OHANNESBURG,
March 30 Peter Mokaba is a member of Parliament, a senior official in
the governing party and a fiery orator who rallied a generation of young
blacks to the fight against apartheid.
But he now has a new, controversial calling: explaining why the world
should stop worrying about South Africa's AIDS epidemic.
"H.I.V.? It doesn't exist," Mr. Mokaba said this week as he settled
into his honey-colored couch. "The kind of stories that they tell that
people are dying in droves? It's not true. It's not borne out by any
facts.
"Where the science has not proved anything, we cannot allow our
people to be guinea pigs," he said, outlining his concerns about the
AIDS drugs commonly used in the West. "Antiretrovirals, they're quite
dangerous. They're poison actually.
"We cannot allow our people to take something so dangerous that it
will actually exterminate them. However well meaning, the hazards of
misplaced compassion could lead to genocide."
Mr. Mokaba, 43, has been dismissed as a misguided renegade for
promoting AIDS theories that have been roundly rejected by the World
Health Organization, the National Institutes of Health near Washington
and scientists and officials here and abroad.
Officials in the governing party, the African National Congress,
emphasize that Mr. Mokaba was defeated during a debate this month in
which the party formally accepted "the assumption that H.I.V. causes
AIDS." But critics say Mr. Mokaba's prominence and the willingness of
the leadership to debate his views leaves little doubt that a small
group of politicians still questions the basic assumptions about AIDS,
even while the disease devastates the country.
South Africa's AIDS skeptics came to prominence two and a half years
ago when President Thabo Mbeki mused publicly about the safety of AIDS
drugs and whether H.I.V. causes AIDS. He withdrew from the debate after
critics said he was allowing people to assume they could engage in risky
sexual behavior by suggesting that poverty, more than H.I.V., was the
crucial factor in the spread of the disease.
But the questions that Mr. Mbeki raised still simmer within the
ruling party. In its statement released last week, the party referred to
the doctors, politicians and advocates who were demanding the widespread
distribution of AIDS drugs as supporters of "pseudoscience."
This month, Mr. Mokaba started to promote his views within the party
and among its allies in the Communist Party and the trade unions. His
campaign has stirred a furor here in South Africa, where more people are
infected with H.I.V. than in any other nation. One in nine South
Africans, and one in four adults, are believed to be living with H.I.V.,
government officials say.
Some senior party officials have distanced themselves from Mr. Mokaba,
emphasizing that South Africa's AIDS programs have been and continue to
be based on the assumption that H.I.V. causes AIDS. Health officials
have hastened to point out that the government allocated about $100
million in new spending on conventional AIDS programs this year.
In recent weeks, former President Nelson Mandela and former
Archbishop Desmond Tutu have pressed the government to do even more and
to expand a pilot program that provides AIDS drugs to pregnant women
infected with H.I.V. to reduce their risk of transmitting the virus to
their newborns.
But Mr. Mokaba, the former deputy minister of tourism, says growing
numbers of people are eager to hear what he has to say. He does not deny
that something is attacking the immune systems of many South Africans,
but he believes it might be malnutrition or other common illnesses.
He argues that H.I.V. does not exist and cannot be spread through
sexual intercourse, that AIDS drugs are deadly and that the epidemic
itself is a fiction created by multinational drug companies hoping to
boost their profits by forcing poor countries to buy AIDS drugs and by
financing researchers to terrorize the public with lies about AIDS.
"There's a small minority of very senior people in the party who
support the dissident view," said Saadiq Kariem, the party's national
health secretary, who has described Mr. Mokaba's campaign as
"irresponsible."
"The implications of this are enormous and disastrous," said Dr.
Kariem, who is an epidemiologist. "People have already come to me and
said, `If H.I.V. doesn't cause AIDS and AIDS isn't sexually transmitted,
why am I wearing a condom?' "
In the history of South Africa, the white government long abused
science to oppress the black majority. Apartheid-era scientists
developed poisons to kill black people and tried to develop drugs to
make them sterile. In that climate, Mr. Mokaba's argument meets with
some acceptance. Even his critics say that drug companies have sometimes
lowered their standards when testing medicines in third world countries.
Such concerns were heightened here this month when the drug company
Boehringer Ingelheim of Germany announced that it was withdrawing its
application to market the AIDS drug nevirapine in the United States. The
drug, which reduces the risk of H.I.V. transmission from mother to
child, is an important topic in South Africa.
A judge has ordered South Africa to distribute nevirapine at public
hospitals that have adequate staff and expertise. The government is
appealing the ruling, saying the drug should be tested before it is
distributed beyond the government's pilot programs.
Nevirapine is still prescribed legally in the United States. But
officials at the Food and Drug Administration have raised questions
about "procedural" problems with the data from the drug trial in Uganda,
which was completed in 1999.
This week, officials from the National Institutes of Health
emphasized that they believed nevirapine was safe and effective and that
the Food and Drug Administration was concerned only about problems with
paperwork and documentation in the trial. The United Nations and the
World Health Organization issued a joint statement reiterating that
their experts, too, were convinced that nevirapine was safe.
"There's no question that the drug works," said John Ring La Montagne,
the deputy director of the National Institute of Allergy and Infectious
Diseases, a branch of the National Institutes of Health. "We believe the
studies were done to extremely high standards."
But the questions raised by the F.D.A. and the debilitating side
effects that sometimes accompany the use of AIDS drugs have fueled
worries about the safety of nevirapine here.
"I think it's completely explainable," Helen Schneider, director of
the Center for Health Policy at the University of the Witwatersrand,
said of the persistent questioning about AIDS. "There's a very recent
history of direct conspiracy against black people in this country."
Besides that, she said, "People can't cope. What you're seeing is this
enormous struggle to come to terms with this problem."
Health officials emphasize that they are still running a conventional
AIDS program that focuses on preventing the disease, distributing
condoms, treating opportunistic infections and providing AIDS drugs to
pregnant women in the pilot sites.
"In a practical way, the debate within the A.N.C. really does not
affect what we are doing," said Dr. Ayanda Ntsaluba, the director
general of South Africa's Department of Health.
"I would have been more concerned if I got the impression that we
were being diverted from the current program at government," Dr.
Ntsaluba said.
"But a conscious decision has been taken to prioritize these
programs, whatever debates are going on."
Smuts Ngonyama, a spokesman for the party, said Mr. Mokaba speaks for
himself, not the party, although many members share his concerns about
the safety of AIDS drugs. Mr. Ngonyama said he could not stop Mr. Mokaba
from promoting his ideas, even though some people believe he is damaging
the party's reputation.
"How can you have a situation where you must ban ideas?" Mr. Ngonyama
said. "We are coming from a situation in this country where
organizations were banned, newspapers were banned, people were banned.
Are we returning to that stage now?"
Mr. Mokaba said he supported the government's decision to promote
condoms because they prevent sexually transmitted diseases. But he said
he would continue to spread his message despite the cries of outrage
from his critics.
"Always when the truth emerges, there are people who doubt," Mr.
Mokaba said.