AIDSTruth.org - Features http://www.aidstruth.org/new/taxonomy/term/2/0 More substantial features and articles written by AIDSTruth contributors en Christine Maggiore and Eliza Jane Scovill: Living and dying with HIV/AIDS denialism http://www.aidstruth.org/new/features/2009/christine-maggiore-and-eliza-jane-scovill-living-and-dying-hivaids-denialism <p>&lt;!--break--><br /> by <a target="_blank" href="http://www.sciencebasedmedicine.org/?author=8">David Gorski</a><br />This post first appeared on <a target="_blank" href="http://www.sciencebasedmedicine.org/?p=328">Science-Based Medicine</a>.</p> <p><img alt="" style="border: 1px solid black; margin: 4px; width: 200px; height: 173px;" src="http://www.aidstruth.org/new/sites/default/files/images/Maggiore.jpg" align="left" />On Science-Based Medicine, we strive to apply the light of science and reason on all manner of unscientific belief systems about medicine. For the most part, but by no means exclusively, we have concentrated on so-called “complementary and alternative medicine” (CAM) because there is an active movement to infiltrate faith-based, rather than science-based, modalities into “conventional” medicine. Indeed, such efforts are well-financed, both by public and private organizations, and are alarmingly successful at insinuating postmodernist and pseudoscientific beliefs into academia to form an unholy new monster that has been termed by some as “quackademic medicine.”</p> <p>However, one pseudoscientific belief system about medicine that we at SBM have perhaps not dealt with as much as we should is the belief that, contrary to the overwhelming scientific consensus built up over 25 years, the Human Immunodeficiency Virus (HIV) does not cause Acquired Immune Deficiency Syndrome (AIDS). True, working with Tara Smith, our fearless leader Steve Novella has published an excellent primer on the phenomenon, but not on this blog. This belief system, which is commonly called HIV/AIDS denial or HIV/AIDS denialism, is championed by virologist Peter Duesberg, along with a panoply of groups, such as Alive&amp;Well AIDS Alternatives and Rethinking AIDS; blogs, such as Science Guardian, HIV/AIDS Skepticism, and AIDS Is Over; podcasts, such as How Positive Are You?; books, such as What If Everything You Thought You Knew About AIDS Was Wrong? by Christine Maggiore; and movies, such as The Other Side of AIDS (which resembles in many ways the anti-evolution movie Expelled! and the pro-quackery movie The Beautiful Truth). The influence of HIV/AIDS denialism is horrific, too, particularly in Africa, where advocates of such nonsense, such as Matthias Rath, have advocated quackery over antiretroviral therapy and had the ear of South African President Thabo Mbeki, who lost power in late 2007.</p> <p>Before I go on to do a case study of the tragic price of HIV/AIDS denialism, perhaps it is worthwhile to take a moment to discuss just what HIV/AIDS denialism is. It is not “skepticism” or “rethinking” any more than creationism is a “rethinking” or “skepticism” of evolution, although denialists like to try to claim the mantle of those labels. Seth Kalichman, author of the book <em>Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy</em> has written a good primer of the phenomenon, and I’ll appropriate an excerpt:</p> <blockquote><p>AIDS denialism actively propagates myths, misconceptions, and misinformation to distort and refute reality. Denialism is the outright rejection of science and medicine. It involves actively contradicting and disregarding medical advice. It is steady state. Denialism is not open to criticism, and evades modification. Denialism is only open to additional evidence supporting its tenets and such evidence most often comes from the misuse of science and from pseudoscience. AIDS denialists, often for the sake of personal preservation or recognition, hold fast to old ideas in the face of new evidence.</p> <p>One feature of denialism is the tendency to think of the denialist position as beleaguered, and under attack and in a minority that has to stave off the assaults of the vast wrong-thinking majority. As a consequence, those involved in denialism often, in the other justifications for their position, declare their strong allegiance to the principle of free speech. Interestingly, then, denialists often set themselves up as plucky underdogs, battling for their right to speak the truth against a tide of misinformation and, as often as not, conspiracies aimed at keeping them silent.</p></blockquote> <p>Indeed, denialism, specifically the denial of scientific medicine, tends to be at the heart of the quackademic medicine movement, just as the denial of evolution is at the heart of the anti-evolution movement known as “intelligent design” creationism. It is a more general phenomenon that involves a dogged clinging to pseudoscientific or pseudohistorical beliefs (creationists and antivaccine advocates are a good example of the former; 9/11 Truthers and Holocaust deniers are a good example of the latter) and the use of logical fallacies and conspiracy theories to bolster their world view.</p> <p>Like vaccine denialists, HIV/AIDS denialists promulgate an ideology that kills. Indeed, last week, it very likely did just that to a prominent HIV/AIDS denialist named Christine Maggiore, whose activism led her to form the group Alive&amp;Well AIDS Alternatives. Three years earlier, her HIV/AIDS denialism cost the life of her daughter, Eliza Jane (EJ) Scovill. Let us examine both cases. In the case of Eliza Jane, I will go into considerable detail, because much more is known; in the case of Christine Maggiore’s death, less so, because much less is (yet) known.<br /> <h3>From Businesswoman to HIV/AIDS Denialist</h3> </p><p>Before she became an HIV/AIDS denialist, Christine Maggiore was a successful businesswoman. In 1986, she started what ultimately developed into a multimillion dollar inport/export clothing company, Alessi International, which is based in Italy. However, her life changed in 1992, when during a routine medical examination she was found to be HIV-positive. Initially, she became involved with AIDS charities, including the AIDS Project and Women At Risk, but then in 1994 she met Peter Duesberg, the biologist who, arguably more than anyone else, started the whole phenomenon of HIV/AIDS denialism. By that time she also had had other HIV tests that varied from negative to indeterminate to positive, which had made her start to question whether she really had HIV. After being “converted” by Duesberg, she became an HIV/AIDS denialist and activist, founding Alive&amp;Well, an organization dedicated to providing “information that raises questions about the accuracy of HIV tests, the safety and effectiveness of AIDS drug treatment, and the validity of most common assumptions about HIV and AIDS.” She herself refused to take antiretroviral drugs and discouraged other at-risk mothers from doing so–or from even permitting themselves to be tested for HIV–under the guise of “telling both sides.”</p> <p>Not surprisingly, when she became pregnant with her second child Eliza Jane, she similarly refused to take antiretroviral drugs in order to decrease the risk of maternal-fetal transmission of HIV. Indeed, she even appeared on the cover of Mothering Magazine sporting her pregnant belly with the word AZT in a circle with a slash through it and the headline HIV+ Moms Say NO to AIDS Drugs. The issue featured Maggiore in an article entitled Safe and Sound Underground: HIV-Positive Women Birthing Outside the System and included other articles about AIDS, such as Molecular Miscarriage: Is the HIV Theory a Tragic Mistake? and AZT in Babies- Terrible Risk, Zero Benefit. (Mothering Magazine’s promotion of HIV/AIDS denialism and antivaccine misinformation may well make a topic for a future post in and of itself. Suffice it to say that Christine Maggiore was very much into “alternative medicine” and refused to vaccinate her children, making Mothering, which is well-known for its promotion of antivaccine views, the perfect venue for her.) After EJ was born, Maggiore refused to allow her to be tested for HIV and insisted on breast-feeding her, even though breastfeeding results in an unacceptable risk of virus transmission to the baby. The stage was thus set for the tragedy that was to come.<br /> <h3>The Preventable Death of a Child</h3> </p><p>In March 2005, Christine Maggiore was interviewed on the liberal talk network Air America. In the interview, she boldly proclaimed:<br /> <blockquote>"Our children have excellent records of health,” Maggiore said on the Air America program when asked about 7-year-old Charlie and 3-year-old Eliza Jane Scovill. “They’ve never had respiratory problems, flus, intractable colds, ear infections, nothing. So, our choices, however radical they may seem, are extremely well-founded."</blockquote></p> <p>As the article noted, seven weeks later, Eliza Jane was dead of Pneumocystis carinii pneumonia (PCP) and HIV encephalitis.</p> <p>In early April, Eliza Jane developed a runny nose with yellow mucus. Here is what happened next:</p> <blockquote><p>On April 30, Maggiore took her daughter to a pediatrician covering for Fleiss. That doctor found the girl had clear lungs, no fever and adequate oxygen levels, the coroner’s report said.</p> <p>Five days later, Maggiore sought a second opinion from Gordon. In an interview, Gordon said he suspected an ear infection but believed it could be resolved without antibiotics. In a follow-up call, he said, Eliza Jane’s parents told him she was getting better.</p> <p>Maggiore then asked Denver physician Philip Incao, who was visiting Los Angeles for a lecture, to examine her, the mother told the coroner’s investigator. He found fluid in Eliza Jane’s right eardrum.</p> <p>On May 14, Incao examined her again and prescribed amoxicillin, Maggiore told the coroner.</p> <p>Incao is not licensed to practice medicine in California.</p> <p>The next day, Eliza Jane vomited several times and her mother noticed she was pale. While Maggiore was on the phone with Incao, the little girl stopped breathing and “crumpled like a paper doll,” the mother told the coroner. She died early the next morning, at a Van Nuys hospital.</p></blockquote> <p>I consider it rather ironic that Dr. Jay Gordon, who has been castigated for his antivaccine apologia, was involved in the case. He was quoted thusly at the time:</p> <blockquote><p>Dr. Jay Gordon, a Santa Monica pediatrician who had treated Eliza Jane since she was a year old, said he should have demanded that she be tested for human immunodeficiency virus when, 11 days before she died, Maggiore brought her in with an apparent ear infection.</p> <p>“It’s possible that the whole situation could have been changed if one of the doctors involved – one of the three doctors involved – had intervened,” said Gordon, who himself acknowledges that HIV causes AIDS. “It’s hindsight, Monday-morning quarterbacking, whatever you want to call it. Do I think I’m blameless in this? No, I’m not blameless.”</p></blockquote> <p>No, Dr. Gordon was not blameless. If he did not know that Christine Maggiore was HIV-positive, it’s not unreasonable to conclude that he probably should have, given that he had been caring for EJ since she was one, Maggiore’s notoriety in the Los Angeles area, and Dr. Gordon’s fame among the “alternative” medicine and antivaccine crowd. If he didn’t insist on having EJ tested for HIV, he should have. Of course, it’s very possible that Maggiore went from doctor to doctor in order to avoid having any of them find out about her HIV status or ask for an HIV test Indeed, Dr. Gordon states that his office called Maggiore a week later to see how EJ was doing. Be that as it may, he was closer to blameless than Christine Maggiore, who, along with her apologists in the HIV/AIDS denialism movement, immediately launched a public relations blitz to try to spin Eliza Jane’s death as not having been due to AIDS. The “real cause” of her death, according to the HIV/AIDS denialism spin, has to be heard to be believed. I will now examine in detail that blitz and why the spin used to try to convince the public that EJ did not die of AIDS complications was so scientifically ludicrous.<br /> <h3>Spinning EJ’s Death</h3> </p><p>After the death of EJ, the HIV/AIDS denialist propaganda machine went into high gear. The man who was hired, Mohammed Ali Al-Bayati, PhD, DABT, DABVT, was the perfect choice to go over the L.A. County Coroner’s report and try to find another explanation for EJ’s death, regardless of how much he had to twist the truth to do it. Dr. Al-Bayati represents himself as a toxicologist and “pathologist.” However, most pathologists who deal with HIV are MD’s. So what kind of pathologist is he? “DABVT” stands for Diplomate, American Board of Veterinary Toxicology; so basically he’s a veterinary pathologist and toxicologist. Whether that means he’s qualified to evaluate postmortem findings in AIDS, I don’t know. He has a few papers published in the peer-reviewed medical literature, but none of them have anything to do with HIV or AIDS; so his publication history doesn’t help me evaluate him. He does, however, have a very obvious and undeniable bias, as demonstrated by his listing on the infamous Virus Myth website or his book Get All the Facts: HIV Does Not Cause AIDS.</p> <p>Dr. Al-Bayati also runs a company called Toxi-Health International, which, according to its website, provides expert witness services and “can evaluate the health effect resulting from acute and chronic exposure” to various agents,” including medication reactions, adverse reactions to vaccines, pesticides, and a variety of other compounds. He is also notorious for his role in another famous case, in which he produced a report similar to the one that he would ultimately produce about EJ. This report tried to spin the death of a baby due to shaken baby syndrome was a case of “vaccine-induced encephalitis.” The report was one of the most outrageous lies I have ever seen, and was used to try to win the freedom of a baby killer named Alan Yurko. Dr. Al-Bayati’s report on the death of Eliza Jane Scovill would approach, and possibly even surpass, his previous “achievement.” Soon HIV/AIDS denialist bloggers would be trumpeting the “Al-Bayati report” far and wide as “proof” that EJ did not die of AIDS.</p> <p>But what, according to Dr. Al-Bayati, did EJ die of? If we’re to believe Dr. Al-Bayati’s report, she died of an allergic reaction to amoxicillin prescribed to her. I kid you not.</p> <p>The first thing I noticed when I first read Dr. Al-Bayati’s report is that it appears not to be intended for a scientific audience. Instead, it was constructed more like a legal document designed to cast “reasonable” doubt on the coroner’s conclusion that AIDS-related pneumonia was the cause of Eliza Jane’s death, rather than actually putting together a coherent case for an alternate explanation. One particularly egregious example of his style was that he lambasted the coroner for not testing for a certain virus (more about this below), and then confidently concluded that Eliza Jane had that virus and not HIV, even though he couldn’t possibly have made such a conclusion without the results of the very test that he criticized the coroner for not having done in the first place! Let’s summarize the autopsy conclusions as Dr. Al-Bayati reports them:</p> <ol> <li>Pneumocystis carinii was found in Eliza Jane’s lungs by Gomori methenamine silver staining in association with pink foamy casts in the alveoli. The lungs were also edematous (water-logged).