Consensus eludes South Africa panel on AIDS

By M.S. Prabhakara

CAPE TOWN, APRIL 6. South Africa's presidential advisory panel on AIDS has not agreed, or even come to a consensus, on some of the key questions it considered.

The panel remains divided between the orthodox (or dominant) position and that of the dissidents on the so-called ``causal links'' between HIV and AIDS, and the use of anti- retroviral drugs to control them. The former accepts that such ``causal links'' exist and recommends the use of anti-retroviral drugs, a position rejected by the latter, or at least questioned.

The panel, appointed in April last year, came into being in the context of the controversy created and the dismay caused among health workers by the questioning by the President, Mr. Thabo Mbeki, of the ``causal links'' between HIV and AIDS; and his flirting with dissident scientists like Prof. Peter Duesberg and Dr. David Rasnick. These were considered to be having a deleterious effect on the ground situation, causing confusion among policy makers. South Africa has an estimated four million people affected by HIV/AIDS.

It was in order to get some ``clarity'' on the issue, though most scientists and health workers maintain there is really no ambiguity at all, that Mr. Mbeki decided to constitute a 33- member experts' panel, which also included two scientists from India, to consider, very broadly, the viral aetiology of AIDS, the role of therapeutic interventions in the context of developing countries, and preventive measures.

The panel met twice, in May and July last year, in Pretoria and later continued its deliberations via the Internet. The exercise is believed to have cost about 2.5 million rands.

The panel recently submitted a ``preliminary report'' which runs to 134 pages. At a media briefing here on Wednesday, the Health Minister, Dr. Manto Tshabalala-Msimang, said the panel included individuals who held diametrically opposing views on several key questions pertaining to the link between HIV and AIDS, some adhering to the dominant position accepting that there was a clearly established causal link and others rejecting it. ``This basic difference was reflected in all debates, especially those relating to treatment, surveillance and diagnostic methods,'' she said. She maintained that the objective of the exercise was never to achieve a consensus.

However, despite the image of Mr. Mbeki as an inveterate sceptic on the issue of ``causal links'', insofar as policy prescriptions are concerned, the South African government has followed and continues to follow the orthodox path. This position was reiterated by the Health Ministry, even while suggesting that further research was needed in the light of the inconclusive findings of the panel.

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