Many of the scientists gathered in Durban for the 13th international AIDS conference were deeply disappointed by President Thabo Mbeki's opening speech last night. Mr Mbeki maintained his controversial support for the `dissident' theory of Dr Peter Duesberg, professor of biochemistry and molecular biology at Berkeley, California, which rejects the link between AIDS, the leading cause of death in Africa, and the HIV virus.
Most scientists wanted Mr Mbeki to back the war on HIV, including efforts to reduce promiscuity and to end the stigma of AIDS, which makes women, especially, hide their infection from their partners. They had hoped he would embrace the new drugs that can prevent the transmission of HIV from mother to child - especially since Boehringer Ingelhiem, the drugs company that makes the most effective drug for this purpose, Nevirapine - offered on Friday to donate it free for five years to developing countries.
Instead, Mr Mbeki berated scientists for stifling free speech by denying him the right to question the received wisdom, and made it clear he believes that the true cause of his country's health crisis is poverty. The terrible extent of that crisis became clearer yesterday, as figures released by the Department of Home Affairs confirmed South Africa's position as a country under siege by the virus and syndrome.
The latest figures, presented to the South African Cabinet by the president of the South African Medical Council, Dr Malegapuru Makgoba, showed that the number of South Africans who died before the age of 50 doubled over the past decade, largely because of the rapid spread of the human immuno-deficiency virus (HIV) and the resulting acquired immune deficiency syndrome (AIDS).
The publication of these startling figures came in the wake of the shocking disclosure by the latest UN AIDS report that South Africa, the most highly developed country in sub-Saharan Africa, is as severely threatened by HIV-AIDS as its poorer neighbours.
"In seven countries, all in the southern cone [of Africa], at least one adult in five is living with the virus", the report said. Noting that 20 per cent of adult South Africans were infected with HIV, it added: "With a total of 4.2 million infected people, South Africa has the largest number of people living with HIV-AIDS in the world".
The UN AIDS figures were challenged when they first appeared, but the rise in the death rate of relatively young South Africans appears to confirm the UN AIDS conclusion that South Africa is imperilled by the disease.
Prof Makgoba, who has no doubts that AIDS is caused by HIV, compared the devastation wrought by HIV-AIDS on young, economically active South Africans with the destruction inflicted by war. "These are not projections," he said, "these are real figures . . . Here you have young people dying, and young women dying earlier than young men, which is unheard of in biological terms."
These figures add even greater urgency to the controversy created by Mr Mbeki's heterodox views on the disease. The presidential spokesman, Mr Parks Mankanhlana, did little to enhance President Mbeki's cause last week when he warned that a declaration signed by scientists from all over the world would find its "comfortable place" in the presidential dustbin. Known as the Durban Declaration, and timed for release on the eve of the AIDS conference in Durban, the declaration said: "The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous . . ."
Prof Makgoba - who used nearly identical phraseology when summing up the conclusions of the presidential panel, on which he served - said of Mr Mbeki: "He is an intelligent person . . . he is a learning person".
He went on to criticise the media for exaggerating the differences between the orthodox scientific view on the causes of AIDS and President Mbeki's plea for more detailed examination of its genesis and particularly rampant development in Africa, where, as distinct from earlier identification of illness in the US, it is not primarily a disease associated with homosexuals.
Apart from the causes of AIDS, another issue already firmly on the agenda for the week-long conference is the cost of drugs for poorer, developing countries. As the South African Health Minister, Mr Manto Tshabalala-Msimang, told reporters yesterday: "The access of affordable drugs needs to be vigorously pursued."
Dr Makgoba said South Africa hoped to by-pass pharmaceutical companies and undertake its own vaccine development programme. "We aim to develop a vaccine by 2005," he said. "We felt that ownership of vaccines by the public sector is crucial if vaccines are to be affordable and accessible."
Another issue on the agenda is the cancellation of the international debt of poorer African countries. Additional reporting: Guardian service.