BERKELEY biochemist Peter Duesberg had his five minutes of fame about a
decade ago when he suggested that HIV did not cause AIDS. His provocative notion
died after population studies clearly showed the footprint of an infectious
agent and anti-retroviral drugs delayed the onset of AIDS. It鈥檚 a shame, then,
that Duesberg鈥檚 ideas are expected to be revisited at the first meeting this
weekend of an expert panel on AIDS set up by South African President Thabo
Mbeki.
It鈥檚 a shame not only because a national leader refuses to accept from his
own scientific advisers that Duesberg鈥檚 ideas just don鈥檛 stand up, but also
because they are eclipsing the real importance of the meeting鈥攆inding a
way to manage AIDS in South Africa.
Compared with other African countries, HIV came late to South Africa, but the
statistics are still chilling. Some 10 per cent of the population鈥攁bout
4.4 million people 鈥攁re infected with HIV. In young women, the rate is
more than 22 per cent. Every day, another 1800 people, most of them young, are
infected.
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Although the country has had an HIV action plan since 1992, it is in disarray
(New 杏吧原创, 29 April, p 14).
Prevention campaigns are patchy and
there is no national strategy for who should be treated and how. HIV-positive
people head from rural areas to city hospitals in search of treatment. Already
hospitals are filling up with people suffering opportunistic infections or
simply waiting to die.
The lack of treatment guidelines is demoralising health workers
(see 鈥淲e can do better than this鈥�),
especially since Mbeki won鈥檛 even act when the evidence is compelling. Research
in South Africa shows that giving AZT to women in the last weeks of pregnancy
can cut the rate of transmission of HIV from mother to child by at least half.
What鈥檚 more, it鈥檚 cheaper than treating the infections that punctuate the short
lives of HIV-positive children. Yet the government refuses to sanction AZT for
pregnant women, arguing either that it is too costly or too toxic.
The only explanation for this bizarre behaviour is the government鈥檚
well-publicised dislike of multinational drugs companies. It does not want to
enrich companies it considers exploitative. And it鈥檚 easy to see why this
attitude has arisen. In the rich world, antiretroviral drugs have begun to turn
HIV from a guaranteed killer into a chronic infection. But at $10 000 a
person a year, they are way beyond South Africa鈥檚 pocket.
Yet of all the tasks facing Mbeki鈥檚 expert panel鈥攆rom better prevention
campaigns to training doctors and nurses鈥攖he priority must be to find
affordable sources of anti-HIV drugs.
One option is 鈥渃ompulsory licensing鈥�. Under South African law, the government
can force domestic pharmaceuticals companies to make a drug even if a foreign
competitor owns the patent for it. This would dramatically reduce the price of
some drugs. Although this type of action is allowed under international trade
rules, it is supposed to be used only in emergencies. The US spent most of last
year warning South Africa that this strategy would lead to trade sanctions.
Which all seems very bleak. And it would be were it not for several recent
events. The tragedy unfolding across southern Africa seems to have woken up
politicians in rich nations. At last December鈥檚 World Trade Organization meeting
in Seattle, President Bill Clinton hinted that the US would soften its line
against developing countries trying to get cheaper anti-HIV drugs. In January,
president of the World Bank James Wolfensohn told the UN Security Council that
HIV is contributing to political instability.
A fortnight ago, Wolfensohn said the bank would find the money for any
country with a coherent strategy for managing HIV. He also suggested that drugs
companies would soon offer low-cost drugs to developing countries. Last week,
the White House announced that the potential for AIDS 鈥渢o destabilise nations
and the economies of whole continents鈥� has made the disease a threat to national
security.
What鈥檚 the bottom line? Without global action and more money, the whole
world鈥攏ot just the developing part鈥攊s in trouble. The G7 group of
rich nations urgently needs to draw up a plan to deal with HIV.
For Mbeki, it means he will never find a better time to write his own deal
for obtaining anti-HIV drugs. When the expert panel meets this week, let鈥檚 hope
it quickly sees off Duesberg鈥檚 ideas and reaches a consensus on drug treatment.
As the leader of an influential developing country, Mbeki has the power to sway
other nations and so help to seal the fate not only of South Africa鈥檚
HIV-positive people, but of millions more besides.
