therapy, innovative approaches to reach sex workers, and male circumcision.
Fifteen separate satellite link-ups made it a huge affair. And several cultural events took place at the same time to bring awareness to the AIDS issue.
However, any scene of intense activity happened to be where new or old drugs were on offer, ranging from AZT to Nevirapine.
Combination therapy or cocktails, the most popular being the triple combination therapy known as HAART, was also touted as a remedy to reduce viral load to undetectable levels.
The subject of vaccines attracted great interest too, and worthy of note was the work of the International AIDS Vaccine Initiative (IAVI), a New York-based NGO, which seeks private and governmental funding to develop free AIDS vaccines. Bill Gate's Foundation has donated $26 million to its cause.
Apparently biotech companies were unwilling to invest in the development of vaccines for the main reason that those who need it most were poor and could not afford it. A U.S.-based company, Genetec, which tried, found its share price drop dramatically on the stock markets.
The drug wars reached a head on the third day of the conference when a fierce battle ensued on the floors, side rooms and even toilets of the conference centre. The giant pharmaceutical companies were out to get firms offering no-name brand drugs for AIDS sufferers.
Representatives of the large companies were busy on a misinformation campaign to discredit generic drug manufacturers even though it had been shown that some of the drugs made in Brazil and India were more effective than the very expensive brand names.
The infighting got so bad that an international lobby group, ACT UP, called a meeting at the offices of the Durban Chamber of Industries to resolve the matter with government ministers from several countries.
The drug giants had complained that the generic drug manufacturers were trying to cash in on a multi-billion dollar trade. "We are talking billions here," one representative who did not want to be named said.
With no drug able to claim outright victory over AIDS, the strategy shifted to drugs or a combination of drugs that prevent mother to child transmission of HIV. By the end of the week, cost/benefit analyses suggested victory for Nevirapine which claimed to be more effective and less costly. Two single doses to the mother, costing as little as R24 as compared to R1,608 for AZT was said to reduce the risk of mother to child transmission of HIV by 47%. There was also talk about differential pricing which could see a significant reduction in the price of drugs and vaccines when exported to developing countries.
Apparently of little consequence to these "First World" drug wars were traditional healers. Representatives of traditional healers at the conference seethed at the lack of respect shown them even though they claimed that 90% of people in the most affected areas saw traditional healers. Their holistic methods, they said, was far superior to Western remedies and yet they were shunned even by their own governments.
In addition, "bio-piracy", a situation where Western drug companies steal African remedies and pass them off as theirs, is rife and unremedied. Incidentally, the two "most successful" African countries in dealing with the AIDS crisis happened to be those which had a programme of close collaboration between traditional and Western therapies -- Senegal and Uganda.
So where were the so-called AIDS dissidents? Obviously the party was organised by a very rich gentleman who goes by the initials HIV, and since dissidents had not acknowledged his status and power, they were non-guests at his feast. They were not on the agenda and had to resort to guerrilla warfare, unofficially taking on anyone who dared to debate.
They took their case to the corridors as nobody would provide them with a forum for a settled issue. Absent was the dissident guru, Peter Duesberg, but another prominent dissident, Christine Maggiore, made it to print.
She reiterated her position mooted in her book "What if everything you thought you knew about Aids was wrong?" She was tested HIV positive and negative and positive on numerous occasions, and fed on AZT that made her sick, until she repudiated the HIV theory and refused any treatment.
She has lived a healthy life for eight years since her first diagnosis, and has even given birth to a healthy baby. She called on everybody to reject the HIV-AIDS link and shun the so-called anti-retrovirals like AZT which she describes as toxic.
At the end of it all, the focus had shifted from prevention and drugs to hopes for a vaccine. Regrettably, sex was too powerful a force to prevent. An African vaccine initiative between Kenya and South Africa, with financial assistance from IAVI was going to be tested at Hlabisa, one of the worst afflicted areas in the region of KwaZulu-Natal.
Nelson Mandela had the final word. He addressed the closing ceremony to rapturous applause. Touching on the HIV-AIDS dispute, he said: "I am old enough and have gone through sufficient conflicts and disputes in my lifetime to know that in all disputes a point is arrived at where no party, no matter how right or wrong it might have been at the start of that dispute, will any longer be totally in the right or totally in the wrong. Such a point, I believe, has been reached in this debate."
He defended both the position of Mbeki and the integrity of the scientific community and admonished all to put the primacy of politics or science on the backburner and proceed to address the needs and concerns of those suffering and dying. It can only be done in partnership. History was going to judge them harshly if they did not. It was vintage Mandela at his diplomatic best.