</li> <li>Eliza Jane was mildly neutropenic (low neutrophil–a type of white blood cell–count) and profoundly anemic (low red blood cell count)</li> <li>Eliza Jane’s brain contained throughout its white matter with relative sparing of cortex a number of variable-sized microglial nodules characterized by multinucleate giant cells associated with moderate pallor and myelination, occasional macrophages, and and angiocentric pattern. These lesions stained positive by immunohistochemistry (IHC) for the HIV core p24 protein, a finding consistent with HIV encephalitis.</li> <li>There was atrophy of the spleen and thymus</li> <li>There was enlargement of the liver with fatty infiltrate of the cells (steatosis) and ascites.</li> </ol> <p>Dr. Al-Bayati then tried to “refute” each of these findings, using a variety of handwaving techniques and “might have beens” that truly astounded me at the time. One thing that puzzled me, though, was why he thought it so important to refute the finding that HIV was present at all. After all, if, as Dr. Al-Bayati clearly believes very strongly, HIV does not cause AIDS, then why didn’t he just come right out and argue that in his report? Why didn’t he just argue that AIDS couldn’t possibly have killed Eliza Jane and that the HIV protein detected in her brain was a red herring because HIV doesn’t cause AIDS? To argue otherwise was intellectually dishonest.</p> <p>But I digress. I can’t help myself whenever I come across HIV/AIDS denialists trying to demonstrate that an HIV-positive person who died of what is considered an AIDS-defining illness did not, in fact, die of HIV.</p> <p>Dr. Al-Bayati did concede that P. carinii, an AIDS-defining organism, was present in Eliza Jane’s lungs but tried to wave this finding away by pointing out that there was not a “pneumonia” because no inflammation was observed, citing a definition in a pathology textbook (a technique not unlike arguing about technical words using dictionary definitions). He also stated that P. carinii is ubiquitous, only causing disease in immunosuppressed patients. There are couple of problems with these arguments. First, immunosuppressed AIDS patients tend not to be able to mount a very effective inflammatory response to infection. Indeed, it has been noted that, in HIV infection, PCP pneumonia provokes fewer inflammatory cells and that PCP is worse in patients immunosuppressed by other causes as their immune system recovers and starts attacking the organism, causing inflammation, as real pathologist Dr. Trent McBride explained at the time. Dr. McBride also pointed out, for P. carinii to be detected in routine tissue samples at autopsy, there have to be a lot of organisms there. In immunocompetent individuals, there simply aren’t enough bugs to show up on silver stain.</p> <p>The one argument Dr. Al-Bayati made in this context that wasn’t totally off the wall is that PCP can occur due to immunosuppression from other causes, and he cited several references that show that PCP can occur in people without HIV if they are immunosuppressed for other reasons. Of course, this line of argument totally begged the question of what the cause of this Eliza Jane’s profound immunosuppression was in the first place if it wasn’t HIV infection. Given that the HIV protein was also detected in the brain, there was an obvious cause for the immunosuppression that led to the presence of so much P. carinii in Eliza Jane’s lungs. By definition, Eliza Jane had AIDS-associated PCP. Dr. Al-Bayati clearly realized that he had to try to throw doubt on that finding.</p> <p>And how did he try to do that? Disputing the findings of an experienced neuropathologist, Dr. Maurice A. Verity of UCLA, who examined the sections of Eliza Jane’s brain, Dr. Al-Bayati argued that the brain lesions seen are nonspecific and that the finding of the HIV p24 protein must have been a false-positive. He pointed out a paper from 1992 indicating a high level of false positivity of this test in the presence of inflammation. Tellingly, however, despite listing the numbers and types of tissues stained in the study (which included only 3 brains from HIV-positive patients and one brain without HIV), he did not cite the percentage of false positive results reported in the paper, only that it is “common.” The problem with this line of argument is that it’s not enough just to say that this “might” have been a false positive using references that, being 13 years old at the time, may not even be relevant to how IHC for HIV proteins was done 2005 or today. He has to show compelling reason that it was, rather than hand-waving and saying that some combination of a viral infection and/or an allergic reaction to amoxicillin caused this (see below). Even Dr. Al-Bayati appeared to realize this shortcoming.</p> <p>And that’s where his strangest argument of all came in.</p> <p>There’s a saying in medicine that, when you hear hoofbeats you don’t look for zebras. (A zebra is medical slang for a rare or highly unlikely diagnosis.) Yes, occasionally it you will find a zebra, but the vast majority of the time you will not. Consequently, when one hears hoofbeats from a tragic case of a dead child of an HIV-positive mother who was found to have profound anemia, PCP, and encephalitic lesions with HIV proteins detected in them, by far the most likely diagnosis is AIDS. Indeed, in the differential diagnosis, the first ten diagnoses in the differential would be AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, and then–very far down the line in probabilities–everything else. Given this, it’s not surprising that, in his rebuttal, Dr. Al-Bayati heard not one, but at least two zebras approaching.</p> <p>Which zebras, though? The first one was erythrocytic aplastic crisis due to infection with parvovirus B19 (PVB19, the virus mentioned above), of course! Shouldn’t it have been obvious? He based this speculation on Eliza Jane’s anemia, encephalitis, upper respiratory infection, and atrophy of the spleen and thymus. I’ll give him props, though. This was a clever gambit, because this particular virus is common enough that a significant percentage of children have been exposed to it, meaning that there’s a reasonable probability that antibodies to it would be found if looked for, whether it was this virus that actually caused Eliza Jane’s death or not. Let’s look at this claim a little more closely.</p> <p>PVB19 is a parvovirus that is fairly common and can cause upper respiratory infections, erythema infectiosum, arthritis and arthralgias, and transient aplastic crisis. Dr. Al-Bayati made much of the ability of this virus to cause anemia by transiently suppressing the progenitor cells that develop into red blood cells and blames infection with this virus for Eliza Jane’s profound anemia. He also attributed Eliza Jane’s encephalitis and bone marrow atrophy to infection with this virus. However, he neglected the observation that PVB19 is rarely much of a problem in healthy individuals. Severe anemia secondary to PVB19 usually only occurs in patients with a pre-existing anemia or pre-existing destruction of red blood cells and who therefore require a high level of reticulocyte production to keep their blood counts up. Conditions in which this can be a problem include chronic hemolytic anemias, sickle cell anemia, thalassemia, acute hemorrhage, and iron deficiency anemia, all of which cause red blood cell loss requiring replacement. Also, severe infections of the bone marrow with PVB19 causing aplastic anemia are rare aside from patients with pre-existing immunosuppression, such as transplant recipients, patients with malignancy, and, of course, patients with HIV. In such patients, PVB19 infection can result in severe, prolonged, recurrent, or even permanent anemia. Dr. Al-Bayati did point out a couple of case reports of a aplastic anemia due to PVB19 in immunocompetent individuals. However, PVB19 appears to be a fairly rare cause of aplastic anemia in healthy individuals. It is, of course, possible that PVB19 infection caused Eliza Jane’s serious anemia (that’s where “reasonable doubt” comes in). However, even if it had, given what is known about this strain of parvovirus, a far more likely explanation would be that the virus caused Eliza Jane’s anemia because of immunosuppression secondary to her HIV infection, if it did anything at all.</p> <p>The second zebra was a severe amoxicillin hypersensitivity. An amoxicillin allergic reaction in and of itself is not a zebra, but it was in the context of this particular case. Never mind that Eliza Jane had, as was emphasized in the report, never been exposed to antibiotics before and that her clinical course did not seem consistent with a hypersensitivity reaction. Never mind that there was no eosinophilia, no urticaria, or no other stigmata of an allergic reaction mentioned in Dr. Al-Bayati’s report (and you can bet that, had any of them been there, he would have mentioned them again and again). Amoxicillin hypersensitivity was also blamed for Eliza Jane’s steatosis (fatty liver infiltrate). It is true that amoxicillin-clavulanate has been associated with hepatocellular, cholestatic, granulomatous, or focal destructive cholangiopathy (all types of liver damage), and references are cited showing this. However, one would think that Dr. Al-Bayati would know that steatosis is not the same thing as any of these. Moreover, the pathology report did not state that Eliza Jane’s liver had any of the more common manifestations of amoxicillin-clavulanate-induced liver injury, casting further doubt on the antibiotic as the cause. (Drugs more classically associated with steatosis include valproic acid, tetracycline, amiodarone, and aspirin, not amoxicillin-clavulanate. I didn’t see any of Dr. Al-Bayati’s references supporting his implication that amoxicillin could cause steatosis within a day of exposure. Clearly, the steatosis must have been a pre-existing condition. As for the pulmonary edema and ascites reported, that could be due to allergic reaction, septic shock from an ear infection, cardiopulmonary collapse from whatever cause, or a number of other factors, but in the context of Eliza Jane’s HIV infection, rapid deterioriation, and cardiovascular collapse, it fits, especially given that steatosis is very common in pediatric AIDS patients.</p> <p>The bottom line is that you can compare these two sets of conclusions about what caused Eliza Jane’s death and decide which seems more plausible. The first, the coroner’s report, looks at a child of an HIV-positive mother who refused to take AZT during pregnancy, breast-fed her child even though that is known to increase the rate of transmission of HIV, and refused to have her child tested for HIV, a child who collapsed after upper respiratory and ear infections, whose autopsy findings showed HIV encephalitis, P. carinii in the lungs, and severe anemia. Given such findings, it’s hard not to conclude that Eliza Jane died of AIDS complications. The second hypothesis, promulgated by an HIV “dissident” with a definite axe to grind, requires us to believe in not just one, but three, highly unlikely occurrences (plus one simply unlikely occurence), namely:</p> <ol> <li>A previously completely healthy girl developed PVB19 infection leading to both encephalitis and aplastic anemia (possible, but highly unlikely, and, even if PVB19 were found, it would be far more likely that it was able to cause anemia because of immunosuppression due to AIDS).</li> <li>This same girl also developed an acute allergic reaction to amoxicillin that led to cardiovascular collapse and–oh, by the way–also caused steatosis of the liver within a day after starting the drug, the steatosis being something even Dr. Al-Bayati’s own references do not seem to support as being likely.</li> <li>This same otherwise healthy girl had sufficient quantity of P. carinii in her lungs to show up on Gomori methenamine silver staining at her autopsy.</li> <li>The medical examiner and neuropathologist either botched the staining for the p24 protein (or that it was a false positive) and an experienced neuropathologist didn’t know the pitfalls of the diagnosis of HIV encephalitis using brain tissue sections.</li> </ol> <p>A veritable herd of zebras indeed.</p> <p>Sadly, none of this stopped Christine Maggiore from going on ABC’s PrimeTime Live to argue her case. In the intervening three years, efforts continued on and off to present Maggiore as lacking any culpability in EJ’s death, and, like a vampire, the Al-Bayati report kept rising from the dead whenever it was required. Denialist bloggers stated that Eliza Jane “died of an allergic reaction to an antibiotic, not of AIDS” as though it were a settled fact. In addition, Maggiore and her supporters continued a smear campaign against the L.A. County Coroner as incompetent or somehow in the pocket of big pharma. The preventable death of al little girl can’t be anything but tragic, but the desperate and scientifically dishonest methods used by HIV/AIDS denialists to try to deny that this little girl died of anything other than complications from AIDS added immeasurably to the tragedy.<br /> <h3>History Repeats Itself</h3> </p><p>Three years later, it appears that Maggiore’s belief that HIV doesn’t cause AIDS might finally have caught up with her. I say “might have” because we do not know for sure right now and cannot know for sure without an autopsy. The one thing we do know is that about a week ago she died of pneumonia at the age of 52:</p> <blockquote><p>On Saturday, Maggiore died at her Van Nuys home, leaving a husband, a son and many unanswered questions. She was 52.</p> <p>According to officials at the Los Angeles County coroner’s office, she had been treated for pneumonia in the last six months. Because she had recently been under a doctor’s care, no autopsy will be performed unless requested by the family, they said. Her husband, Robin Scovill, could not be reached for comment.</p></blockquote> <p>Maggiore was HIV-positive. When any HIV-positive person develops pneumonia, the galloping hooves usually signify horses, not zebras, the horse being an HIV-associated pneumonia. This is especially true in light of the coroner’s statement that she had been treated for pneumonia in the last six months. Two bouts of pneumonia in less than a year in an HIV-positive individual is, at the very least, very suspicious for AIDS-defining illness.