THIS ARTICLE WAS WRITTEN ON Wednesday, March 28, 2007 and updated on Sunday, May 17, 2009

In early September 2006, South Africa's Minister of Health, Dr. Manto Tshabalala-Msimang, was met with boos and hoots of derision at the International Conference on AIDS hosted in Toronto, Canada, when she vehemently denounced the role of antiretroviral drugs in the treatment of AIDS, and instead insisted that a diet of African potatoes, garlic, lemon, and beetroot could keep the disease under control. She made this announcement with the implicit imprimatur of the South African President, then Thabo Mbeki, who has long been an HIV denialist and who has repeatedly claimed that antiretroviral drugs are "toxic" and useless in treating AIDS.

Members of a small (but rabid) group of activists insist, in the face of overwhelming evidence to the contrary, that HIV is not the cause of AIDS. I learned a long time ago not to argue with these people -- they have an answer for everything, and they are utterly, irretrievably set in their belief that AIDS itself either does not exist at all, or is the result of sustained recreational drugs use, or is the result of treatment of otherwise healthy people with antiretroviral drugs. In short, many members of this group insist that HIV is a harmless virus, and that AIDS is actually caused by the drugs that are prescribed by doctors who have been duped into believing that HIV causes AIDS. Members of this group insist that the entire medical establishment, bar a small number of enlightened doctors and health care professionals, is complicit in a program of extortion and murder, and that Highly Active Antiretroviral Therapy (HAART) causes AIDS. Stated differently, these people believe that AIDS is an iatrogenic illness, induced by the very treatments that are posited as therapeutic.

This claim is supposedly supported by a highly selective sampling and interpretation of the research data and the literature. As more and more drugs are found to be effective against HIV (the integrase inhibitors now play a key role in treating this disease, particularly in patients who have failed other regimens), the "AIDS is not cause by HIV" model has become increasingly elaborate and embarrassing in its efforts to explain away the millions of prolonged and relatively healthy lives that have been extended indefinitely by the antiretroviral drug regimens. This essay does not focus on the truthfulness of the theory that HIV cases AIDS; it accepts a priori the validity of the HIV model of AIDS. Many, many scientists and rigorous thinkers have addressed the truthfulness of the HIV model of AIDS, and this is not the forum in which the validity of this model will be explored.

Thabo Mbeki and like-minded individuals have insisted that HIV is not the true cause of AIDS, and have instead insisted that this disease is really the outcome of "colonialism" and "apartheid." Seven years ago, Mbeki gave a speech in which he stated that conventional views of AIDS causation reinforced the image of Africans as "germ carriers." He referred to the discourse in which AIDS is viewed as a medical illness caused by HIV as part of the "dark continent discourse" which he so deplores (this discourse views Africa in a very negative light, as the "dark continent" in which people are unable to subject passion to reason). After respected AIDS scientist Malegapuru Makgoba launched a salvo of embittered accusations to the effect that Mbeki was responsible for "genocide," Mbeki partially relented and agreed to distribute antiretroviral medications; however, Mbeki never renounced his view that AIDS is really caused not by HIV but by "the legacy of apartheid" and poverty.

Following the Health Minister's bizarre announcement that a diet of African potatoes, garlic, lemon, and beetroot could keep AIDS at bay, more than 60 internationally acclaimed AIDS scientists, including the putative "co-discoverer" of HIV, Dr. Robert Gallo, demanded that Mbeki fire Dr Manto Tshabalala-Msimang, describing her in writing as an "embarrassment" who enjoyed "no international respect." How could Mbeki -- an educated man who graduated from the British University of Sussex with a Master's degree in Economics -- have fallen prey to the line of thinking, influenced by Dr. Peter Duesberg, that holds, in the face of overwhelming scientific evidence to the contrary, that HIV is not the cause of AIDS?

There are now more than 40 drugs available to treat HIV infection -- nucleoside reverse transcriptase inhibitors and nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors (FIs), entry inhibitors (EIs), integrase inhibitors (IIs), and adjunctive therapies such as hydroxyurea -- and more drugs become available almost every year as science evolves (one integrase inhibitor (raltegravir) was recently released, and another (elvitegravir) is currently in late-stage testing). By combining these drugs -- typically by combining protease inhibitors with reverse transcriptase inhibitors and / or non-nucleoside reverse transcriptase inhibitors -- doctors in the US , the UK, Canada, European nations, and other First World nations are now able to keep patients with HIV alive more or less indefinitely. This is not to deny the reality of serious side-effects associated with HAART (including lipodystrophy, peripheral neuropathy, cardiac disease, etc.), but the bottom line is that these drugs are highly effective, when taken in strict compliance with treatment regimens, in preventing the advance of this disease, and are able to suppress HIV to the extent that the most sensitive assays commercially available are no longer capable of detecting the presence of HIV particles in the bloodstream of infected patients.

Yet in the country that now has the highest prevalence of HIV in the world, the current government insists that these drugs should not be the mainstay of treatment, and instead resorts to measures that caused the scientists who authored the letter demanding the firing of South Africa's Minister of Health to write the following:

"To deny that HIV causes AIDS is farcical in the face of the scientific evidence; to promote ineffective, immoral policies on HIV/AIDS endangers lives; to have as health minister a person who now has no international respect is an embarrassment to the South African government. We therefore call for the immediate removal of Dr Tshabalala-Msimang as minister of health, and for an end to the disastrous, pseudo-scientific policies that have characterized the South African government's response to HIV/AIDS."

When confronted with criticism of his handling of HIV / AIDS treatments, Mbeki insists that his detractors are "racists" and that "traditional African medicine" is as effective, if not more so, than established, highly effective modern treatment regimens. AIDS activists and scientists were outraged by the views expressed by Dr. Tshabalala-Msimang in Toronto, and by a display of vegetables as part of the treatment for AIDS at the government stand (no antiretroviral medicines were on display). Yet Dr. Tshabalala-Msimang was selected by Mbeki to become Health Minister precisely because of her discredited and ludicrous views, and because she has expressed the view that antiretroviral medications are both dangerous and useless.

It is estimated that between one in 10 and one in five South Africans carry HIV, and in some parts of the country, doctors believe that the prevalence of this disease is much higher (one doctor I interviewed several years ago estimated that as many as one in three black men are infected in the part of the country named KwaZulu Natal).

Tellingly, those South Africans who are infected with HIV and who have access to good healthcare are all on HAART regimens (in South Africa, healthcare is offered through employers, guaranteeing that the vast majority of South African citizens lack health coverage of any sort) (unemployment currently exceeds 50%).

As this quackery masquerades as science, the health of between five and 10 million people infected with HIV continues to decline. These people will almost certainly die unless the South African government changes course immediately.

PHILIP CHANDLER