says “H.I.V. and AIDS Clinic.” There are Annals of science no doctors, nurses, or medical techni- cians at this particular clinic, and just one product: ubhejane, which is the Zulu the denialists word for black rhinoceros. Every day, from eight in the morning until four— The dangerous attacks on the consensus about H.I.V. and aids. unless he runs out first—Gwala sells ub- hejane in litre-sized milk containers. BY MICHAEL SPECTER There are two kinds. The bottle with a white lid holds an herbal mixture in- eblon Gwala is a husky forty-nine- to his bed, and eventually, when it had tended to rebuild an immune system rav- year-old man with an unusually grown to eighty-nine, his grandfather in- aged by the AIDS virus. The second, with vividZ dream life. For many years, he structed him to divide the herbs into two a blue lid, is a potion to reduce the worked as a long-haul truck driver, criss- groups and boil each batch. The result- amount of the virus that has already ac- crossing South Africa from his base, in ing concoctions, the apparition assured cumulated in the bloodstream. Durban. But he is in a different business him, would cure AIDS, the disease that On a typical day, as many as a hun- now. A few years ago, Gwala began to was destroying his country. Gwala fol- dred people come to Gwala’s clinic, each dream about herbs. Some nights he lowed instructions. He quit his job, paying the equivalent of about a hundred would see just one, on others two or turned his garage into a factory, and dollars—nearly two weeks’ pay—for a three. Gwala’s grandfather, who died opened a storefront dispensary in down- thirty-day supply. Gwala says that the when he was a boy, was a traditional vil- town Durban, wedged between a dry medicine never fails. He also says that he lage healer, and in the dreams he would cleaner and a furniture store. He hung has no idea how it works. “Ubhejane pro- tell Gwala which herbs to collect and two signs next to the door: one has “Doc- tects the cells from any virus,’’ he told me where to get them. Gwala kept a list next tor Gwala” written on it, and the other when I met with him at his clinic, last

As prominent South African politicians dismiss antiretroviral drugs as “poison,” traditional healers have flourished.

TNY—2007_03_12—PAGE 32—133SC.—live art r15820_B.eps, critical cut to be watched throughout entire press run! fall. “I don’t know how that happens. I year, a thirty-five-year-old man who had am not a scientist. But what I do know is unprotected sex with three women—and that people who were on the edge of infected one—despite knowing that he death go back to work. It makes them was H.I.V.-positive, was found guilty of feel better, and it gives them life.” endangering their lives. He has appealed, The use of ubhejane has been encour- saying that H.I.V. does not cause illness. aged by President Thabo Mbeki’s Health His main witness is Eleni Papadopulos- Minister, Manto Tshabalala-Msimang, Eleopulos, a medical physicist at Royal and by the Director-General of Health, Perth Hospital, who claims that H.I.V. Thami Mseleku. The health minister in has nothing to do with AIDS. The Perth the province of KwaZulu-Natal has also Group, as she and several other Australian spoken in favor of the remedy, and the H.I.V. denialists are known, has argued mayor of Durban has supplied funds to for more than twenty years that the virus buy it for patients at a hospice not far has never been isolated or identified prop- from the city. Ubhejane’s most vigorous erly. Papadopulos-Eleopulos and her col- promoter, a retired professor of sociology leagues insist that AIDS in gay men results named Herbert Vilakazi, says that anti- from drug abuse and repeated exposure retroviral drugs, or A.R.V.s—which have to semen. Last month, the President of proved to be the only successful treat- Gambia, Yahya Jammeh, disclosed that ment for the millions of people infected he had found a secret remedy for AIDS and with H.I.V.—are so toxic that they can asthma, and announced that he would cause more harm than good. Like Mbeki begin to cure AIDS on Thursdays and himself, he seems to be convinced that a asthma on Saturdays. genuine cure for AIDS is more likely to be AIDS denial plays a corrosive role in found in the arsenal of traditional Afri- the health policies of many countries, but can medicine than in any chemical com- nowhere has the damage been as extreme pound sold by a Western pharmaceutical or as enduring as in South Africa. Five company. For years, Vilakazi, Mbeki, and a half million of the country’s forty- and Tshabalala-Msimang have used eight million people are infected with words like “damaging,” “toxic,” and “poi- H.I.V., which makes South Africa by son” to describe A.R.V.s. any epidemiological standard the coun- Ubhejane is far from the first untested try with the world’s deadliest AIDS epi- remedy that South African leaders have demic. Nearly a thousand people there recommended to aids patients. Viro- die of AIDS every day, and at least twice dene, a powerful industrial solvent with that many are newly infected. Between no medicinal value, was embraced by 1997 and 2004, death rates from infec- Mbeki and his comrades as soon as it was tious diseases more than tripled for men introduced by South African researchers, and increased fivefold for women—from in 1997. More recently, Secomet V, an numbers that were already among the extract from red clover, made a splash in worst in the world. The country, while the market. It is sold as Ithemba Le- not rich, has sub-Saharan Africa’s largest sizwe—Hope of the Nation. Minister economy, and it is one of the few on the Tshabalala-Msimang, whose antipathy continent that could genuinely afford to toward pharmaceutical AIDS treatments administer an antiretroviral-drug regi- has long been an international scandal, men that would cover those people who has never wavered in her support for such need it. Today, only about two hundred remedies. Last summer, she astonished thousand receive the drugs. participants at an international AIDS con- Recently, there have been hints that ference in Toronto by presenting a gov- the government might be open to a ernment public-health display that fo- new approach. Last fall, South Africa’s cussed on beetroot, olive oil, garlic, Deputy President, Phumzile Mlambo- lemons, and African potatoes. Antiretro- Ngcuka, a progressive and measured viral drugs were included only after furi- leader, emerged as the government’s ous protests. most prominent spokesman on AIDS— Denying the scientific consensus in part, it seemed, because Mbeki’s Health dux e about what causes AIDS and how to treat Minister, Tshabalala-Msimang, had /r a