</p> <p>Of course, it is possible that Christine Maggiore, in fact, died of a community-acquired pneumonia or some other sudden cause. It happens sometimes. However, if Maggiore’s cause of death had been something other than a mystery illness, seemingly a pneumonia that sounds as though it might be HIV-related, chances are that Maggiore’s family would have stated plainly in a press release the cause of her death. Even though we’re unlikely ever to know for sure unless Maggiore’s family requests an autopsy, it’s still pretty unlikely that a 52 year old died of a simple community-acquired pneumonia or dropped dead of another illness, and if it wasn’t HIV-related why be so coy about it, anyway? Moreover, the fact that Maggiore had been treated for this “pneumonia” in the last six months sure sounds suspiciously as though she had developed a more chronic infection, consistent with Pneumocystis pneumonia. Assuming that’s the case, which is a pretty reasonable assumption, Maggiore has now joined the list of other HIV/AIDS denialists infected with HIV who have gone to their grave claiming that their HIV does not cause AIDS, that antiretrovirals do not improve survival of HIV-positive patients even though the evidence is overwhelming that they do, and that the illness that claimed them was not due to HIV, activists such as Michael Bellefountaine and David Pasquarelli.</p> <p>Just as they did after EJ died, the HIV/AIDS denialists came out in force trying to deny that Maggiore died of HIV-related causes. Leading the charge to try to “prove” that it was not AIDS that killed Maggiore was Celia Farber, writing on on the blog of a prominent HIV/AIDS denialist blogger named Dean Esmay, who is most vociferous in his claim that AIDS did not kill Maggiore. Not unexpectedly, her claim was that Christina Maggiore did not die of AIDS. Surprisingly, according to Farber, it was rather a combination of stress and a “radical detoxification” regimen that led to Maggiore’s demise. However, even if Farber’s account is accurate, then, no matter what killed Maggiore, HIV or quackery, her case stands as a shining example that pseudoscience and antiscience kill. Indeed, HIV/AIDS denialists must be pretty desperate to blame quackery for Maggiore’s demise.</p> <p>Farber begins with some drama, which, believe it or not, I can understand given that her friend just died but unfortunately her drama adds a lot of heat but no light on the case:</p> <blockquote><p>The news has been shattering to all who loved her around the world. Speaking for myself, I can say that Christine Maggiore was one of the strongest, most ethical, compassionate, intelligent, brave, funny, and decent human beings I have ever had the honor to know. I spoke to her in great depth about all aspects of life, death, love, and this battle we both found ourselves mired in, and I will be writing about her and about those conversations here, in the future. No matter what she was going through, and it was always, frankly, sheer hell-every day of her life, since 2005, she faced, acute grief, sadistic persecution, wild injustice, relentless battle, and deep betrayal-she was always there for her friends, and she never descended to human ugliness. She always tried to take the high road. She always tried to be stronger than any human being could ever be asked to be. I feared for her life, always. I feared the battle would kill her, as I have felt it could kill me, if I couldn’t find enough beauty to offset the malevolence. This is a deeply occult battle, and Christine got caught in its darkest shadows.</p></blockquote> <p>While I understand the pain the death of a loved one produces and even though one never likes to speak ill of the dead, I have to point out that Maggiore brought at least some of that “sheer hell” upon herself when her cultish belief in HIV/AIDS denial led her to fail to take simple steps that could have prevented the death of her daughter. I have no doubt that Maggiore suffered horribly from the grief that comes from losing a child, and I’m not unsympathetic to that. She suffered a loss that no parent should have to suffer, made all the more tragic because it was potentially preventable. Perhaps, somewhere deep within, she even felt guilty that her belief led her to fail to prevent it. However, the clear preventability of Eliza Jane Scovill’s death is why my sympathy for her mother only goes so far. While my sympathy for Eliza Jane for having had her young life snuffed out prematurely by AIDS is enormous, my sympathy for Eliza Jane’s mother ended at the point that she allowed an antivaccine and HIV/AIDS denialist hack to try to whitewash her daughter’s autopsy report and try to spin the cause of death as being from an antibiotic reaction, as described above. My sympathy also bumps up against Maggiore’s prominent role in spreading a denialist philosophy that has arguably led to the deaths of an estimated hundreds of thousands in Africa. As for this being a “deeply occult” battle, Farber is more correct than she knows, but not in the way she thinks. The battle is “occult” in the sense that HIV/AIDS denialism is very much like magic and the occult; it is based on faith, not science, and its adherents cling to it in the face of all evidence, science, and reason to the contrary like some dark religion.</p> <p>So what did actually kill Christine Maggiore? Well, if we’re to believe Celia Farber, the rankest of quackery killed her, plain and simple:</p> <blockquote><p>She had apparently been on a radical cleansing and detox regimen that had sickened her and left her very weak, dehydrated, and unable to breathe. She was shortly thereafter diagnosed with pneumonia and placed on IV antibiotics and rehydration. But she didn’t make it.</p></blockquote> <p>Later in the post, Farber tries to refute the reports that Maggiore had been ill for a while:</p> <blockquote><p>She had been HIV positive since 1992, and never had an AIDS defining illness. Her foes have predictably begun their attacks, and there is already a misleading statement from the LA County Coroner’s office, against whom Christine was scheduled to testify two days from when she died, stating that she had had pneumonia for six months. This is incorrect, but helps foster the impression that it was an AIDS related pneumonia (PCP) which is a longer term illness.</p></blockquote> <p>This is a twisting of what the news reports actually said, which was: “According to officials at the Los Angeles County coroner’s office, she had been treated for pneumonia in the last six months.” To me that means she had been treated for pneumonia sometime within the last six months. It does not mean that she had had pneumonia for six months prior to her death. Also, that Maggiore lived symptom-free with HIV for 16 years does not mean that HIV doesn’t kill. As Nick Bennett explains, a period of 16 years is not too far outside of the normal range for time to progression of untreated HIV infections.</p> <p>More importantly, though, Farber’s account has a glaring inconsistency. Here Farber tries to argue that Maggiore was as healthy as the proverbial horse, aside from her understandable emotional distress over the death of her daughter due to AIDS, and yet she was undergoing some sort of “radical detoxification regimen.” (One wonders if she was undergoing the Gonzalez regimen, which is certainly a radical detoxification regimen–and about as dubious a “therapy” as there is.) If Christine Maggiore was in fact so healthy, why did she think she needed to undergo such a radical detoxification regimen? Healthier people, a.k.a. the “worried well” who are most drawn to “alternative” medicine, tend to opt for much less radical detoxification regimens. True, sometimes healthy people do undergo extreme regimens for vague symptoms or as a “preventative” measure, but in general usually only people who have a serious illness or who have persistent health problems that they can’t shake are drawn to the radical detoxification regimens. According to Farber, Christine Maggiore underwent a “detox cleansing” regimen so radical that she perceives it as being plausible that the regimen was what caused Maggiore to lose weight, become weaker, and finally become too weak to fight off the pneumonia that killed her. Quite frankly, that must have been one hell of a “detox regimen,” and I’d be very curious to know exactly what it involved.</p> <p>In any case, in a followup post, Farber published a letter allegedly written by Maggiore on December 19, a mere week before her death. First, she launches an attack against anyone who has suggested that Maggiore may have died of AIDS:</p> <blockquote><p>I’m told that I stand accused in Internet hate swamp sites of claiming Christine Maggiore died “from a cleanse,” in the name of “denying” that she died of AIDS.</p> <p>She died, while suffering from bilateral bronchial pneumonia, after taking on a de-tox cleanse, is what I reported. These people at these swampy sites apparently can’t read, can’t decipher basic English. Every time I report they accuse me of “denying,” but how can you be denying while you are reporting?</p></blockquote> <p>Apparently, Farber can’t read her own words (see above), because that’s exactly what she said: That a “cleanse” rendered Maggiore so weak that she could not fight off a case of pneumonia. She apparently can’t read the words of her friend, either. I quote an excerpt:</p> <blockquote><p>Regarding my health, I finally figured out what’s going on…but it got really scary. Here’s the scoop I just sent a friend:</p> <p>I have been through the absolute worst health nightmare ever. The cleanse, while definitely bringing about some profound benefits, left me feeling weak and dehydrated. I lost my appetite almost completely about 10 days ago and for some weird reason could only tolerate hot tea and hot chicken broth. I had been in touch with the cleanse doc who said all was typical, uncomfortable but typical. Not one to quit, I kept going. Then I started to have trouble breathing, I was feeling winded after the most simple task like making the bed.</p> <p>This last Sunday, I stopped being able to sleep at all. So finally, genius that I am, I made an appointment to see my MD who is really smart and very well versed in natural health care and not at all into the HIV paradigm.I could only get in to see her yesterday. She said I was totally dehydrated and having a reaction to the herbs in the cleanse which she thought were suspicious. I asked her to check my lungs and she said they sounded clear. I told her I thought I should have a chest Xray anyway, just to be sure, but she was skeptical because I hadn’t had a cold, flu, cough or fever. But I insisted so she wrote me up to go to a radiology place that would give an immediate reading. By then I felt so ill I had to ask my neighbor to drive me and thank god he was there with me because I never would have made it to the radiologist without his help. As it turned out, the Xray showed a very serious case of bi-lateral bronchial pneumonia. The doctor immediately gave me IV rehydration, IV natural cortisone, and IV antibiotic.</p></blockquote> <p>It sure sounds to me as though Maggiore had been seriously ill at least since early December. Indeed, Farber’s reposting of Maggiore’s e-mail reinforces my opinion that she was either very ill beforehand, became ill (or more ill) after a “cleanse,” or both. Perhaps the most bizarre claim I’ve seen as to the cause of Maggiore’s death came from a commenter called Baby Pong on the Science Guardian blog, who claimed that EJ died as a result of a covert operation and that Maggiore’s death was similarly “extremely suspicious,” even going so far as to speculate that “the ‘holistic cleanse’ would have been an excellent opportunity for someone to have covertly introduced some extremely toxic substance into Christine’s body.” I don’t claim that this is what HIV/AIDS denialists are arguing in general; I only present it to show the depths of conspiracy mongering to which some of them routinely descend.</p> <p>Of course, I can’t help but think of an alternate explanation to the one provided by Celia Farber, one that, to me at least, fits better the facts as we know them so far. I admit I’m speculating, but, without hard evidence from an autopsy to tell us what killed Christine Maggiore, I submit to you that my speculation fits the known facts better than Farber’s explanation. My explanation would be that Maggiore had been ill for a while. Because she had become ill, she started a “radical detoxification” regimen. Perhaps she even had a little dry cough that got a bit worse, which she would never allow herself to recognize as an early symptom of PCP. She became weaker and sicker not primarily because of whatever quack regimen she was undergoing but because of HIV. Most radical detoxification regimens, even the worst, usually do not sicken people to the point of being so weak they are susceptible to fatal pneumonia–unless, of course, they are already seriously ill. This is especially true after only one such “cleanse,” rather than the multiple sessions that quacks generally recommend.<br /> <h3>Conclusion</h3> </p><p>Progress against the scourge of AIDS is one of the most dramatic success stories of science-based medicine. Think about it. In 1981 the CDC reported a newly identified immunodeficiency syndrome affecting homosexual men in New York and San Francisco and hemophiliacs. This syndrome was associated with lymphadenopathy, Kaposi’s sarcoma (a tumor previously very rare in populations other than old men of Mediterranean descent), and opportunistic infections such as PCP. Within four years, the virus causing the disease was isolated. Within a few short years after that, AZT was shown to be effective against HIV. By the mid-1990s, combinations of antiretroviral therapy including protease inhibitors were shown to significantly delay the onset of AIDS. Within a decade after that, these cocktails of three or four antiretroviral drugs, known as highly active antiretroviral therapy (HAART) had dramatically reduced mortality from HIV. In the meantime we learned about the clinical course of HIV infection, discovered genetic mutations that made some people very resistant to progression to AIDS, and characterized the molecular mechanism by which HIV gradually destroys the immune system. Within 25 years of its description as a distinct clinical entity, HIV had been transformed from a probable death sentence to a chronically manageable disease. True, many challenges remain. HAART has many side effects, some of them serious, and resistance to the drugs can develop. Nonetheless, by any reasonable measure, science-based medicine has done more faster to improve the outlook of HIV-infected patients than it has for virtually any other disease.</p> <p>It is also very clear that HIV/AIDS denialism is a delusion that kills. It kills by encouraging HIV+ individuals not to take antiretroviral drugs, which have been shown unequivocably to prolong life and forestall progression of HIV infection to AIDS. It kills by encouraging quackery over effective antiretroviral therapy, as has happened in Africa, particularly under Thabo Mbeki’s regime in South Africa. Indeed, it has been estimated that the delay in introducing HAART therapy into Africa, which was in part due to denialist policies, resulted in the potentially preventable deaths of over 300,000. In the case of Christine Maggiore and her family, it has claimed at least one life and likely two lives, devastating a family. Unfortunately, HIV/AIDS denialists will continue to use logical fallacies, pseudoscience, and cherry picking of data and studies to argue otherwise.</p> <p>There is, of course, one way for HIV/AIDS denialists to prove my discussion of Maggiore’s death wrong, and it’s one area where I actually agree with Celia Farber:</p> <blockquote><p>We all agree that it is imperative that an impartial and thorough autopsy bring to light all facts about Christine’s cause of death, and the state of her immune system, and how these facts might bring us all closer to the ultimate truth we all seek.