Magazine Article	Articles Archive

AIDS researchers and activists around the world couldn't believe it. South African president Thabos Mbeki, an august figure in the fight against apartheid, announced in March that he wanted to appoint a commission to advise his country on a question most think long-resolved– whether HIV causes AIDS. Trawling the World Wide Web, President Mbeki's eye had caught the writings of HIV dissidents. The most prominent of them, University of California, Berkeley, virologist Peter Duesberg, has argued for years that HIV does not cause AIDS, a position he holds unblinkingly in the face of massive evidence otherwise. Duesberg contends that in rich countries, environmental and lifestyle factors, such as drugs and promiscuity, have worn down AIDS patients' immune systems. Mbeki was intrigued by the controversy, and created an international commission to advise him on HIV's causal role in AIDS, in an effort to develop strategies against the disease that are "appropriate to the African reality."

View our poll archive

Mbeki never said publicly that he thinks HIV doesn't cause AIDS, but his dalliance with HIV denialists produced criticism at home and abroad. In addressing the panel, which met in Pretoria in May and will soon meet again before issuing a report, Mbeki granted that questioning HIV's role in AIDS may seem folly, but he defended the right to an open dialogue taking in all points of view.

David Scondras, Boston's first gay city councilor and founder of Search for a Cure , an HIV treatment and advocacy group, was appointed to Mbeki's panel, and participated in round one of its meetings.

In rich nations, a sense of urgency around AIDS has faded with the falling death rate, thanks to the introduction of new and expensive anti-retorviral therapies. The sense of complacency may be premature– some 20 percent or more of AIDS patients cannot tolerate the new drugs, they have dangerous side effects, and their long-term toxicities are unknown. But the new drugs have had almost no impact in the developing world because people there cannot afford them. Despite some national success stories in reducing rates of infection– Thailand and Uganda, for instance– the dramatic improvements in AIDS treatments have only widened a chasm between the world's AIDS sufferers, some 95 percent of whom can't afford the drugs. Conventional wisdom holds that they are simply doomed to die from the disease, the new drugs are regarded too expensive and difficult to administer outside of first-world health care systems.

But AIDS activists are challenging that view. Last year protesters hounded Vice President Al Gore over his support for pharmaceutical companies, backed by US trade officials, seeking to prevent poor nations from manufacturing needed drugs on their own or importing them from nations that did– activities completely legal under world trade statutes.

Under pressure, the Clinton administration recently backed down from its effort to protect and drug company patents no matter what the cost in lives. Meanwhile, some drugs firms announced token programs to supply AIDS medicines at lower but still high cost to poor nations. Given that their "intellectual property" is in many cases paid for by western taxpayers, that only seems fair. But US pharmaceutical firms are still pursuing a lawsuit in South Africa's courts blocking that county's efforts to manufacture AIDS drugs that it could not otherwise afford to buy.

Scondras and other activists say that access to drugs is only a first step in really dealing without the global AIDS epidemic, which demands a an effort of Marshall Plan proportions. With their ability to cut the amount of virus in the blood, anti-retrovirals can play a vital role in stemming new infections. But also needed are immune-based therapies that can knock out the virus without long-term anti-retroviral treatments. Results of one of the first trials of this approach in England will soon be released. Anger with Western complacency over the global AIDS crisis may have sparked the curious debate about HIV now unfolding in Pretoria. Can that energy be put to use? The Guide talks with David Scondras.

Would it have been better had this panel never happened?

It's complicated. You have an accidental confluence between something that's not true and something else that might be in the best interests of people in developing countries. What Mbeke seems to believe is that there is some conspiracy among pharmaceutical firms. On the one hand, that means he's cautious about dealing with drug companies, suspicious they just want to make lots of money. That attitude gives more leverage to get better deals for medicines than if he were drooling at the mouth to get them. But there's no contradiction between seeing the drug companies as an enemy and also understanding that HIV exists, and that the drugs work. The problem is maybe he hasn't separated those out in his mind. If Mbeke has genuine concerns and questions about HIV and AIDS, then putting together a panel in which he has some faith was a good idea, especially if we comes up with concrete suggestions. The worst situation would be one where the president has the kind of doubts that he is articulating and didn't do something about it.

This was one of the rare opportunities for AIDS dissenters to meet with prominent mainstream researchers and activists. How did they make their case?

If you just read what the HIV denialists say, you come away with a different feeling than when you actually meet them in person. You're dealing with people who have lost a lot of marbles. Harvey Bialy, one denialist, told me that "It's never been shown that a passive virus can hurt anybody." How can anyone say that about viruses? There's no point in discussing something with a person who selects out only those pieces of information that sustain their point of view. Anyone who has dealt with religious fanatics knows what I mean.

Anyway, the question of causes is secondary to treatment. Up until recently, we didn't know what caused lots of diseases but we could still successfully treat them. We had an effective smallpox vaccine before we knew anything about viruses. We knew how to stop cholera epidemics before we knew what caused them There's no question that HIV is what has set off the AIDS epidemic. We also know something more important– that if you take these pills, it's much harder to pass the virus on, and people who were very sick get out of bed. More important than any theory you have about AIDS is whether you do the things that demonstrably stop the epidemic.

