Global Policy Forum

Dear President Mbeki

EXPRESSION OF CONCERN BY HIV SCIENTISTS

We are members of the global scientific community working on HIV/AIDS who wish to express our deep concern at the response of the South African government to the HIV epidemic.

HIV causes AIDS. Antiretrovirals are the only medications currently available that alleviate the consequences of HIV infection. The evidence supporting these statements is overwhelming and beyond dispute. Much credit for the impressive advancement of HIV science belongs to scientists and clinicians based in South Africa and elsewhere on the African continent. Their expertise should play a critical role in alleviating the awful consequences HIV has caused to South African society. We are therefore deeply concerned at how HIV science has been undermined by the South African Minister of Health, Dr Manto Tshabalala-Msimang.

Before and during the XVI International AIDS Conference, Dr Tshabalala-Msimang expressed pseudo-scientific views about the management of HIV infection. Furthermore, the South African government exhibition at the Conference featured garlic, lemons and African potatoes, with the implication that these dietary elements are alternative treatments for HIV infection. There is no scientific evidence to support such views. Good nutrition is important for all people, including people with HIV, but garlic, lemons and potatoes are not alternatives to effective medications to treat a specific viral infection and its consequences on the human immune system. Over 5 million people live with HIV in South Africa. According to the best estimates of South African actuaries, over 500,000 people without access to antiretrovirals have reached the stage of HIV-disease when they now require these medicines to save their lives.

We commend the South African Department of Health's Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa released on 19 November 2003. This plan committed to treating over 380,000 people by this time in the public health sector. Unfortunately, fewer than half of that target number are currently receiving treatment in the public sector. Many people are therefore dying unnecessarily.

We are also deeply concerned by the proliferation of unproven remedies being marketed in South Africa, some of them with the implicit or even explicit support of the Minister of Health. Slick marketing practices cause people not to take proven medications, or at best to waste money on false hopes. We condemn all those who profit from this type of quackery, at the expense of the sick and dying.

We echo the words of Mr Stephen Lewis, special advisor to the UN Secretary General, that South Africa's response to AIDS is "obtuse, dilatory and negligent".

Dr Mark Wainberg, chairperson of the XVI International AIDS Conference, stated in his Closing Address:

"We went to the Durban meeting, expecting a South African government that would be on the same side as us. Instead, we found a denialist president who turned his back on us... and who began to convene committees that would articulate on his behalf that somehow it was in dispute whether or not HIV was truly the cause of AIDS ... We were all completely taken aback, we were all insulted. ... I for one am no longer prepared to take a back seat as a scientist and not express my personal concern that this situation seems to have continued unabated."

We support and endorse Dr Wainberg's words.

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 characterised the South African Government's response to HIV/AIDS.

Signed (in alphabetical order):

1. Abdool Karim, Quarraisha, Professor, Head, CAPRISA Women and AIDS Programme, University Kwazulu-Natal, South Africa

2. Anastasi, John, MD, Associate Professor, Director, Residency Training Program, University of Chicago, USA

3. Aubertin, Anne Marie, PhD, Directeur de recherche INSERM 778, Institut de Virologie, Université Louis Pasteur, France

4. Baltimore, David, President Emeritus, California Institute of Technology, USA

5. Bardeguez, Arlene, MD, MPH, Director, HIV Services, Department Obstetrics, Gynecology & Women's Health, New Jersey Medical School, USA

6. Barin, Francis, Professor, Virology lab and National Reference Center for HIV, Université F Rabelais, France

7. Barnett, David, Dr, Consultant Clinical Scientist and Honorary Senior Lecturer, UK

8. Barnett, Tony, ESRC Professorial Research Fellow, London School of Economics, UK

9. Bartlett, John G., MD, Chief of Infectious Diseases, Johns Hopkins School of Medicine, USA

10. Bellos, Nicholaos, MD, Southwest Infectious Disease Associates, USA

11. Berkman, Alan, MD, Associate Professor and Acting Chair Department of Epidemiology, Mailman School of Public Health, Columbia University, USA

12. Bomsel, Morgane, Research Director at CNRS, Mucosal entry of HIV and mucosal immunity, et Immunité muqueuse, Cell Biology dept, Cochin Institut, France

