Editorial from The Guide	Editorials Archive

"What an idiot!" was one HIV researcher's response when contacted for The Guide's July 2000 story on South African President Thabo Mbeki's AIDS policies.

That scientist's reaction is common. Mbeki has invited those who claim HIV is not the cause of AIDS to government-sponsored panel discussions. He has repeatedly asserted that European and North American models for controlling AIDS do not make sense in an African context. As a result, in much of the Western press he has been painted both as a fool who has been duped by paranoid charlatans, and as an opportunist exploiting bad science for political gain.

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But Mbeki is both bright and principled, as his life story illustrates. Only when one grants that he is most assuredly not "an idiot," can his seemingly reckless dalliance with dubious science be understood. Far from being idiotic, Mbeki's controversial stance can be seen as demonstrating political acumen, pointing the world to a truly global solution to the HIV epidemic.

First, Mbeki's political skills have been tested for decades as one of the central figures leading South Africa away from Apartheid-- he knows how the press works. By inviting HIV-dissidents to a government-sponsored panel on AIDS just months before the South African-hosted International AIDS Conference (IAC), Mbeki generated controversy, drawing greater world attention to the first IAC held in the epidemic's ground zero, sub-Saharan Africa. Maybe he planned it, maybe he didn't, but Mbeki would not be the first politician to manipulate the press by engineering controversy.

Secondly, by all reports, Mbeki has a less-hierarchical leadership style that encourages discussion, consensus, and compromise. He does not demonize dissent. Such an approach was fought for by early AIDS organizers in the US and Europe who battled drug trial protocols dictated by precedent and bureaucratic convenience rather than patients' medical needs.

ACT UP activists, themselves scientific dissidents at the time, can remember being told that good science absolutely required studies that lasted forever and offered most participants no benefit. Only by changing what could be considered "good science" were faster trials launched wherein more benefited from participating, and results came back in time to do tangible good. Of course, a style that tolerates, and even encourages, dissent will endure some crackpots. But science is not a straight, well-mapped road; today's loonies can become tomorrow's heroes, and sometimes new theories overturn long-held, well-developed conventional wisdoms. Dissent, though irritating and potentially time wasting, is the hallmark of an atmosphere conducive to truly good science.

And finally, questioning HIV's role in AIDS is appropriate-- though not for the reasons touted by HIV-dissidents. Infection with the HIV virus is undoubtedly necessary for an individual to develop the disease AIDS, and HIV-dissidents are wrong to assert otherwise. But, HIV the virus need not lead to AIDS the disease. Drug regimens exist that are effective in controlling HIV in previously-untreated individuals without advanced disease. Furthermore, drug treatment, which lowers transmission rates, coupled with prevention education can stop HIV from spreading exponentially, thus halting an epidemic. Poverty and the resultant lack of access to proven treatments is now a necessary co-factor for HIV to lead to AIDS.

Though Mbeki's reputation as an HIV doubter is unfair (he has been careful not to himself claim HIV does not cause AIDS), his stance reminds the world that the AIDS epidemic is not a biological inevitability. We know how to fight HIV and thus forestall disease in individuals and prevent epidemics in populations. Mbeki understands that the problem now is not simply HIV, but political and economic forces that ignore 70 percent of the globe's HIV-infected because they are poor Africans.