Influence of AIDS denialism on early South African public health policy decisions

The 1980s were years of political and health upheavals in South Africa and the USA. Internal resistance to apartheid resulted in the detention and premature death of numerous activists, including the white South African medical doctor and trade union organizer, Neil Aggett (6 October 1953– 5 February 1982). In 1984, an article in the American Journal of Medicine about the first patient infected with an unknown sexually transmitted virus gained the attention of the medical community. More than 8000 miles away, anti-apartheid riots continued to rage in the townships of South Africa. A global anti-apartheid disinvestment campaign aided the struggles of the majority of South Africans and contributed to the initiation of negotiations between the African National Congress, a future- government-in-exile, and the ruling National Party in South Africa. Thabo Mbeki, the second post-apartheid president and a man who would later appeal for “a reinvigoration of the African renaissance movement,” and Jacob Zuma, current president, were two of the leaders engaged in negotiations with the minority government prior to the 1994 one-man-one-vote-election which resulted in Nelson Mandela’s presidency. Meanwhile, painstaking international detective work led to the identification of the “gay pathogen” first clinically observed in Patient Zero as human immunodeficiency virus (HIV, a slow-growing retrovirus – also known as a lentivirus).

Following the accumulation of a large body of evidence over several years, most scientists accept that HIV causes acquired-immunodeficiency (AIDS) and that antiretroviral therapy (ART) can convert a life-threatening illness into a chronic disease. However, some scientists and activists disagree with the evidence. One of these AIDS denialists is Peter Duesberg, recipient of an outstanding investigator grant from the National Institutes of Health. Duesberg based his arguments on the fact that HIV failed to meet pivotal microbiological postulates. These postulates were published in 1877 by Robert Koch, German discoverer of Bacillus anthracis. The German co-founder of bacteriology theorized (subject to the limitation that the rules do not apply to every microbe) that a pathogen must be: 

1.       Absent in the tissue of healthy animals and present in the case of diseased hosts

2.       Isolatable and grown in pure culture

3.       Able to cause the disease when injected into a healthy animal

4.       Retrievable from an inoculated animal and shown to be identical with the initial isolate

In her book, Virus Hunt: The Search for the Origin of HIV, Dorothy Crawford (Professor of Virology, University of Edinburgh, Scotland) rebutted Duesberg’s arguments, adding her voice to a growing chorus of pro-science activists. As articulated in Crawford’s book, identification of HIV through appropriate tests and early studies showing that only previously healthy HIV-positive individuals went on to develop AIDS provided the first line of evidence. Postulate one could not be fulfilled because “HIV per se does not kill, but allows a whole gamut of other microbes to flourish and eventually kill in untreated cases.” Postulate two was equally tricky, as a HIV-positive person might be co-infected with unrelated organisms over his or her lifespan. Similarly, postulate 3 could only be tested indirectly as HIV is not cultivable on microbiological media.

Further evidence could be obtained from immunological tests. A drop in T-helper or CD4 cell count in an HIV-positive individual (normal range: 500 to 1,500 cells per cubic millimeter of blood) is indicative of a weakening immune system and the likelihood of developing a more severe illness. Discoveries such as the accidental infection of workers with a pure laboratory clone of HIV (workers subsequently presented with markedly low CD4 T cell counts), and retrieval of the same clone from their blood provided proof of a cause-effect relationship. Crawford’s summary of sleuthing and building of a consensus as to the causal link between HIV and AIDS, represents the common scientific view and contradicts the arguments of Duesberg, who served on an advisory panel to Thabo Mbeki in 2000. Another AIDS denialist and HIV-positive activist, Christine Maggiore, may have also impacted Mbeki with her views, prior to her death at age 52, from AIDS related infections. Mbeki delivered a speech in 2000 (at the International AIDS Conference in Durban) which avoided references to HIV and focused on poverty as an important co-factor in diagnosing the disease. Because Mbeki lent credence to minority views, the introduction of lifesaving ART was delayed, with disastrous consequences to the health of many South Africans. According to researchers from the Harvard School of Public Health, more than 330, 000 lives were lost (from 2000 and 2005) because ”a feasible and timely ART program was not implemented in South Africa [1].” AIDS rebel and co-founder of the Treatment Action Campaign, Zackie Achmat, eventually won the battle for accessible and affordable ARTs in South Africa – thus saving millions of lives.

Currently, South Africa has more HIV-carriers than any other country - 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children (aged 0-14), out of a population of just over 51 million. Moreover, the rate of HIV infection among adult South Africans rose from below 1% in 1990 to approximately 17.9% by 2012. Although an almost 4-fold decline in disability-adjusted life years lost to HIV in 2010 represents progress in stemming this daunting epidemic, the continued loss of the “productive part of the population” (group most affected by HIV is between 15 and 49 years old) due to HIV-related deaths, may slow the economic growth of that country.

The specter of HIV/AIDS haunted Nelson Mandela, partly due to the death of his son, Makgatho, from the disease. HIV/AIDS will also continue to be a topic on the minds of South Africans, including former president, Thabo Mbeki. In his first public address since Mandela passed away, Mbeki was quoted as follows: "Twenty years into democracy, how far are we with regards to the goal of creating a non-racial society, of achieving national reconciliation, of creating a non-sexist South Africa, a prosperous South Africa ... of a shared wealth among our people and eradication of poverty?" Stemming the tide of HIV-related deaths and increasing the number of educated and skilled people who participate in production, entrepreneurism, innovation, and development, will be vital steps to realizing this goal.

Reference

1.            Chigwedere, P., et al., Estimating the lost benefits of antiretroviral drug use in South Africa. J Acquir Immune Defic Syndr, 2008. 49(4): p. 410-5.