</p></blockquote> <p>I agree with the expressed sentiment, and, if an autopsy is done and it turns out that Maggiore did not die of an AIDS-related pneumonia, I will forthrightly admit my speculation was incorrect. However, even if Maggiore did not die of AIDS, it would not in any way validate her HIV/AIDS denialist beliefs, although no doubt that’s exactly what denialists like Farber and Esmay would try to do. I will also point out that, if Farber’s account is confirmed, then Maggiore’s death would be prima facie evidence that unscientific quackery can kill.</p> <p>If, on the other hand, however, an autopsy is performed and it does show PCP and other evidence of AIDS, will Celia Farber and Dean Esmay concede that AIDS killed Christine Maggiore? I sincerely doubt that they would. Indeed, if there is an autopsy and it shows that Christine Maggiore died of AIDS-related pneumonia, expect a replay of the Eliza Jane Scovill story. Expect more dubious attempts to spin the results as being something else. Expect HIV/AIDS denialists to trot out Dr. Al-Bayati again, who will dutifully examine the autopsy report and come up with an equally inane “explanation” for Maggiore’s death as he did for Eliza Jane’s</p> <p>There are at least three tragedies in this sad tale. The first was the death of EJ at such a young age. She was sacrificed on the altar of her mother’s cultish refusal to accept the overwhelming scientific consensus that HIV causes AIDS and that antiretroviral therapy can not only prolong life but decrease the risk of maternal-fetal transmission of the virus. The second is that since the mid-1990s Maggiore has done a lot to spread the pseudoscience and misinformation that claims that HIV does not cause AIDS. Perhaps the worst of her offenses was that she discouraged at-risk women from being tested for HIV and HIV-positive women to take antiretroviral drugs during pregnancy to reduce the risk of maternal-fetal transmission of HIV. Moreover, she was undoubtedly a leader and spokesperson of the HIV/AIDS denialist movement, which is why denialists are now trying to hard to deny that her death might have been due to HIV, as Seth Kalichman documents. The third tragedy is that Maggiore had another child, a son. Fortunately, he appears to have escaped having HIV transmitted to him by his mother. Unfortunately, he and his father are left mourning the deaths of his sister and mother, whose deaths occurred a mere three years apart.</p> <p>I have almost no hope that this tragedy, whatever the cause of Christine Maggiore’s death is determined to be or not to be, will silence HIV/AIDS denialists or even make them truly “rethink” their position, I do hope that Maggiore’s survivors, her husband Robin and her son Charlie, can somehow find some peace and manage to get on with their lives after their mourning is finished. A cultish ideology claimed at least one, and probably both, of them.<br /><em><br />David H. Gorski, MD, PhD, FACS is a <a href="http://www.surgicaloncologist.com/">surgical oncologist</a><br /> specializing in breast cancer and an Associate Professor of Surgery at<br /> the Wayne State University School of Medicine based at the Barbara Ann<br /> Karmanos Cancer Institute. He blogs at <a target="_blank" href="http://www.sciencebasedmedicine.org">Science-Based Medicine</a>.</em></p> Features Tue, 06 Jan 2009 17:11:00 +0000 AIDSTruth 115 at http://www.aidstruth.org/new Christine Maggiore's Death: Lessons from A Tragedy http://www.aidstruth.org/new/features/2009/christine-maggiores-death-lessons-tragedy <p>&lt;!--break--></p> <p style="margin-bottom: 0cm;"><img alt="" style="margin: 4px; width: 150px; height: 187px;" src="http://www.lacitybeat.com/site_images_upload/legacy/media/157/24cvr_story.gif" align="left" />The death from pneumonia of AIDS denialist Christine Maggiore, 52, is eliciting sadness but no surprise from HIV researchers, AIDS activists, and clinicians.&nbsp; The known facts of the Maggiore case follow the tragic arc of HIV disease in untreated HIV-infected women.&nbsp; Christine Maggiore was HIV-positive, rejected medical care, gave birth to two children, one of whom died at three of AIDS, and then died herself, about 16 years post diagnosis, of prolonged pneumonia, which is a common consequence of HIV infection.<a class="sdendnoteanc" name="sdendnote1anc" href="#sdendnote1sym"><sup>1</sup></a> These events are consistent with mother-to-child transmission and HIV disease progression to where antiretroviral treatments are not available.</p> <p>These untimely deaths were unnecessary: they could almost certainly have been prevented by appropriate medical treatment.&nbsp; The still greater tragedy is that Christine Maggiore spent almost 15 years persuading other people with HIV to follow her example, and many of these have died.&nbsp; We hope that the terrible lesson in the deaths of Eliza Jane and Christine will be heeded by those who are still alive: HIV will almost always lead to AIDS and death in those who are untreated, and refusing to believe that this is so offers no protection from the virus.</p> <p>Ms. Maggiore reportedly first tested positive for HIV, the virus that causes AIDS, in 1992.&nbsp; Unwilling to accept the challenges of her diagnosis and under the influence of Berkeley denialist Peter Duesberg, who has never done research on HIV, Maggiore adopted the scientifically indefensible position that HIV does not cause AIDS, known as AIDS denialism.&nbsp; On this basis she refused anti-retroviral therapy for herself and to prevent transmission to her children, whom she breastfed despite the known risks. When her untested 3-year-old daughter become desperately ill in 2005, Maggiore did not disclose to hospital personnel that HIV was a possible underlying cause, and the little girl died.&nbsp; While information about the underlying causes of the pneumonia that took Maggiore’s life is not yet available, deaths from pneumonia among otherwise healthy women in their early 50s are extremely rare.&nbsp; At this time, it is not known if the family will allow an autopsy to be performed.</p> <p>We urge her family and supporters to have an official autopsy performed and to publish the full facts of her illness and death.&nbsp; Christine Maggiore’s visibility and influence were based on the details of her personal story, and specifically on her claim that despite her HIV diagnosis she and her family were vibrantly healthy without medications. Maggiore wrote a book and founded an organization, Alive and Well AIDS Alternatives, that promoted AIDS denialism and encouraged the rejection of HIV science and the medical advances in treating the virus that have sharply reduced HIV-related deaths in the United States and elsewhere.&nbsp; She met the former South African president, Thabo Mbeki, and encouraged his denialist policies that have recently been found to have resulted in <a target="_blank" href="http://www.aidstruth.org/new/denialism/deaths">more than 300,000 preventable deaths</a> in that country. Maggiore’s own life and her healthy family were the evidence she offered for her denialist claims.&nbsp; Now, the two family members known to be HIV positive are dead, and those known to be uninfected (her husband and son) are alive.&nbsp;&nbsp; Her survivors and supporters have a moral obligation to make all the facts public.&nbsp; Anything less can be reasonably assumed to be a cover-up.</p> <p>Maggiore certainly acted in accordance with her misguided beliefs: during her two pregnancies, she refused the perinatal anti-viral treatments and formula feeding that would have sharply reduced the likelihood of mother-to-child HIV transmission from about 25% to less that 2%.&nbsp; In 2005, three-year- Eliza Jane died of AIDS-related pneumocystis pneumonia.&nbsp; (Her son, Charlie, reportedly tested negative for HIV after his sister’s death: since a majority (75%) of children of women with HIV are not infected even without prophylaxis, his status does not suggest that Maggiore was not herself infected.)</p> <p>HIV denialists immediately rejected the role of AIDS in her death, noting that she had lived for 16 years without antiviral treatment since her first positive test.<a class="sdendnoteanc" name="sdendnote2anc" href="#sdendnote2sym"><sup>2</sup></a> But 16 years isn't outside the normal progression for untreated HIV infection. At 10-15 years post-diagnosis, about 10% of those infected, who do not suffer rapid immune suppression.&nbsp; Most of these still eventually progress to AIDS—about 86% by 18 years after diagnosis.&nbsp; Christine Maggiore’s infection, illness, and death are entirely consistent with HIV/AIDS, and unless a legitimate, official autopsy by a licensed M.D. pathology team can conclusively prove that she was uninfected and that her immune system was healthy, the cause of her death should be considered "AIDS-related pneumonia."</p> <p>The story of Christine Maggiore interweaves several tragedies.&nbsp; Eliza Jane and her mother are both dead.&nbsp; The lives of Christine’s husband and her young son have been devastated. Hundreds, perhaps thousands, of other people with HIV have been persuaded by HIV denialists to reject the best available treatment, and have become ill and died.<a class="sdendnoteanc" name="sdendnote3anc" href="#sdendnote3sym"><sup>3</sup></a> In South Africa, official denialism killed hundreds of thousands. If anything good were to come from this tragic story, it would be the end of AIDS denialism.</p> <div id="sdendnote1"> <p class="sdendnote"><a class="sdendnotesym" name="sdendnote1sym" href="#sdendnote1anc">1</a> If the pneumonia is recurrent and/or of the genus Pneumocystis (carinii) jiroveci (also known as PCP), it is considered an AIDS-defining condition in HIV-infected persons. See Stringer JR, Beard CB, Miller RF, Wakefield AE. A new name (Pneumocystis jiroveci) for pneumocystis from humans. Emerg Infect Dis [serial online] 2002 Sep;8. Available from: <a target="_blank" href="http://www.cdc.gov/ncidod/EID/vol8no9/02-0096.htm">http://www.cdc.gov/ncidod/EID/vol8no9/02-0096.htm</a></p> </div> <div id="sdendnote2"> <p class="sdendnote"><a class="sdendnotesym" name="sdendnote2sym" href="#sdendnote2anc">2</a> Denialist supporters have theorized that she died as a consequence of an alternative detoxification cleanse a month before, or from grief and chronic stress in the aftermath of her daughter's senseless death.</p> </div> <div id="sdendnote3"> <p class="sdendnote"><a class="sdendnotesym" name="sdendnote3sym" href="#sdendnote3anc">3</a> Christine Maggiore was one of the last surviving visible, influential HIV-positive denialists.&nbsp; Most prominent denialists are HIV-negative: those who were HIV-infected <a target="_blank" href="http://www.aidstruth.org/new/denialism/dead_denialists">have either died</a> or abandoned denialism and sought ARV treatment with generally good results.</p> </div> Features Sat, 03 Jan 2009 02:40:45 +0000 AIDSTruth 111 at http://www.aidstruth.org/new Discovery of HIV recognised with Nobel prize http://www.aidstruth.org/new/story/08-oct-discovery-hiv-recognised-nobel-prize <p><span class="inline inline-left"><a href="http://www.aidstruth.org/new/sites/default/files/images/LucMontagnier1995_065.preview.jpg" onclick="launch_popup(101, 503, 640); return false;" target="_blank"><img src="http://www.aidstruth.org/new/sites/default/files/images/LucMontagnier1995_065.preview.jpg" alt="Luc Montagnier" title="Luc Montagnier" class="image image-preview " width="120" /></a><span class="caption" style="width: 120px;"><strong>Luc Montagnier</strong></span></span>The Nobel prize for Physiology or Medicine has been awarded to Luc Montagnier and Francoise Barre-Sinoussi for their work on the isolation of HIV (as well as Harald zur Hausen for the discovery of Human Papillomavirus as a cause of cervical cancer).</p> <p>A brief history of discovery of HIV may be helpful in putting the recent awarding of the Nobel prize in perspective. There has been a great deal of controversy over the award recognizing the contribution of the French team while ignoring the contribution of the US/Gallo team. The real story of the history is not well understood by either the media or the public. Unfortunately, it seems that the Nobel Committee also lacks some of the facts, or has chosen are narrow interpretation of what was important in the early discoveries.<br /> &lt;!--break--><br /> In February of 1983, Luc Montagnier's group at the Pasteur Institute published a report of finding a previously unknown virus in a lymph node taken from a person with risk factors for AIDS, in particular large swollen lymph nodes. At the time it was only a theory that Lymphadenopathy Syndrome (LAS) was a precursor to AIDS, since there were many other conditions which could produce similarly swollen lymph glands. But when swollen lymph nodes were found in otherwise healthy young gay men, it was believed to be a possible indicator that AIDS would follow. While this is no longer considered a necessary indicator today, it was perhaps the best available in the early 1980’s. A team of French clinicians who were working with people with the new disease brought the tissue sample to the Pasteur for analysis. As I understand it, prior to that, the people at the Pasteur Institute (Montagnier, etc.) were not specifically working on AIDS. A group of 21 French and British clinicians published a letter in one of the journals in the late 1990's asserting the importance of their own role in the discovery of HIV and in collecting the lymph tissue for analysis. They subtly complained that the group at the Pasteur may have been given too much of the credit while their own contribution had been completely overlooked. </p> <p>The Montagnier paper of 1983, however, did not prove that the virus they had isolated was the cause of AIDS. Based on the data they had at the time, all they could conclusively say was that they had found a previously unknown retrovirus virus in the lymph tissue of a person suspected of having the new disease. Francois Barre-Sinoussi had taken the lead in the isolation of the virus and the determination that it was a retrovirus, while Montagnier was given more of the public credit as the head of the lab. This was reflective of the hierarchical organization of French science at the time. Barre-Sinoussi had worked previously for a period in Gallo's lab at the NCI and the two groups shared information and technology on how to detect reverse transcriptase, a key marker of the presence of a retrovirus. Around the same time, Gallo reported having independent isolates of a virus which he acknowledged may have been the same as the French had found, though initially he believed it a member of a related but different family of viruses. </p> <p>Cut to April of 1984. A little more than a year later, the Gallo team simultaneously published 4 papers in Science which collectively demonstrated that the virus was the cause of the disease and was sexually transmitted. One of the papers demonstrated a method for growing the virus in quantity in cultures, something not reported by the French