Malaria and tuberculosis each kill more people than AIDS in poor countries, and people with compromised immune systems are especially vulnerable. Wouldn't targeting these diseases, along with such killers as unsanitary water and malnutrition, produce more results than targeting AIDS?

These other diseases kill off very young kids or the very old. They don't affect people in between very much, and people with AIDS will die of other infections, as they do when left untreated in the West, even if malaria and TB were eradicated. The problem with AIDS that it targets people who sustain the economy. With HIV infection rates of 25 percent of the population in central Africa, the survival of the whole society is in danger. In the US, around one out of 250 people has HIV. We have an AIDS problem that though we feel strongly about, doesn't threaten anything like social collapse. The vice president of Malawi is coming here in October at my invitation, and he is going to say publicly that, for his nation, it isn't a question of the loss of a generation, it's a question of a nation.

A country of 10,000,000, Malawi today has 370,000 orphans because of AIDS, and only a certain number can be taken care of by cousins and extended family. If you think you have problems now, wait till you have a bunch of teenagers running around who have raised themselves. Malawi's per-capita income is $250. About half its young adults have HIV, and hospitals are already burdened beyond capacity. They lost 8000 teachers last year and, their public school system is beginning to fall apart. Imagine a society in which half the doctors and taxicab drivers are sick, and the other half trying to take care of them.

If magic happened and tomorrow we had an effective vaccine stopping all further spread of HIV, it would not help these countries. There are too many people already infected in a socioeconomic structure that is now too fragile.

Conventional wisdom says that cost aside, there's simply not the infrastructure in poor countries to support the complex, new AIDS treatments that have been effective so far in rich ones. Compliance with the regimens, for those who can tolerate the side effects, is difficult enough with people who are motivated, used to living by the clock, and with access to health care– conditions hard enough to achieve in The Bronx, let alone a remote African village with little food, bad water, and no clinic.

I would predict a much higher degree of compliance in, say, Africa or India than you have in the US because individualism is not out of control in these cultures like it is here. We've had a 43 percent drop in the death rate due to AIDS as a result of the anti-retroviral drugs. But Europe, which as a society more highly respects collective action and has a single payer health care system, has had an 85 percent drop– twice as good.

It's really very simple– you have a disease that you can't cure, but can prevent and treat. How can this still loom as one of the biggest threats that the world has ever known? Our inability to stop this virus follows from an inability to deal with each other. AIDS is really a political and economic crisis.

Around 95 percent of the 33 million people in the world infected with HIV can't afford medicines that could save their lies. But not being able to afford something is not a law of nature, it's a set of decisions. There are some things that people have a basic right to, I think, and one of them is medicine. The marginal cost of increasing production to meet the need is trivial, so why aren't we doing it?

The US and other Western countries have the opportunity to create a depth of relationships with poor countries that will translate into long-term economic and social benefits, not least to ourselves. If you save a baby's life, you'll win mom and dad over to you. To this day, the relationships the US has with Europe and Asia are connected with the commitment the US made to the resolution of World War II. Taking on HIV as an enemy allows us the opportunity to make agreements and develop relationship with societies around the world for which nothing but a crisis on this scale would allow us the opportunity. Of course, don't do it if you can't afford it. But the Republicans talk about giving back 700 to 800 million dollars in a tax rebate, so everyone in the US can have one extra meal at a fancy restaurant once a year. The cost of the cocktail is like a buck a day. So the amount of the proposed Republican tax rebate is ten times as much necessary to provide access to all necessary essential medicines around the planet for everyone.

Anyway, the economic instability that AIDS will eventually cause to Asia, Africa, India, and maybe Russia will cost more for us to deal with than confronting the epidemic now. You'd think politicians would recognize this just out of self interest. Plus, treating HIV allows us to stop the virus from spreading before it gets more catchy, before a version of this develops that we can't stop at all, which could happen sooner or later in Africa, or wherever the epidemic runs rampant.

We act as if we sort of fell out of the womb, walked into the kitchen, poured ourselves a glass of milk, and just started reading the newspaper. We don't acknowledge mom feeding us, the teacher teaching us, the eye doctor who made sure we could see. We don't acknowledge the hundreds of people it took who made it possible for us to live. So you end up with people who say, everyone should do it by themselves. Rich people, especially, say they did it all themselves. But when was the last time they took an airplane? Did you build the airport? Wasn't that a collective endeavor? Isn't the very definition of an economy a large number of people who make each others lives richer through their activities? That disconnect between "us" and "them" makes it possible for us to sit back and say, "Well, we can't afford it, so let them all die." But that sounds like, "Let them eat cake." Historically, those who've said that have gotten there heads cut off. At some point someone's going to say, how come you let my mom die? Why did you let my son die? Why did you let my brothers and sisters die? You had the means to stop it, why didn't you do it?

Author Profile:  Bill Andriette
Bill Andriette is features editor of The Guide
Email:	theguide@guidemag.com