13. Bourne, David, School of Public Health, University of Cape Town

14. Burton, Dennis, Professor of Immunology, The Scripps Research Institute, USA

15. Campo, Rafael, MD, Professor of Clinical Medicine, University of Miami Miller School of Medicine, USA

16. Carpenter, Charles, MD, Professor of Medicine, Brown University, USA

17. Cohen, Mardge, MD, Director of Women's HIV Research, CORE Center, USA

18. Cohen, Robert L., MD, USA

19. Colebunders, Robert, Institute of Tropical Medicine, Belgium

20. Coovadia, Hoosen, Professor, Co-Director Centre for HIV/AIDS Networking, lson Mandela School of medicine, University of Kwazulu/Natal, South Africa

21. Coutsoudis, Anna, Professor, Senior Research Scientist, Dept Paediatrics and Child Health, University of KwaZulu-Natal, South Africa

22. Crowe, Suzanne, Professor, Head, AIDS Pathogenesis and Clinical Research Program, NHMRC, Principal Research Fellow, Macfarlane Burnet Institute for Medical Research and Public Health, Australia

23. Cu-Uvin, Susan, MD, Associate Professor, Obstetrics-Gynecology and Medicine, The Miriam Hospital Brown University

24. Cullen, Bryan R, James B Duke Professor and Director of the Center for Virology, Duke University Medical Center, USA

25. D'Aquila, Richard, MD, Director, Division of Infectious Diseases Director, Vanderbilt AIDS Center Professor of Medicine Professor of Microbiology and Immunology, Vanderbilt University School of Medicine, USA

26. Danel, Isabella, MD MS, USA

27. Del Rio, Carlos, MD, Professor of Medicine Director of the Emory AITRP Grady Memorial Hospital Director for Clinical Sciences and International Research, Emory University, USA

28. Denny, Thomas N., MSc, Principal Investigator, NIH-NIAID-Division of AIDS, Immunology Quality Assessment Program, USA

29. Desrosiers, Ronald C., PhD, Professor of Microbiology and Molecular Genetics, Harvard Medical School

30. Doms, Robert W., MD, PhD, Chair, Department of Microbiology, University of Pennsylvania, USA

31. Elion, Richard, MD, George Washington University School of Medicine, USA

32. Gallo, Robert C., MD, Professor and Director, Institute of Human Virology; Co-Discoverer of HIV as the cause of AIDS; Developer of the first HIV blood test. University of Maryland, USA

33. Gathe, Joseph, MD, Therapeutic Concepts, P.A., USA

34. Girard, Marc P Lyon, Professor, (retired and formerly of Pasteur Institute and Mérieux Foundation), France

35. Groenewald, Pam, Public Health Researcher, South Africa

36. Gulick, Roy M., MD, MPH, Associate Professor of Medicine, Director, Cornell HIV Clinical Trials Unit Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, USA

37. Harries, Anthony D, Professor, HIV Unit, Ministry of Health, Malawi

38. Helbert, Matthew, FRCP FRCPath PhD, Head of Service, Immunology, Manchester Royal Infirmary, UK

39. Holmes, Harvey, Dr, Division of Retrovirology, National Institute for Biological Standards and Control, UK

40. Hoxie, James A., University of Pennsylvania, USA

41. Hviid, Lars, Professor and Head of Research, Centre for Medical Parasitology, Department of Infectious Diseases, Rigshospitalet, Denmark

42. Jarlais, Don Des, Director of Research, Chemical Dependency Institute, Beth Israel Medical Center, USA

43. Johnson, Leigh, Senior Researcher, Centre for Actuarial Research, South Africa

44. Keeney, Michael, ART,FIMLS, Technical Specialist Hematology/Flow Cytometry, Associate Scientist Lawson Health Research Institute, London Health Sciences Centre, Canada

45. Kharsany, Ayesha BM, Dr, CAPRISA, Nelson R Mandela Medical School, University of KwaZulu-Natal, South Africa

46. Kiepiela, Photini PhD, Associate Professor, University of KwaZulu Natal, Faculty of Health Sciences, Nelson R Mandela School of Medicine, South Africa

47. Kourilsky, Philippe, Professor at the College de France, Member of the French Academy of Sciences, Honorary President of the Pasteur Institute

48. Kuritzkes, Dan, Director of AIDS Research, Brigham and Women's Hospital, Associate Professor of Medicine, Harvard Medical School, Chair, HIV Medicine Association, USA