team but which was critical for fully characterizing the virus and making a test to detect it. One of the other four papers demonstrated a method for making a blood test to detect the virus, a method that was soon licensed to private industry for commercialization. The Gallo team reported that by then they had dozens of isolates of the virus of their own, though history and DNA testing later showed that nearly all stored samples, on both sides of the Atlantic, had been contaminated by the original French virus, which turned out to be one of the most aggressive ever isolated. Even the French team’s later isolates were contaminated in the same way. The fact that early tests showed the French and US virus to be exactly the same led to charges that Gallo had “stolen” the French virus and used it to conduct his studies and develop the blood test. The later finding that the original French virus had contaminated all the early labs was key to overcoming the charge that Gallo's group "stole" the French virus. </p> <p>Disputes broke out between the US and the French almost immediately after the publication of the Gallo teams four papers in Science. The disputes began when the US Department of Health and Human Services (DHHS) called a press conference to announce the 4 Gallo papers and stated that the cause of AIDS had been firmly identified. The conference was called by Margaret Heckler, head of DHHS, not Gallo as is commonly believed. Gallo was in Europe at the time the press conference was called and had to be rushed back to the US to attend. The press conference was originally planned for a later date at the time when the papers were to be published and when both the French and US teams would be present. However, the story leaked to a reporter who threatened to make it public almost immediately. DHHS decided the only way to regain control was by calling an immediate press conference. Gallo arrived back in the US in the early morning hours and was rushed to the site of the press conference. But unlike in the original plan, there had been no time to get the French team to the US in time for the conference. The original script for the press conference, which still exists today, included full recognition of the French role in first finding the virus and their collaboration with the US team, but on the day of the press conference, Heckler was ill with the flu and insisted on cutting the meeting short. She ended the press conference before the part about the French could be read, setting off an international incident. The French team was understandably insulted. All of this is well documented. </p> <p>While it is great to see the work on AIDS finally recognized, many think it was unfair to simply give the Nobel to the French team. Yes, the first discovery of the virus was indeed important, but that first discovery left a great deal to be done before it would lead to useful outcomes. It did not prove that the virus was responsible for the disease, nor did it provide technology for growing the virus in quantity or making a blood test. The work of the Gallo team was at least equally important, in that it demonstrated the link between the virus and the disease by demonstrating evidence of sexual transmission and blood-borne transmission from transfusions. It showed how to grow the virus in cultures and how to make a blood test to detect it. It's pretty hard to separate the two different contributions as each was critical to moving forward on treatment, testing and pathogenesis. The snubbing of Gallo seems to be more about the political battle between the French and US governments over revenues from the blood test, thought it will be felt more by Gallo and his team.. </p> <p>I believe that Gallo has long gotten the worst of everything for his contributions. For nearly a decade he was accused of stealing the virus, until DNA testing showed otherwise. He was accused of writing the French out of the picture in the US press conference, when in fact he was the one who had written them in and was not responsible for cutting the conference short. He and his team were accused of misconduct and suffered thru many years of federal investigations, all of which ultimately went nowhere. All the negative verdicts were overturned on appeal. While some place great emphasis on the internal accusations of misconduct, the fact is that of all the investigations, the only one in which Gallo was allowed to cross examine the accusers and defend himself was the Appeals process. The outcome of that process was a complete exoneration. So what we have is a man, and a whole team of his investigators, who made discoveries which have clearly saved millions of lives, and for this they have suffered years of public humiliation. And now to top it off their scientific contributions are being overlooked and all credit is given to a team they had collaborated with instead. Gallo and Montagnier have written a number of joint histories of the discovery of HIV which outlined their various contributions and shared credit. </p> <p>Bob Gallo can be controversial for sure and the fight over the blood test patent cost the French huge amounts of money (though that was caused not by Gallo but by the US Office of Technology Transfer, a Reagan era creation). But does he deserve the way he has been treated, either by history or the Nobel Committee? Whatever the reason, I think it is unfortunate and unfair to Bob. It is a little ironic though that Bob is still recognized world-wide as the "co-discoverer" of HIV. I wonder how the Nobel Committee got around that. Of course, this is the same Nobel Committee that once gave the award to Kary Mullis, a famed HIV denialist. </p> <p>Fortunately, Bob Gallo has shown himself to be above his critics. He has responded to the Nobel decision only with congratulations to his French collaborator and a complete lack of criticism of the Nobel Committee.</p> Features Sun, 12 Oct 2008 20:34:30 +0000 AIDSTruth 91 at http://www.aidstruth.org/new Zackie Achmat: Crimes of the great denialist http://www.aidstruth.org/new/story/08-sep-zackie-achmat-crimes-great-denialist <p><b>by Zackie Achmat</b></p> <p><span class="inline inline-right"><a href="http://www.tac.org.za"><img src="http://www.aidstruth.org/new/sites/default/files/images/Zackie Achmat.jpg" alt="Zackie Achmat: South African AIDS activist" title="Zackie Achmat: South African AIDS activist" class="image image-preview " width="120" /></a><span class="caption" style="width: 120px;"><strong>Zackie Achmat</strong><br />South African AIDS activist</span></span>On September 20 2008, as South Africa’s newly acquired Gripen fighter jets took off from a local air show to parade across Cape Town skies, residents would awaken to one of the most remarkable days in the political history of the republic. The Mbeki-Pahad monolith had collapsed.</p> <p>The decision by the ANC to recall President Thabo Mbeki represents the downfall of the most hubristic executive in contemporary South Africa, and one that has been characterised by the unrelenting denialism of the greatest threats facing our country -- the mounting failure of the criminal justice system to prosecute and convict criminals, the increasingly disturbing nature of violent crime, burgeoning inequality and unemployment, the HIV/Aids catastrophe and the culture of impunity for corrupt and incompetent public officials.</p> <p>The imposed resignation was long overdue. There were valid reasons to impeach Mbeki even before the Chris Nicholson judgement on three particular charges, all of which in their own right provide enough justification for such action.<br /> &lt;!--break--><br /> First his culpability in the death of hundreds of thousands of ­people in South Africa with HIV/Aids cannot be underestimated and its impact will be felt for generations. Death certification by Stats SA shows more than 1,5-million deaths in the ages 0-49 and more than two million new infections during his rule. The long-overdue roll-out of a comprehensive antiretroviral programme, compounded by state-sponsored pseudo-science, has left 524 000 people desperately in need of the life-saving treatment unable to access it. As a direct result life expectancy has dropped every year Mbeki has been in office.</p> <p>Second is the indisputably corrupt nature of the arms deal, in which he ruthlessly covered up the extent of the venality of European companies, ANC politicians and business people associated with the deal. Mbeki’s downfall coincides almost eight years to the day (September 15 2000) when the Auditor General reported to Parlia­ment that the arms deal departed from procurement practices in terms of conflicts of interests and the exclusion of price as criteria in the selection of the companies.</p> <p>Parliament then established a joint investigation team (JIT) comprising the Auditor General, the National Prosecuting Authority and the Public Protector. In November 2001 the JIT report was finally released. The original report confirmed the Auditor General’s earlier findings, but it was amended by the executive under Mbeki to exonerate Cabinet and MPs. Here is the smoking gun of executive lawlessness. The tampering with the JIT report should be explained by Mbeki in a high court trial should he wish to clear his name.</p> <p>Last is the criminal breach of the separation of powers based on the two issues outlined above, which led to the undermining of Parliament, the Medicines Control Council led by Peter Eagles, the Medical Research Council led by Anthony Mbewu, the Human Rights Commission then led by Barney Pityana, the Public Protector, the Commission on Gender Equality, Scopa, the Auditor General, the National Prosecuting Authority and others.</p> <p>Mbeki’s failure of principle, and the consequent executive lawlessness and culture of impunity, from Manto Tshabalala-Msimang to Alec Erwin and Jackie Selebi, has undermined democracy, the rule of law and freedom. Corruption has entered the body politic like a malignancy everywhere, from Travelgate to local government, Schabir Shaik, Fidentia and deals on nuclear power.</p> <p>The ANC leadership, under its president Jacob Zuma, must now guarantee four critical elements to stabilise and rebuild South and Southern Africa:</p> <p>First it must guarantee that the rights enshrined in the Constitution, the founding values of open, accountable and responsive government based on the rule of law and the supremacy of the Constitution will be respected.</p> <p>Second the violent rhetoric of thugs such as Julius Malema -- underscored by the physical violence at ANC branches across the country -- against political opponents and the judiciary demands unequivocal condemnation by every ANC, Cosatu and civil society leader.</p> <p>Third Kgalema Motlanthe, the new acting president of the country, must appoint a commission of inquiry into the arms deal immediately. Leaving corruption intact will undermine the legitimacy of all governance by the ANC. The arms deal must be cancelled because of the corruption and the past and future drain on resources to rebuild our country.</p> <p>Finally the ANC must develop a clear vision to rebuild our country’s safety and security, education and health systems, based on sound economic policies that address the structural inequalities based on class, race and gender and affirm a mixed economy. This must be accompanied by an action plan for democracy, the rule of law and economic integration in Southern Africa.</p> <p><a href="http://www.mg.co.za/article/2008-09-27-crimes-of-the-great-denialist" target="blank_">First published in the Mail &amp; Guardian</a>.</p> Features Sun, 28 Sep 2008 18:07:08 +0000 AIDSTruth 89 at http://www.aidstruth.org/new AIDS Denialists Lie About More than HIV: Deception and Duplicity among the “Dissidents” http://www.aidstruth.org/new/features/lying-denialists <p>HIV denialists boast that they oppose the science-driven “AIDS orthodoxy,” and many people who distrust medicine find this self-ascribed rebel stance appealing. But the denialists paradoxically idealize the very “establishment” they claim to reject. This is manifested in a striking pattern of exaggerations and outright lies from denialists about their institutional positions, scientific qualifications, and publications, and their false and often fraudulent claims of support from legitimate scientists and doctors. Some of these lies are symptoms of denialists’ delusions that they are knowledgeable and important, while others are part of a systematic effort to deceive a vulnerable public. In both cases, the denialists’ lies about themselves are a dimension of their lies about HIV and AIDS. </p> <p><a href="http://www.aidstruth.org/new/sites/default/files/lying-denialists_0.pdf">Read the full article</a>.</p> Features Sat, 02 Aug 2008 00:22:16 +0000 AIDSTruth 81 at http://www.aidstruth.org/new Mr Duesberg goes to Washington http://www.aidstruth.org/new/mrduesberg-goes-to-washington <p>News reaches us of yet another farcical event in the life of the 'Rethinking AIDS' group. RA's media expert (sic), David Crowe has been trumpeting the news that Peter Duesberg and Celia Farber were supposed to collect "Clean Hands" awards from the Semmelweiss Society, as part of "Whistleblower Week in Washington". These awards come from a fringe group, and have no scientific or political significance. And yet even this non-event turned into farce, as it so often does when RA gets involved. We would like to thank Liz Ely for bringing us into the loop with another misrouted email (Hey Liz, are you being taught by <a href="http://www.aidstruth.org/documents/AndrewManiotis.pdf" target="blank_">Andy Maniotis</a>?). In any case, you're doing a fine job as RA's new publicist, so well done on your first major project! It won't be long before you're as successful in this role as David himself was. We think back fondly to when he gave AIDSTruth such valuable help in winning the "Battle of the BBC" with his brilliantly judged, <a href="http://scienceblogs.com/aetiology/2007/10/bbc_apologizes_for_promotion_o.php#comment-615391" target="blank_">superbly timed press release</a>!<br /> &lt;!--break--><br /> Protests from the TAC and some individual gay men alerted the meeting organizers to the view that giving a whistle-blowing award to Duesberg and Farber would be akin to honoring Saddam Hussein for field-testing chemical weapons so successfully. As a result, the organizers finally did due diligence on just who they were dealing with, and decided not to make the award in public, fearing a hostile reaction from the audience. Farber and Duesberg had a "debate" about which of them was the most "radioactive" and whether either of them should withdraw to save the other, rather missing the point: Both of them have blood on their hands, particularly the blood of the South Africans that Duesberg so insultingly dismisses as "Schwartzes" and the gay men he calls “homos” (see <a href="/new/denialism/duesberg_homophobia" target="blank_">here</a> and <a href="/new/news/discover" target="blank_">here</a>). We should never forget that Duesberg formulated the propaganda that Farber preaches, just as Tariq Aziz did for Saddam Hussein in their day.