Long after the conference, media knives were still out for Mbeki -- this time on his refusal to supply anti-retroviral drugs to pregnant women on the grounds of expense.
Economists have calculated the highest cost of saving a child's life from an HIV-infected mother at R2,968 (£1 = R10 approximately), using the cocktail of AZT and Nevirapine. Formula feeding instead of breastfeeding would put the cost at R5,243.48, significantly less than the R18,966.70 that every HIV positive child costs the state. The government seemed to be listening.
Also significant was a U-turn done by Judge Edwin Cameron, a renowned white South African high court judge, who had publicly declared his HIV positive status. He had, earlier on during the conference, slammed the Mbeki government for its assertion that poverty was the root cause of the rapid spread of the disease.
A week later, after the conference, he agreed with the government that poverty played a crucial role in the pandemic. He laid into "the fundamental moral iniquities" of pharmaceutical companies who inflate the prices of anti-retroviral drugs, which should cost little more than aspirin, condemning millions of Africans who had AIDS.
He openly apologised to the government, saying: "The government has the right legal framework in place to combat HIV-AIDS." It was some about-turn!
His strident condemnation of the government and his sudden repentance have sent government critics scurrying for cover, and muttering about Mbeki wanting to use the AIDS issue as a weapon to redress colonial economic and political wrongs.
If that was so, then it is a noble pursuit. And Africa can indeed be proud of a political grandmaster who has thought 20 moves into the global chess game of richman/poorman, plunderer/victim. If AIDS cannot, then nothing can move the "greedy" North to cancel Africa's debts and give a new Africa a fighting chance to survive and triumph over adversity.
AIDS: There is no more room to hide anymore ----- By Anita Allen
There appears to be some confusion about the process of the South African cabinet-approved Presidential AIDS Advisory Panel.
It is a fact that the mainstreamers [orthodox scientists] without exception said they would not attend or participate if the proceedings were open to the media, and the "dissidents" were quite happy to have it open. Nevertheless, the proceedings were recorded on tape and video.
The process at the first panel meeting at the Sheraton Hotel [6-7 May] was an attempt to identify the issues, pose the questions arising from the issues and provide answers to the questions. This process was ongoing throughout the six-week internet discussion that followed.
Regrettably, the mainstreamers did their best not to participate [in the internet discussion]. Nevertheless, those that did, and thanks to the "dissidents", fairly complete answers were provided to questions posed and some directions were sketched out to cover areas of ignorance.
So at the second meeting [3-4 July at the Crowne Court Hotel, Sandton], people were assigned by the South African moderators to give presentation on the first day of the meeting:
1. Aetiology of AIDS (Prof. Hoosen Coovadia) 2. Aetiology of AIDS (Prof. Peter Duesberg) 3. Prevention of AIDS (Dr. Roberto Giraldo) 4. Prevention of AIDS (Prof. Salim Abdool-Karim) 5. Treatment of AIDS (Dr. Joseph Sonnabend) 6. Treatment of AIDS (Prof. David Rasnick) 7. HIV testing and surveillance (Dr. Val Turner) 8. HIV testing and surveillance (Dr. Helene Gayle)
Each person did their presentation and then each person around the square table was asked to comment. All this is a matter of record.
As a result of this first day, when the mainstreamers were in total disarray, the entire second day was spent discussing upcoming tests and experiments to sort out once and for all what was going on.
The protocols for these tests are now being drafted by a team led by Professor Sam Mhlongo. Any scientist who thinks they have a unique contribution to make can still be a part of this process that will lead to a final report to be given to the South African government.
I have every reason to say that the Centers for Disease Control [USA] are involved in this through Dr. Helene Gayle, the National Institutes of Health [USA] through Dr. Clifford Lane, the Clinton Administration through selected observers, and the South African Medical Research Council through its president, Malegapuru William Makgoba, and its principle AIDS researcher, Salim Abdool-Karim.
I can also say that Prof. Luc Montagnier [of France], despite having signed the Durban Declaration, is prepared to put his science up for scrutiny and is collaborating.
There is no more room to hide anymore. There are no secrets anymore. A process in underway in South Africa, and with or without the media's understanding or attention, it will be completed.
Once again I appeal to all to stop petty point scoring and get on with the job of telling the world that the time for rhetoric has passed. You should aim to talk not only among yourselves but to engage the debate where and whenever you can.