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The Mystery of AIDS in South Africa

One of Mbeki’s most famous speeches, given at the adoption of South Africa’s new constitution in May 1996, movingly addressed this paradox:

I am an African. I owe my being to the hills and the valleys, the mountains and the glades, the rivers, the deserts, the trees, the flowers, the seas and the ever-changing seasons that define the face of our native land…. I owe my being to the Khoi and the San whose desolate souls haunt the great expanses of the beautiful Cape—they who fell victim to the most merciless genocide our native land has ever seen…. I am formed of the migrants who left Europe to find a new home on our native land. Whatever their actions, they remain still part of me…. I am the grandchild of the warrior men and women that Hintsa and Sekhukhune led….

I have seen our country torn asunder as these, all of whom are my people, engaged one another in a titanic battle…. The pain of the violent conflict that the peoples of Liberia, Somalia, the Sudan, Burundi and Algeria experience is a pain I also bear. The dismal shame of poverty, suffering and human degradation of my continent is a blight that we share…. This thing that we have done today says that Africa reaffirms that she is continuing her rise from the ashes. Whatever the setbacks of the moment, nothing can stop us now!… However much we have been caught by the fashion of cynicism and loss of faith in the capacity of the people, let us say today: Nothing can stop us now!

Thus Mbeki expresses his faith in an Africa whose suffering is its strength, and is finally optimistic about a continent whose future can’t possibly be worse than its past.

In the book African Renaissance, one of the contributors, Bernard Makhosezwe Magubane, praises Barbara Tuchman’s idea, derived from William McNeill’s book Plagues and Peoples, that Europe’s Renaissance was partly made possible by the calamities of the Middle Ages such as plague, inequality, and war. Magubane speculates that Africa’s Renaissance may also emerge from Africa’s current political, ecological, and health crises.

I was particularly interested in the scientific elements of the African Renaissance movement, which emphasizes the exploration of indigenous knowledge systems, such as traditional medicine. I wondered if Dr. Makgoba knew whether any South African scientists were looking for a cure for AIDS in the herbal pharmacopeia of Africa’s indigenous medicine men and women. I was very eager to speak to Dr. Makgoba about this because, if such research were going on, it would not be the first time the government had been involved in unconventional AIDS research.

In 1997, a group of researchers at the University of Pretoria approached Mbeki, who was then deputy president under Nelson Mandela, and Nkosazana Zuma, who was health minister at the time. The researchers claimed to have a cure for AIDS, which they called Virodene. Zuma invited them to address the Cabinet on their research, a highly unusual move in any country. Virodene consisted of an impure solution of dimethylformamide, an industrial chemical used in dry cleaning, among other things. It is very unlikely to be in any way beneficial to AIDS patients, and may well be harmful, since it is known to cause liver damage and skin rashes and may even activate HIV, possibly accelerating the course of AIDS.17

Clinical trials of Virodene on HIV-positive people were carried out without the authorization of the Medicines Control Council, the state body that regulates research and approval of drugs,18 and Zuma, Mbeki, and the Virodene researchers were criticized for their behavior concerning the drug by numerous South African doctors and scientists and by the South African Medical Research Council, the Democratic Party, and the Medicines Control Council.19 In an open letter in the South African press, Mbeki wrote an indignant defense: “How alien these goings-on seem to be to the noble pursuits of medical research! In our strange world, those who seek the good for all humanity have become the villains of our time.” He defended his decision to try to “facilitate the carrying out of the critical clinical trials that would test the efficacy of Virodene.”20 Shortly after the Medicines Control Council tried to block further trials of Virodene in human subjects, its chairman and several other officials were fired.

Dubious AIDS cures are nothing new in Africa, or anywhere else, but the strange thing about Virodene was that it seemed to attract interest in such high places. The owners of the company that manufactured Virodene, called CPT, were engaged in a court battle over ownership of the company, and during the proceedings, a memorandum from the company surfaced, which stated that “the ANC is to receive six percent shares in the CPT.”21 Zuma and Mbeki denied any knowledge of this document, and there is no evidence that they had been aware of the offer. The Virodene story made headlines in South Africa and elsewhere in 1998, but since then the furor has subsided, and no one I spoke to in South Africa seemed to know whether any further research on it is being conducted.

Virodene was not an indigenous African cure for AIDS, but it did emerge from an African university, and I wondered whether Mbeki, who was so hostile to AIDS drugs made by Western pharmaceutical companies, might not have been interested in it simply because he wanted to give support to drugs developed in Africa.

The Virodene episode, Mbeki’s skepticism of Western approaches to the AIDS epidemic, and his support for the African Renaissance reminded me of an essay I had read in The Sunday Times of South Africa by Mark Gevisser, Thabo Mbeki’s biographer.22 Gevisser describes a correspondence between Mbeki and his friend Rhianon Gooding that took place when Mbeki was studying in Moscow in 1969. In his letters, Mbeki discusses his admiration for Coriolanus, who fought to save Rome, but was too high-minded to live in it, and ended up making war on his own people. Gevisser does not quote Coriolanus’ most famous lines from the play, but I immediately thought of them as I read the essay. When the Senate threatens to banish Coriolanus from Rome because he refuses to accept the mantle of a Roman hero, Coriolanus replies, “I banish you!… There is a world elsewhere.” Like Coriolanus, Mbeki has stubbornly decided to debate AIDS on his own terms, whether by defending the Virodene researchers or by denying fifteen years of research on HIV and AIDS. As he does so, his pride may well destroy his own people.