<br /> We were also pleased to note that no less a luminary than Michael Geiger drove, uninvited, all the way from San Diego to Washington to take part in this oh so important event. But when he tried to make his views on HIV/AIDS known to the organizers, he was asked to leave the meeting he’d gate-crashed! Clearly, a “private meeting on sensitive political matters” is not a suitable environment for nutty old Michael. Never mind Michael, if you keep the receipts, RA will reimburse you for your gas, even when it's up there at $4 a gallon! And don't worry about the time you wasted making the trip, as you never do anything useful anyway (at least, not useful to the RA group). </p> <p>And even Anthony "Tony Baloney" Liversidge tried to "contribute" to the events, phoning in his views on HIV/AIDS only to taken for an anti-Duesberg, South African AIDS activist! The confusion is hardly surprising as Anthony's views are always expressed so incoherently that nobody can ever understand just what he's trying to say. </p> <p>The Semmelweis Society's involvement in this pathetic affair has a bitter irony. Dr. Semmelweis is remembered for his role in preventing mother to child transmission of lethal pathogens. In contrast, Duesberg and Farber are remembered for their efforts to kill new born children by restricting their mothers' access to the life-saving drugs such as AZT and nevirapine that prevent mother to child transmission of that lethal pathogen, HIV. If Dr. Semmelweis were alive today, he would be turning in his grave. Or perhaps the Semmelweis Society was acting satirically? </p> <p>Finally, our sincere sympathies go to Celia Farber for the stress she suffered during her taxi ride from the airport to the hotel. It must be tough not to get an upgrade to the front seat of a Yellow Cab, Celia! Or are you just running out of cash for the fare nowadays, after <a href="/new/denialism/harpers-farber" target="blank_">we blew the whistle</a> on the errors in your Harper’s Magazine article and exposed to the media world just how “radioactive” you truly are?</p> <p><strong>PS:</strong> AIDS Truth team members have since been in touch with various professional organizations linked to this awards ceremony, further explaining just what the RA group is and the nature of its perverse, anti-science, anti-health agenda. Doors are now slamming all over Washington, phones will go unanswered, lunches uneaten. This has been yet another political fiasco for the RA group, which never seems to realize that no rational person will ever give them the time of day, once the shroud of deceit is lifted and the reality exposed.</p> Features Wed, 14 May 2008 22:19:54 +0000 AIDSTruth 62 at http://www.aidstruth.org/new Mbeki's AIDS denial - Grace or folly? http://www.aidstruth.org/new/features/gumede <p>by William Gumede</p> <p><em>This is a chapter from William Gumede's book <a href="http://www.amazon.com/Thabo-Mbeki-Battle-Soul-ANC/dp/184277848X/ref=pd_bbs_2?ie=UTF8&amp;s=books&amp;qid=1210281969&amp;sr=8-2" target="blank_">Thabo Mbeki and the Battle for the Soul of the ANC</a>.</em></p> <h2>Part I</h2> <p><cite>For too long we have closed our eyes as a nation, hoping the truth was not so real. For many years, we have allowed the HI virus to spread, and at a rate in our country which is one of the fastest in the world. <strong>– Thabo Mbeki, 9 October 1998</strong></cite></p> <p><cite>Now ... the poor on our continent will again carry a disproportionate burden of this scourge – would if anyone cared to ask their opinions, wish that the dispute about the primacy of politics or science be put on the backburner and that we proceed to address the needs and concerns of those suffering and dying. <strong>– Nelson Mandela, 13 July 2000</strong></cite></p> <p><cite>It is important that we recognise that we are facing a major crisis and that we want to invest as many resources as we did when we fought against apartheid. This is not a state of emergency but it is a national emergency. <strong>– Archbishop Desmond Tutu, 30 November 2001</strong></cite></p> <p>As his international AIDS Advisory Council met for the first time, Thabo Mbeki mulled over the words of Irish poet Patrick Henry Pearse: ‘Is it folly or grace?’<br /> &lt;!--break--><br /> Notwithstanding the conclusions of mainstream scientists almost a decade before, Mbeki set up the council to examine both the cause and most effective way of treating acquired immune deficiency syndrome (AIDS) in developing countries. His ‘folly’ in reopening the debate on what causes AIDS rather than focusing on practical ways to curb the pandemic sweeping Africa was roundly condemned. ‘Stop fiddling while Rome burns,’[1] chided Desmond Tutu, former Archbishop of Cape Town. But AIDS denial is not the exclusive province of presidents. Mbeki’s controversial health minister, Manto Tshabalala-Msimang, enthusiastically prescribed an alternative therapy that sounded more like a salad dressing than treatment for a sexually transmitted disease that kills around 600 South Africans a day[2].</p> <p>After years of foot-dragging and obfuscation, the South African government finally rolled out antiretroviral drugs that could save the lives of millions at state hospitals two weeks before voters went to the polls in April 2004.The long-awaited plan to distribute ARVs to an estimated 5 million people had been approved in November 2003, but due to what officials claimed were ‘capacity constraints’, patients had to wait another five months for the first drugs to reach them.</p> <p>Few were surprised when AIDS activists questioned the government’s timing and motives. ‘Even though we welcome the roll-out plan, we have mixed feelings about whether the government reached a turning point because of elections, ’said Tembeka Majali of the Treatment Action Campaign (TAC), the country’s most vocal and visible AIDS activist group.</p> <p>Before the limited public roll-out, fewer than 20000 South Africans were taking ARVs, as only those with expensive private medical insurance could afford them. Zackie Achmat, head of the TAC and the country’s best-known AIDS activist, only started taking ARVs towards the end of 2003 after refusing for years to avail himself of the life-giving drugs until the government agreed to offer treatment through the public health system.</p> <p>Leading black gay activist Simon Nkoli,a close friend of Achmat, died in 1998 after contracting AIDS-related thrush. He was among the millions who could not afford the drugs, and at his funeral Achmat announced that he was launching a campaign to make ARVs available to poor South Africans.[3] He had learnt that a single dose of the generic version of fluconazole, used to treat thrush but not sold in South Africa because of international patent laws, cost just eighty cents.[4]</p> <p>Government blamed lack of efficacy, potential toxicity and high costs for ARVs not being made available at state expense, but scientific evidence indicates that the drugs are highly effective against mother-to-child transmission of HIV and, at least in the short term, the benefits appear to outweigh the risks.</p> <p>In Europe, North America and Brazil, ARVs have reduced mortality due to HIV/AIDS-related illnesses by between 50 and 80 per cent. In South Africa, two critical barriers remain to the widespread availability of these life-saving medicines and a possible nett saving on the health budget in the long run: lack of political will, and resistance on the part of patent holders to generic competition.</p> <p>Pharmaceutical companies are protected by intellectual property rights policed by the World Trade Organisation from the manufacture or import of cheaper versions of their drugs. The corporate view is that high prices are necessary to recoup research and development costs.</p> <p>However, generic anti-AIDS drugs are sold in India for a quarter of the price charged by the big pharmaceutical companies, and have the added advantage of Thabo Mbeki and the battle for the soul of the ANC combining three drugs in a single pill that has to be taken twice a day. The Western ARV protocol requires patients to take up to twelve pills – all produced by different companies – a day, at different times, some with water, some without. Despite the obvious advantages of a simplified regimen, South Africa succumbed to pressure from the West and opted for the more expensive and complex therapy in its limited ARV roll-out.[5]</p> <p>Private health care in South Africa makes up around 70 per cent of the total national budget, yet only about 7 million of the country’s 44 million citizens can afford private health insurance. The rest depend on government services. Until 1999, medical aid funds were allowed to cherry-pick their paying members, and typically accepted young, healthy, low-risk candidates.</p> <p>The poor and unemployed were generally excluded due to the high premiums, and relied on the state for health care. An Act of Parliament put a stop to the rejection of certain candidates by insurance carriers, but most South Africans still cannot afford the astronomical costs of private care.</p> <p>Drug costs are a significant factor in the national health budget. Only medication that is included on a list of essential drugs is available within the state system, and generics are encouraged where possible. When no generics exist, the health department buys in bulk from the pharmaceutical industry via a tender system. Drug companies have fiercely resisted parallel imports of cheaper generics, insisting that their patents be respected.</p> <p>The social, economic and health consequences of AIDS for South Africa are devastating. Particularly harrowing has been the rise in the number of orphans and the emotional impact on millions of children who will grow up without parents. Not only are crime and social instability destined to follow in the wake of the pandemic, but current and future demands on the state coffers are astronomical. In alliance with COSATU, the SACP, churches and social organisations, the TAC has been at the forefront of attempts to shift government’s head-in-the-sand AIDS policies. The cabinet plan released in November 2003 promised that government would establish a network of centres for distribution of ARVs, beef up efforts to prevent transmission of the virus and increase support for families affected by HIV/AIDS.</p> <p>The cost of offering treatment to all South Africans with AIDS by 2010 was estimated at between $2.4 billion and $3 billion a year. The cabinet cited the lower costs of ARVs as a major factor in the decision to go ahead with the roll-out, noting: ‘New developments pertaining to prices of drugs, the growing body of knowledge on this issue, wide appreciation of the role of nutrition and availability of budgetary resources [had] allowed government to make an enhanced response to AIDS.’[6]</p> <p>But why had it taken so long to reach this point?</p> <p>In the heady days following the unbanning of the ANC, little attention was given to AIDS. Although alarm bells were ringing, South Africa’s collective political focus was on the delicate and engrossing negotiations for a democratic dispen- sation. The apartheid regime had been deaf to calls for action, seeing AIDS largely as a disease that affected gays and blacks, constituencies the previous government was not particularly interested in, and was most prevalent among migrant workers from the southern African region.</p> <p>AIDS was not high on the first democratic government’s ‘to-do’list either. The ANC alliance’s priority was trying to hold the fractured country together while getting to grips with governance, delivery and the economy. AIDS was one among many seemingly less urgent problems.</p> <p>Given South Africa’s combustible social mix – a large migrant population, people displaced because of apartheid, the breakdown of traditional family bonds, a labour system that keeps men away from home for most of the year – it is hardly surprising that AIDS struck with such devastation. But when the full realisation sank in, there was first denial, then perplexity, and finally escapism, as confronting the situation became mired in foolish debate over what had caused the pandemic in the first place.</p> <p>During his term of office, Nelson Mandela effectively ignored AIDS, avoiding the subject on the grounds that, in his culture, an elder did not publicly discuss sexual issues.[7] Since then, he has recognised the severity of the problem and become deeply involved in efforts to stop the spread of AIDS.</p> <p>When Mandela assumed the presidency of the ANC in 1991, SACP general secretary Chris Hani and future health minister Nkosazana Dlamini-Zuma were the ANC’s most vocal harbingers of a looming crisis.[8]As deputy president, Mbeki barely mentioned AIDS, except for allusions in a couple of speeches to the disease being as great a threat as poverty in the new South Africa.</p> <p>In fact, the AIDS time bomb threatened to decimate the world’s youngest democracy unless vast resources were made available to defuse it, but the initial response of the ruling elite was ‘this isn’t happening to us ... it cannot be as bad as people say’.[9]</p> <p>But it was.</p> <p>The ANC in exile had held a number of meetings on HIV/AIDS, and the first paper on the disease published in South Africa in 1985 forecast that it would remain largely confined to male homosexuals, as had been the case in America and Europe up to that time. In the same year, the government appointed an AIDS advisory group, followed six years later by a network of training, information and counselling centres.</p> <p>In 1992, the ANC’s health secretariat, the government, non-governmental organisations, AIDS service organisations, representatives from business, trade unions and churches, and a diverse group of concerned individuals set up the National AIDS Coordinating Committee of South Africa (NACOSA). In the spirit of the CODESA talks, it was instructed to reach consensus on a national AIDS strategy for the new South Africa.</p> <p>Their plan, adopted in July 1994,recommended the pooling of large amounts of money from government and donor organisations for expenditure on countrywide education and prevention programmes.</p> <p>First, however, an AIDS infrastructure had to be established. The centrepiece was a special directorate in the department of health, and the government also appointed a ministerial AIDS task team, headed by Mbeki. Awareness campaigns and support for an HIV vaccine initiative followed.</p> <p>By early 1996,it became apparent that the plan was full of holes. Much of the intended funding was diverted by the Treasury to more pressing needs, while money that was allocated to the health department remained unspent as the AIDS plan was buried by competing priorities in a health system in transition. Many of the AIDS policy targets were never attained.</p> <p>Public controversy followed revelations that a hefty chunk of the AIDS budget – R14.27 million – had been spent on Sarafina II.The musical production by acclaimed playwright Mbongeni Ngema was designed to raise AIDS awareness among African youth,but the critics panned it as an ineffective and costly failure in terms of relaying the anti-AIDS message. Worse, it emerged that normal tendering procedures had been bypassed in awarding Ngema the funds, and the production was scrapped in midstream.