49. La Via, Mariano F., Professor Emeritus, Pathology and Laboratory Medicine, Medical University of South Carolina

50. Lange, Joep, MD, PhD, Professor of Medicine, Executive Director, Center for Poverty-related Communicable Diseases, Academic Medical Center, University of Amsterdam, Netherlands

51. Lawrence, Robert S., MD, Director, Center for a Livable Future, Professor of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, USA

52. Lederman, Michael M., MD, Scott R. Inkley Professor of Medicine, Director, Center for AIDS Research, Case Western Reserve University, USA

53. Lenkei, Rodica, MD, PhD, Capio Diagnostik/Calab Research, Flow Cytometry Laboratory, Stockholm, Sweden

54. Levine, Alexandra M., MD, Distinguished Professor of Medicine, Chief, Division of Hematology, University of Southern California, School of Medicine, Medical Director, USC/Norris Cancer Hospital, USA

55. Levy, Yves, Professeur, Service d'immunologie Clinique, Hí´pital Henri Mondor, France

56. Malim, Mike, Professor and Head, Dept of Infectious Diseases, King's College London School of Medicine, UK

57. Mayer, Kenneth MD, Professor of Medicine and Community Health, The Miriam Hospital, USA

58. Miller, Veronica, PhD, Associate Research Professor, Department of Prevention & Community Health, The George Washington University SPHHS

59. Moore, John P., Professor of Microbiology and Immunology, Weill Medical College of Cornell University, USA

60. Nattrass, Nicoli, Professor, Director of the AIDS and Society Research Unit, University of Cape Town, South Africa

61. Nixon, Douglas F., MD, PhD, Professor of Medicine, Associate Chief, Division of Experimental Medicine

62. Powderly, William, MD, Head Professor of Medicine, UCD School of Medicine and Medical Science University Dublin, Ireland

63. Richman, Douglas D., MD, Professor of Pathology and Medicine, University of California San Diego

64. Rosenfield, Allan, MD, Mailman School of Public Health, Columbia University

65. Rybicki, Ed, Professor, PhD, PI, Subunit Vaccines Group, Institute of Infectious Disease and Molecular Medicine and Department of Molecular & Cell Biology, University of Cape Town, South Africa

66. Saag, Mike, MD, Director, UAB Center for AIDS Research Professor of Medicine, University of Alabama At Birmingham, USA

67. Schrager, Jeffrey A., MD, Assistant Professor, University of Cincinnati Academic Health Center, Department of Pathology and Laboratory Medicine, USA

68. Smith, Kimberly MD, MPH, Associate Professor of Medicine, Rush Presbyterian St. Luke's Medical Center, USA

69. Spear, Greg, Professor, Dept. Immunology/Microbiology, Rush University Medical Center, USA

70. Stetler-Stevenson, Maryalice, Chief, Flow Cytometry Unit, LP, NCI, NIH, USA

71. Stevenson, Mario, PhD, Professor, Program in Molecular Medicine, Director, Center for AIDS Research, Univeristy of Massachusetts Medical School, USA

72. Stone, Valerie, MD, MPH, Massachusetts General Hospital Harvard Medical School, USA

73. Trigg, Bruce G., MD, USA

74. Vance, Carol S., PhD, M.P.H., Mailman School of Public Health, Columbia University, USA

75. Veazey, Ronald S., DVM, PhD, Professor and Chair, Division of Comparative Pathology, Tulane University School of Medicine

76. Volberding, Paul, MD, Professor and Vice Chair, UCSF Department of Medicine, Co-Director, UCSF-GIVI Center for AIDS Research

77. Watkins, David, Dr., University of Wisconsin, AIDS Vaccine Laboratory

78. Weiss, Robin A., Professor of Viral Oncology, Wohl Virion Centre, Division of Infection and Immunity, University College London

79. Whiteside, Alan W, Professor, D Econ, AIDS Researcher, South Africa

80. Whitman, Steven, PhD, Director Sinai Urban Health Institute, USA

81. Wilfert, Catherine, MD, Professor of Pediatrics and Microbiology, Duke University Medical Center, USA

82. Williams, Paul, DM FRCP FRCPath, Chairman, UK National Quality Assurance Advisory Panels in Immunology, Consultant Clinical Immunologist, Department of Medical Biochemistry & Immunology, University Hospital of Wales, UK

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