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The fight against Aids in South Africa has been dealt a blow by President Thabo Mbeki who clings to discredited beliefs.
By sacking Nozizwe Madlala-Routledge, the deputy health minister credited with ending a decade of Aids denialism at the heart of the South African political leadership, President Mbeki has turned back the clock.
He has long been an Aids denier. One insomniac night in the late 1990s, it is said, while surfing the internet, he came across a website promulgating the thoughts of Peter Duesberg, professor of biochemistry and molecular biology at the University of California, Berkeley, and arch-HIV sceptic.
Although nearly all scientists with any knowledge of Aids were in no doubt that the human immunodeficiency virus (HIV) was the cause, Duesberg took a contrary view. He and Professor David Rasnick, also of the University of California, were the leaders of the Aids dissidents.
Duesberg argued that the disease was caused by poverty and (illegal) drug-taking, which did so much damage to the immune system to put it into a state of collapse. The disease was not infectious and was not transmitted by sex.
His views had a dramatic impact on Mbeki who underwent the medical equivalent of a religious conversion.
The newly elected president was convinced that the Aids epidemic in Africa was unique and that it demanded a uniquely African solution. Duesberg provided him with the scientific justification he needed for his instinctive response.
The baleful consequences for Mbeki's country are all too plain to see. Millions of children have been infected with the virus transmitted from their mothers at birth when a single dose of drugs could have prevented it. Millions more adults have been denied the treatment that could have saved their lives.
Mbeki argued the poverty of his nation and the prevalence of diseases such as malaria and tuberculosis were just as much to blame for the Aids epidemic as HIV itself.
He dismissed Aids drugs as not only useless but toxic, a neo-colonialist conspiracy by Western drug companies to force a Western solution on his country.
In 2003 he caused outrage by saying in New York he did not personally know anyone who had been diagnosed with HIV - this from the leader of a country where, at that time, one in 10 people was HIV positive.
Duesberg and Rasnick were widely cited all around the world by those sceptical about the cause of Aids. The problem was that the Duesberg thesis could not explain the epidemiology of the disease.
HIV was the singular common factor shared between Aids cases among gay men in San Francisco, well-nourished young women in Uganda, haemophiliacs in Japan and children in Romanian orphanages, as British virologist Professor Robin Weiss wrote in a demolition of the Duesberg thesis in Nature in 1990.
They were not the only deniers. Theories taken up with varying enthusiasm over the last 20 years have suggested the disease was spread by blood-sucking mosquitoes transmitting the virus from one victim to another in their bite, and by dirty needles used in vaccination.
The latter theory was particularly serious as it not only disguised the true risk - unprotected sex - but also posed an extra danger of deterring parents from immunising their children.
Research disproved both theories, though health workers now take greater care to use clean needles with every vaccination. Only a tiny number of HIV infections are thought to have been transmitted by dirty needles yet allaying public concern has been difficult.
The Aids deniers have given succour and support to purveyors of folk remedies such as Matthias Rath, an influential figure in South Africa who treats Aids patients with multivitamins and claims anti-retroviral drugs do more harm than good.
Wherever people are sick and orthodox medical treatment is difficult or expensive to obtain, venal practitioners emerge peddling their folk remedies to desperate victims who will clutch at any straw.
One of the most unexpected is President Yahya Jammeh of The Gambia who, since the beginning of this year has been treating people with HIV in the compound of the presidential palace in Banjul with a herbal concoction he claims is a cure.
To the alarm of the scientific community, the patients stopped taking their anti-retroviral drugs.
The President claimed this year that laboratory tests had proved his remedy worked. But the head of the laboratory at the University of Dakar in Senegal where the tests were done denied it.
He alleged that the Gambian authorities had used subterfuge to get the samples tested and had misinterpreted the results. The Gambian people, meanwhile, are led by a president in denial. What is more worrying still is that it has been the wilfully ignorant policies of Africa's supposedly most developed and progressive state that have allowed him to do so.
The sacked minister was the co-architect of an ambitious five-year plan to accelerate the use of free life-saving Aids drugs, tripling the numbers on treatment by 2011. That plan is now in doubt.
Madlala-Routledge, speaking to the Independent, said she did not know the reasons for the President's decision.
But she wanted to reassert her ideas.
"We are dealing with an emergency where large numbers of people are dying.
"I would be very saddened if we were taken back to the time when people were confused about Aids treatment."
Ostensibly the reason for firing Madlala-Routledge was that in June she travelled business class to Madrid, to speak at a conference on Aids without the President's written authorisation.
Her real crime, say insiders, was to criticise the President's handling of the epidemic.
- Independent