</p> <p>The resulting scandal strained the bond between government and AIDS activists. Opposition parties, the media and many NGOs unleashed a barrage of attacks on the health minister, who withdrew into a defensive shell. Government and Ngema claimed the criticisms were anti-government, anti-black and racially inspired,and on the eve ofWorld AIDS Day in 1996,activists and health workers denounced the entire National AIDS Plan as a shambles, greatly angering both Dlamini-Zuma and Mbeki.</p> <p>The furore erupted just as the gloss of freedom was starting to give way to grassroots anger over non-delivery and thwarted expectations. Acutely sensitive to criticism, especially when it emanated from the ANC camp, political home to most of the AIDS activists, the government lashed out in anger. At the party’s national conference that year, President Mandela railed against NGOs that stood in judgement of government.</p> <p>The dust had hardly settled when a new AIDS scandal broke out.</p> <h2>Part II</h2> <p>Pambazuka News continues to serialize William Gumede's chapter on Mbeki and the controversies surrounding his AIDS policies. This is from his book "Thabo Mbeki and the Battle for the Soul of the ANC." Be sure to look for parts three through five in upcoming issues.</p> <p>In 1996,researchers linked to Pretoria University and representing a biotech company called Cryopreservation Technologies claimed they had found a cure for AIDS.[10] Zigi Visser and his ex-wife Olga lobbied senior officials in the department of health and in the ANC, who put them in touch with Nkosazana Dlamini-Zuma.</p> <p>The go-between, Joshua Nxumalo, a former MK cadre, played a crucial role in setting up meetings between the Virodene drug researchers, Dlamini-Zuma and eventually Mbeki. Nxumalo was later part of a BEE consortium that bought the rights to Virodene. Dlamini-Zuma was sufficiently impressed with the Vissers’ report on their research to secure a quicker meeting with Mbeki, then deputy president and whose diary was notoriously almost always full. The Vissers were looking for government endorsement and money. Their scientific peers had been sceptical. The Medical Control Council had refused to issue the company with a licence to produce Virodene. Following a review of their research, the MCC, Gauteng health department and senior scientists at the University of Pretoria had rejected the application for a licence on the basis that the drug was ineffective, even dangerous. The Pretoria group hoped that Mbeki would prove more receptive. Shortly before Christmas 1996,Dlamini-Zuma and Mbeki set aside protocol and convention and secured for the researchers a cabinet hearing for their preliminary findings, which had not been subject to peer review.</p> <p>The Virodene researchers arrived at the Union Buildings in January 1997 with a posse of ‘cured’ patients who testified to the ‘positive’ effects of the treatment. An excited Mbeki had primed his colleagues well. The cabinet received the group warmly, and almost without question accepted the researchers ’claims[11] and their accusation that the MCC had rejected them because it was in cahoots with inter- national pharmaceutical companies.[12] Jakes Gerwel, Mandela’s cabinet secretary, said later that ministers were overwhelmed with ‘awe and pride ’as the Virodene researchers’ ‘patients’ related tales of miracle cures.[13] Mbeki would later write in the ANC’s journal Mayibuyewhat a ‘privilege’ it had been to hear the moving testi- mony of AIDS sufferers who had been treated with Virodene,with seemingly very encouraging results.[14]</p> <p>The Virodene team’s sales pitch was that not only was the product much cheaper, but it was also home-grown. The latter particularly aroused Mbeki’s interest. At the time, he and most of the cabinet ministers saw themselves as being under siege from a vast conspiracy of local white critics, black trade unions and civil society activists, Western governments and international business. The Virodene researchers appeared to be a godsend. The deputy president had already just about settled on an idea (after much contemplation) that would define his upcoming presidency.[15] Mbeki hoped his term of office would be defined by an African Renaissance, which would see the continent, under the leadership of a democratic South Africa, undergoing social, political and economic renewal that would finally make it an equal partner ofmore prosperous regions, especially the West. An important component would be African solutions for African problems.[16] Mbeki latched onto the Virodene proposal as a possible African solution to one of Africa’s greatest challenges.</p> <p>Virodene was later shown by an independent panel, led by the South African Medical Research Council, to contain dimethylformamide,a toxic industrial solvent used in dry-cleaning. A month after the Virodene researchers so persuasively addressed cabinet, the MCC announced that Olga Visser and her associates were flouting accepted testing norms, and promptly banned them from testing their product on humans. Mbeki and Dlamini-Zuma were severely embarrassed. Oppo- sition parties and the media hit out at the government. DA leader Tony Leon accused Mbeki of being obsessed with finding African solutions to every problem’.[17] He said Mbeki’s support for Virodene amounted to resorting to ‘snake oil cures’ and ‘quackery’.[18] The Sunday Times lashed out at a cabinet whose ‘combined technical knowledge of the HI Virus fits on the back of a postcard’.[19]Both Mbeki and Dlamini- Zuma viewed the attacks as racist, if made by whites or the political opposition, or personal, if made by blacks or those associated with the ANC family. Mbeki called Leon ‘the white politician’ who ‘practices in Africa’.[20] Dlamini-Zuma said bitterly:‘If they [Leon and the DA] had their way, we would all die of AIDS.’[21]</p> <p>Sadly, neither Mbeki nor Dlamini-Zuma admitted to being wrong, instead persistently presenting themselves as victims of racist baiting, and nursing grudges against their critics. In fact, Mbeki would continue to support Virodene’s pro- moters, later even mediating in a feud between the biotech company’s leading researchers.[22] Mbeki and Dlamini-Zuma now also saw the MCC, especially its chairman Peter Folb, as representatives of the ‘racist conspiracy’ against which battle must be joined. Folb was fired a year later.[23]Partly as a result of the Virodene conflict, Dlamini-Zuma abolished the MCC in March 1998 on the recommen- dation of a review team she set up to evaluate the council’s operations, which concluded that the MCC was too intimately linked with the pharmaceutical industry. A new institution, the Medicines Regulatory Authority, replaced the MCC in September 1998.In June 1998,a group of investors, including Nxumalo, who had originally introduced the Vissers to Dlamini-Zuma and Mbeki,bought the rights to their AIDS ‘cure’.[24] Virodene is not officially registered in South Africa, but it is still punted on the Internet as a cure for HIV/AIDS.[25]</p> <p>However dubious these early government forays into the AIDS field were, they were based on the accepted scientific consensus that HIV is the principal carrier of AIDS, rather than the dissident argument that the virus is a ‘harmless’ passenger, and that symptoms associated with AIDS are due to ARV therapy, malnutrition and poverty. From the Virodene saga onwards, the AIDS issue became racially charged in South Africa, and it has remained so. All future responses would be coloured by race, as had already happened in some parts of greater Africa, and even among some Afro-American groups who gave credence to the urban legend that the deadly virus had been brewed in a laboratory as part of a covert Western intelligence plot to decimate blacks – the CIA’s ‘final solution’. For example, a study conducted by the Rand Corporation and the University of Oregon revealed that almost half of all African-Americans believe that the virus that causes AIDS is man-made; more than a quarter believe it was produced in a US government laboratory; and one in eight thinks it was created and spread by the CIA.[26]</p> <p>Bizarre as they were, such rumours were fuelled by revelations from the mid-1990s that the apartheid defence force had run a top-secret germ warfare programme, which included experiments on ethnic-specific killer bugs. The Truth and Reconciliation Commission heard senior former security policemen confess that HIV-positive agents had been instructed to have unprotected sex with black prostitutes as part of a diabolical state-sponsored plan to spread the infection. In 1995,the South African government launched a battle against international tobacco companies by instituting stringent anti-smoking laws, and with the pharmaceutical giants over the high price of essential medicines.</p> <p>The ANC had worked hard to make medication more accessible and more affordable to the majority black population. This led to repeated skirmishes with drug manufacturers, and a protracted trade dispute with America and various countries in the European Union. At the heart of the matter was an amendment to the Medicines and Related Substances Control Act, which gave government the power to fast-track compulsory licensing and parallel imports of medicines.</p> <p>The government argued, correctly, that this was consistent with the World Trade Organisation’s Trade Related Intellectual Property Rights Agreement (TRIPS), which stipulates certain exceptions to normally strict commercial regulations. In times of health emergencies, for example, poor countries are allowed to circumvent patent laws in order to produce cheaper generic versions of desperately needed drugs. Compulsory licensing allows a country to manufacture a drug in such circumstances without the permission of the patent holder, provided that ‘adequate remuneration’ is paid to the company. Parallel importing permits a country to buy a drug from the lowest bidder without the consent of the patent holder. But there is huge resistance from developed countries and pharmaceutical companies to these concessions, and South Africa was placed on an American ‘watch list’ of potential offending countries. The drug manufacturers exerted enormous pressure, both directly and indirectly, on the South African government, outraging Mbeki, Dlamini-Zuma and the ANC leadership.[27]</p> <p>The pharmaceutical industry in the US lobbied the Clinton administration, which threatened sanctions if South Africa went ahead with plans to push through legislation to facilitate the import of cheaper generics. American vice-president Al Gore found support in the South African media and with opposition parties for his demand that the amendment be repealed.</p> <p>It was particularly galling for Mbeki, his policy guru Joel Netshitenzhe, his ‘enforcer’ Essop Pahad and his trusted ally Nkosazana Dlamini-Zuma to have their political opponents and the predominantly white-owned media support foreign opinion against what they saw as South Africa’s interests.[28]</p> <p>The tussle ended when thirty-nine companies joined forces under the banner of the Pharmaceutical Manufacturers’ Association of South Africa and took the government to court. They poured millions into their campaign, which was vigorously opposed by the government and, importantly, the TAC and several trade unions.</p> <p>Dlamini-Zuma herself was an energetic campaigner against both international pharmaceutical and tobacco companies. This made her very unpopular with busi- ness groups, so much so that many business leaders view the possibility that she could replace Mbeki as leader of the ANC at the end of 2007 with undisguised horror. Shortly before the 1999 elections, she told members of the TAC: ‘If you want to fight for affordable drugs, then I will be with you all the way.’[29] Marking the end of his first six months as president of South Africa, Mbeki launched a tough attack on pharmaceutical companies:‘(A)s long as [AZT] is only available at exorbitant prices, it is impossible for the government to make it available to ordinary people.’[30]</p> <p>In the face of local and international protests organised by the TAC, the pharma- ceutical companies reached an out-of-court compromise with the government and withdrew their legal action. By that time, the amendment to the Medicines Act, which applied to all drugs, not just ARVs, had become law.</p> <p>Finally, government seemed to waken to the gravity of the AIDS crisis. Billboards were erected, condom distribution increased and the ABC (Abstain, Beware, Condomise) campaign put in place. Yet, despite what amounted to a victory against the pharmaceutical companies, the government still refused to make ARVs available to the masses.</p> <p>Activists were enraged when the health department announced that AZT would not even be given to pregnant women as a matter of course. There was ample evidence that the drug greatly reduced the risk of foetal HIV infection, but the government stuck to its claim that AZT was both toxic and unaffordable.</p> <p>In December 1998, Zackie Achmat announced that he would go on a hunger strike until ordinary South Africans could be given ARVs at state hospitals. ‘On principle, I won’t take ARVs until they are freely available to the poorest,’[31]he said. His decision coincided with the TAC’s launch of a campaign to prevent mother- to-child infection. By 1999,an estimated 40 000 babies were being born with HIV in South Africa annually, their mothers too poor to pay $75 for a short course of AZT,which would lower the risk of transferral by half. The TAC would maintain its relentless pressure on the pharmaceutical companies for the best part of a year, with NGOs in America staging solidarity protests at various points on US vice- president Al Gore’s campaign trail until the threat of sanctions was withdrawn.</p> <p>The TAC’s sustained efforts to shame Western governments and highlight their indifference to the plight of AIDS victims in South Africa compelled President Bill Clinton to pledge in 2000 that the US would ensure that ‘people from the poorest countries won’t have to go without medicines’. His announcement came as the United Nations revealed that it had negotiated a deal with five multinational pharmaceutical companies to reduce the price of AIDS drugs in the developing world.</p> <p>The South African government’s response was guarded. Mbeki, Pahad, Netshitenzhe, Manto Tshabalala-Msimang, who had replaced Dlamini-Zuma as minister of health, and trade and industry minister Alec Erwin now argued that price reductions negotiated with manufacturers were neither substantive nor a permanent solution. If costs could not be decreased any further, it would be better to obtain the drugs through local generic production or parallel importation from Brazil, Thailand or India, where they were successfully being made at a fraction of even the discount price.</p> <p>In the event, it soon became clear that the high-profile offers of cheaper drugs from the US administration came with punishing strings attached. South Africa could avail itself of some $1.5 billion in the form of export–import loans, at commercial interest rates, to buy American drugs at market prices. In addition, by May 2001, five of the world’s biggest pharmaceutical companies had agreed to enter into talks with African nations on reduced prices, provided the countries concerned agreed to health action plans being drawn up by McKinsey, a leading business consultancy!