Dr. Makgoba arrived an hour late for our meeting, and had to leave almost immediately to catch a plane. As I waited in his office, his secretary told me that she had reminded him of our meeting that very morning, and he had said he would be able to make it. But then he had gone to see his dietician, and as far as she knew, he had been detained there. This seemed odd. Why suddenly consult a dietitian? And then be detained there? I began to feel as though I had come to a land in a fairy tale, where everybody is evasive and ignores appointments.

When Dr. Makgoba finally appeared, he didn’t want to talk about the AIDS dissidents, the African Renaissance, or Coriolanus. He did tell me that research on traditional African medicine for AIDS was underway in South Africa, but when I asked for details, he said he didn’t want to talk about it. After fifteen minutes he asked me to leave.

6.

Back in Johannesburg, I finally found someone who would talk to me about the Kalafong trial. Professor Geoffrey Falkson is a retired oncologist, and he also runs the Ethics Committee at the University of Pretoria, which approved Dr. Steenkamp’s application to conduct the clinical trial on behalf of the American pharmaceutical company. As we sat in Falkson’s small, sunny office in the academic hospital he said, in answer to my questions, that five patients out of forty-two had died on the trial at Kalafong. “Isn’t that rather a lot?” I asked.

They had full-blown AIDS!” he said.

No, they didn’t.”

He took the protocol book off his shelf and turned to the page where the inclusion criteria for the trial were listed. Clearly, patients with AIDS were not allowed on the trial.

Professor Falkson seemed confused about many of the details of the trial, and he didn’t seem to appreciate the gravity of what he was telling me had happened, that five healthy HIV-positive people suddenly died after receiving medications that were supposed to extend their lives. He talked about the difficulty of conducting trials in South Africa, the high ethical standards that prevail there, the selflessness of investigators like Dr. Steenkamp. Finally, he wrote down a web address for me, where, it turned out, some of his oil paintings could be viewed.

Finally I asked Dr. Falkson to tell me who was ultimately responsible for examining and caring for people like Andrew and Molly, who might have been harmed on a clinical trial, and for all the people who died.

Clindipharm are the ones to talk to about that,” he said. Clindipharm is a private company based in Pretoria that serves as an intermediary between pharmaceutical companies wishing to conduct clinical trials of their drugs using South African patients and South African doctors and scientists wishing to carry out the work itself. Clindipharm packages the drugs, distributes them to the doctors, and manages the data that come in from the laboratories and doctors’ offices. The medical director of Clindipharm refused to speak to me, but he did tell me that all adverse events on clinical trials are reported immediately to the Medicines Control Council, at which point they cease to be Clindipharm’s responsibility.

During my last week in Johannesburg, I tried without success to reach Dr. Helen Rees, the new head of the Medicines Control Council. By now, of course, I was not surprised when Dr. Rees did not return my calls. However, just as I was leaving South Africa, I spotted Dr. Rees in the departure lounge of the airport in Johannesburg.

You have your facts wrong,” she said, when I told her I had heard that five people died on the Kalafong trial.

Well, how many people did die at Kalafong, then?” She did not remember. I asked Dr. Rees who was responsible for following up adverse events on clinical trials, and examining patients like Molly and Andrew who might have been harmed by experimental drugs.

We refer the matter to the local Ethics Committee. We take these things very seriously,” she said.

I said I thought that sounded strange, because Professor Falkson, the head of the Ethics Committee at the University of Pretoria, had told me that Clindipharm was responsible for following up adverse events. Clindipharm, in turn, had told me that they referred all reports of adverse events to the Medicines Control Council, and now the head of the Medicines Control Council was telling me she refers them back to the Ethics Committee. The responsibility seemed to have gone full circle.

  1. 17

    S.J. Klebanoff et al., “Activation of the HIV type 1 long terminal repeat and viral replication by dimethylsulfoxide and related solvents,” AIDS Research and Human Retroviruses, Vol. 13 (September 20, 1997), pp. 1221-1227.

  2. 18

    Virodene Is Still Being Sold: SAPS,” The Citizen, March 6, 1998.

  3. 19

    D.C. Spencer, “Virodene—support misguided,” B. W. Hugo, “Virodene—support misguided,” F. Mahomed, “Virodene—support misguided,” South African Medical Journal, Vol. 87, No. 3 (March 1997), pp. 613-614; Peter I. Folb et al., “Virodene—support misguided,” South African Medical Journal, Vol. 87, No. 4 (April 1997), pp. 613-614; W. J. Kalk et al., “Virodene—support misguided,” South African Medical Journal, Vol. 87, No. 6 (June 1997), pp. 775-776; Pat Sidley, “South African Research into AIDS ‘Cure’ Severely Criticised,” BMJ, Vol. 314 (March 15, 1997), p. 771; Mike Ellis, “Virodene: What the DP Is Saying,” The Citizen, March 4, 1998.

  4. 20

    Thabo Mbeki, “‘Alien Goings-On’ Mar Virodene Fight,” The Citizen, March 8, 1998; see also Prakash Naidoo and Pippa Green, “Mbeki Slams Doctors over AIDS Drug,” The Citizen, March 8, 1998; Chris Barron, “Government Swallowed the Wrong AIDS Pill,” The Citizen, March 1998; Jack Lundin, “Tortuous Tale of AIDS Drug Unfolds,” Financial Mail, April 10, 1998; Brian Stuart, “Zuma Seeks Testing Despite Virodene ‘Toxic’ Tag,” The Citizen, March 5, 1998.

  5. 21

    Brian Stuart, “Mbeki and Zuma in Virodene Row,” The Citizen, March 3, 1998.

  6. 22

    Mark Gevisser, “Thabo Mbeki: The Chief,” The Sunday Times (South Africa), June 20, 1999.

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