</p> <p>The offers were turned down, but they had reinforced suspicions that Western governments and the drug manufacturers were locked in a conspiracy against Africa. As Mbeki’s views hardened, the relentless pressure applied by the TAC and various NGOs was starting to pay dividends. Drug companies squirmed under accusations of greed, and some began privately to offer significant discounts on their products. By mid-2001,Boehringer Ingelheim was offering Nevirapine, a drug commonly used by HIV/AIDS sufferers, free for a limited period to pregnant women in South Africa. Glaxo offered AZT at 30 per cent of the average inter- national price.</p> <p>But government still refused to buy the drugs, claiming they were toxic. According to some of Mbeki’s close advisors, the offers were seen as a piecemeal strategy to stave off production of cheaper generics. Yet no moves were made to launch local production or import generics. In fact, keen to play a leading role in the global economy and to be seen as playing by the market rules, the government started back-pedalling on earlier threats to import generics.</p> <p>In November 2001, British trade minister Richard Caborn wrote to the London-based Action for Southern Africa, an organisation that campaigns for Thabo Mbeki and the battle for the soul of the ANC peace, democracy and development across the region: ‘I don’t believe that this or related measures such as parallel importing are the answer here.’[32]</p> <p>South Africa had had the option all along of circumventing TRIPS by citing ‘national emergency’, but Mbeki had come to believe that the pharmaceutical companies were greatly inflating the AIDS threat in order to exploit developing markets.</p> <h2>Part III</h2> <p>What made Mbeki turn to the AIDS dissidents? In July 1999,Anthony Brink, an advocate and the author of the online book Debating AZT, had given him and senior health department officials copies of his book, which argued that the so-called life-giving drug was highly toxic.[33] His interest aroused, Mbeki began doing further research on his own, via the Internet.</p> <p>While surfing the Net, he stumbled on virusmyth.net, a website favoured by the international dissident community. On 28 October 1999, Mbeki told the National Council of Provinces that he had examined ‘a large volume of scientific literature’, which showed that AZT was dangerous.[34]</p> <p>The orthodox scientific community has never claimed that AZT is not toxic, but makes the point that all drugs have side effects, and that those known to be caused by AZT were far outweighed by its benefits to AIDS patients.</p> <p>But Mbeki had been seduced, and before long his meanders along the inform- ation highway led him to question whether HIV caused AIDS and whether the virus was sexually transmitted.The dissidents argued that HIV was a benign ‘passenger virus’, and that AIDS was a lifestyle disease caused by poverty, malnutrition and narcotic abuse by homosexuals. They claimed that, far from helping the infected, ARVs caused even greater damage to their compromised immune systems.[35]</p> <p>The World Health Organisation and the MCC had classified AZT safe, but Mbeki, newly installed as South Africa’s president, decided that his health minister, Manto Tshabalala-Msimang, would be entrusted with determining the ‘truth’ about the disease and its treatment once and for all. On 2 December 1999 she met with AIDS dissident Charles Geshekter, and came away from their discussions convinced that the president was right to question views that had already gained wide international acceptance.</p> <p>In his nocturnal online research, Mbeki also found the writings of American biochemist David Rasnick, a leading rebel against the conventional premise that AIDS stems from HIV. Mbeki contacted him by fax and spoke to him at length by phone, and soon the two were in regular e-mail contact. Rasnick enthusiastically agreed to support Mbeki’s quest for the ‘truth’. The president also made contact with another prominent AIDS dissident, Peter Duesberg, a professor of molecular and cell biology at the University of California in Berkeley.</p> <p>There was a major stir when a South African newspaper published Rasnick’s assertions that ‘condoms don’t prevent AIDS because AIDS isn’t a sexually transmitted disease. In fact it isn’t contagious at all. AIDS in Africa is just a new name for the diseases of poverty caused by malnutrition, poor sanitation, bad water, parasites and so on. Using condoms to prevent the diseases of poverty is the leading obscenity of our time.’[36]</p> <p>Mbeki was sincere in challenging mainstream science and in his support of AIDS dissidents. He stoically believed that he was a modern-day Copernicus who would ultimately be vindicated, even if posthumously. Needless to say, the dissidents, long banished to the scientific wilderness, latched on to the new legitimacy that the president provided, and it would prove all but impossible for Mbeki to dissociate himself from them later.</p> <p>His next mission was to persuade unsuspecting world leaders of the dangers of treating AIDS with conventional methods. In a brazen and bizarre letter to Bill Clinton and UN secretary general Kofi Annan dated 3 April 2000, South Africa’s head of state defended an alternative approach to dealing with AIDS. In the five-page document, Mbeki passionately defended Duesberg and the other dissidents, and suggested that factors other than HIV could be the cause of AIDS in Africa. He called for a uniquely ‘African solution’[37] to the problem, as AIDS seemed to affect Africans differently to those who live in the developed world. He also defended his right to consult dissident scientists, and accused unnamed foreign critics of waging a ‘campaign of intellectual intimidation and terrorism’ akin to ‘the racist apartheid tyranny we opposed’. In an earlier period in human history, Mbeki wrote, Duesberg and his followers ‘would be the heretics that would be burnt at the stake. 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.’[38]</p> <p>The letter, copies of which were delivered by hand to Clinton and Annan, concluded: ‘It would constitute a criminal betrayal of our responsibility to our own people to mimic foreign approaches to treating HIV/AIDS.’[39]</p> <p>The Clinton administration initially thought the letter was a hoax. Upon realising it was genuine, the contents were leaked to the Washington media. Mbeki was suitably embarrassed, and furious, convinced more than ever that Western leaders were conspiring against their African counterparts.</p> <p>Bolstered by the counsel of the AIDS dissidents, Mbeki and Tshabalala-Msimang reiterated that the government would not provide ARVs through the public health system, adding the inability of existing infrastructure to implement the drug protocols to their earlier claims of toxicity and cost. Tshabalala-Msimang now argued that anti-AIDS drugs alone would have scant effect, and that the state simply did not have the money to simultaneously offer recipients clean water, sanitation, nutritional food and adequate housing.</p> <p>Mbeki would charge his AIDS critics, especially those who were ANC members or belonged to the TAC, of being willing ‘to sacrifice all intellectual integrity to act as salespersons of the product of one pharmaceutical company.’[40] Later, he would use this accusation again, to attack ANC MPs critical of his policies,[41] and when he opened the international conferences on AIDS in Durban in July 2000, he lambasted activists in the same manner. He blocked every effort by civil society and private organisations to set up AIDS treatment projects involving ARVs, prompting Desmond Tutu to comment: ‘In South Africa we have to introduce a vibrant and lively education for the people. Churches and religious communities are already playing a role but are hamstrung by the constant worry about what government will say, when they ought to be on the same side.’[42]</p> <p>Mbeki has consistently placed poverty at the heart of all South Africa’s health problems, and few disagree with him, in general. But he found no broad support for his insistence that AIDS should be treated as just another disease, like malaria or TB.The scariest realisation for many people was that Mbeki genuinely believed that a number of factors, including poverty, caused rather than exacerbated AIDS, and that HIV was not to blame.</p> <p>Tshabalala-Msimang drew hoots of derision when she famously announced that people with AIDS should preserve their health not with drugs, but with a diet of garlic, lemon, olive oil and the African potato.[43] In March 2003,her credibility took another dive when she appointed Roberto Giraldo,a leading AIDS dissident and one of the most vocal naysayers regarding the link between HIV and AIDS, as a consultant on nutrition.</p> <p>Amid mounting evidence of AZT’s effectivity and growing criticism of the government’s opposition to ARV distribution, he Mbeki-ites began searching for compliant scientists who would support them.</p> <p>In October 1999, Tshabalala-Msimang had rejected a report favouring the use of AZT by South Africa’s MCC on the grounds that it had not been subject to a satisfactory review process. A month later, she commissioned the Cochrane Centre, an international health-care NGO that reviews clinical trials on new drugs and has branches all over the world, to research the risks of ARVs, especially AZT. Their preliminary study found strong evidence that both an intensive or shorter course of AZT was effective in decreasing the risk of mother-to-child transmission of HIV, even in breastfed babies. The most serious adverse effect the researchers identified was anaemia, but this condition tended to disappear once the full course of drugs had been concluded. Nevirapine, less expensive than AZT, was found to be both safe and effective.</p> <p>These findings were given to the health minister in December. She filed the report and allowed it to gather dust while she turned to the National AIDS Council for an outcome more in line with dissident opinion, as well as her own. Tshabalala-Msimang appointed new members, renamed the former AIDS Advisory Council the Presidential AIDS Advisory Council, and extended the council’s influence to sectors not previously involved in AIDS programmes.</p> <p>Activists saw through the ploy and criticised the council as just another attempt by Mbeki and his health minister to muzzle and marginalise those with a different viewpoint. In due course, the council would issue a report that did nothing but reiterate both the orthodox and dissident views on AIDS, without attaching particular weight to one or the other.</p> <p>In a new affront to activists, government revealed that in the 1999/2000 financial year,40 per cent ofthe AIDS budget had gone unspent. Worse, it announced that funding of AIDS service organisations was to be cut by 43 per cent the follow- ing year. In March 2000, dismayed by government’s persistent obfuscation and continuous flirting with AIDS dissidents, Judge Edwin Cameron, Archbishop Njongonkulu Ndungane (head of the Anglican Church in Southern Africa),Bishop Mvume Dandala (head of the Methodist Church in South Africa), Professor Jerry Coovadia,(chairman of the 2000 International AIDS Conference) and Merci Makhalamele (a prominent AIDS activist) wrote a personal letter to Mbeki, expressing anxiety over the government’s head-in-the-sand policies. They also asked him to reconsider the decision not to provide life-saving drugs to pregnant, HIV-positive women.[44] The Sunday Independent was given a copy of the letter. Mbeki responded by fax, again questioning available evidence that AZT was safe and effective. He warned the signatories that a similar consensus had existed over the use of thalidomide, with deadly consequences. He urged them not to fall into the same trap.</p> <p>Throughout all the polemic, Mbeki was telling senior ANC leaders that the magnitude of the AIDS crisis in South Africa had been exaggerated to serve the interests of the drug giants and NGOs. Unfortunately, South African AIDS statistics have been the subject of dispute for several years, but it remains the only country in Africa that has even remotely reliable figures, even though, as author Rian Malan45 points out, they are computer projections based on surveys on antenatal clinics.</p> <p>The situation has not been helped by international studies of dubious credi- bility. As recently as 2003, the World Bank warned in a report that South Africa faced imminent economic collapse as a result of HIV/AIDS, and, even though respected local experts such as Standard Bank chief economist Iraj Abedian and the South African Business Coalition dismissed the report as inaccurate and unreliable, Mbeki grasped at hyperbole to defend his claims that the figures were inflated.</p> <p>But the first extensive and broadly credible surveys on the incidence of HIV/ AIDS, conducted independently by the South African Medical Research Council and Statistics SA in 2000 and 2001, painted a bleak picture. They estimated that 5.3million South Africans would be infected with the virus by the end of 2002, and that it would be killing 600 people a day.[46]A government report leaked in late March 2004 said 100 000 public servants were HIV-positive, presenting a very real threat to normal government administration.</p> <p>In August 2001, the government was back in court as the TAC and various NGOs claimed it was acting unconstitutionally by refusing to make ARVs available at state hospitals. In its March 2002 judgment, the Constitutional Court agreed, ordering that pregnant women should start receiving the drugs immediately. Still the government prevaricated, claiming that state hospitals did not have the infrastructure necessary to administer ARVs. It was not until seven months later that Nevirapine became available at some urban hospitals as part of a pilot scheme, and not until the eve of the 2004 election that distribution was extended.</p> <p>Costs have unquestionably played a role in the government’s response to the AIDS crisis. GEAR, the economic policy adopted in June 1996,calls for economic austerity and financial prudence, and structural adjustment programmes have seen jobs frozen and public service cuts. In 2000,finance minister Trevor Manuel and Manto Tshabalala-Msimang sketched a gloomy picture for Mbeki of the costs involved in the proposed ARV roll-out, and the government concluded that it was not financially feasible to make the drugs available to all HIV-positive patients at state cost.</p> <p>Thenjiwe Mtintso, assistant secretary general of the ANC at the time, pointed out: ‘Making antiretroviral drugs available is only one side of the story; the state will have to take responsibility for all the costs ofAIDS-infected individuals. The state doesn’t have that kind of capacity or resources.’[47][ Manuel was more blunt: ‘The rhetoric about the effectiveness of ARVs is a lot of voodoo and buying them would be a waste of limited resources.’[48]</p> <p>Underlying the decision was an unspoken belief among Mbeki’s inner circ