ilv it is not limited to South Africa, of course. been seriously ill. Ever since her appoint- s o a H.I.V. itself is now on trial before the Su- ment, in 1999, Tshabalala-Msimang has jo preme Court of South Australia. Last been one of the world’s most polarizing

THE NEW YORKER, MARCH 12, 2007 33

TNY—2007_03_12—PAGE 33—133SC. Without Duesberg’s research, there might have been no significant progress in treating AIDS. In the nineteen-eighties, Robert Gallo, the American scientist who shares a negotiated credit with the French virologist Luc Montagnier for discovering the AIDS virus, had high praise for Duesberg. Introducing him at a scientific conference in 1984, he said, “He was among the first, or perhaps even the very first,” to characterize the struc- ture of the viruses. “He was involved in the first work that provided a genetic map of retroviruses.” Retroviruses can cause several ill- nesses, including some cancers, but it wasn’t until 1983, when French scien- tists conducted a biopsy on the lymph •• nodes of a gay man who had suddenly become sick, that antibodies from a ret- and controversial public-health officials. dead.” She said that she was at the clinic rovirus were found. For more than a She and her husband, Mendi Msimang, because she believes in President Mbeki hundred years, the presence of antibod- a senior official in the African National and suspects that Western drugs won’t ies against any disease had been inter- Congress—the country’s ruling party— save her granddaughter; she knows too preted as good news: antibodies are pro- became close to Mbeki in the nineteen- many people who have died. teins that the immune system uses to sixties, when the A.N.C. was exiled in “The people who want to take those fend off attacks by viruses and bacteria as Zambia. A.R.V.s can take them,’’ Gwala told me they circulate in the bloodstream; if you Mlambo-Ngcuka’s new role has been as we watched his wife hand out bottle have antibodies against chicken pox or greeted with caution, because Mbeki after bottle of ubhejane. “But they don’t measles, it means that your immune sys- has inched away from aids denialism in cure anything. The side effects are like tem is ready to fight the virus. That is the past. In 2002, the cabinet took the poison, and people get sicker. Ubhejane how most vaccines work: they train unusual step of officially affirming that doesn’t hurt anyone. And it works. I can blood cells to secrete the specific anti- H.I.V. causes aids. The next year, the feel it. I know I am not a scientist. But bodies needed to recognize and over- government issued a comprehensive— look at these people. They have hope come an infection. But H.I.V. is an en- and forward-looking—aids policy for now and before they had nothing.’’ tirely new kind of virus, one that doesn’t the country. It has never been fully im- simply attack our cells. It takes control of plemented, however. The cabinet also n 1987, three years after French and the entire immune system. At first, sci- instructed Tshabalala-Msimang to American scientists announced that entists wondered if the disease was re- make aids medications available to the IAIDS was caused by the human immuno- lated solely to the life styles of those who public. She began doing so only after deficiency virus, an eminent molecular fell ill. By 1984, however, the correlation South Africa’s highest court ruled that biologist named Peter Duesberg pub- between infection with H.I.V. and the she must, and the pace has been slow. lished a paper in the journal Perspectives development of AIDS in humans had be- Mbeki, an economist who is one of Af- in Cancer Research entitled “Retroviruses come hard to ignore. “Wherever H.I.V. rica’s most respected leaders, has never as Carcinogens and Pathogens: Expecta- was found, AIDS was present or soon disavowed that H.I.V. medi- tions and Reality,’’ in which he argued present,” Gallo wrote in “Virus Hunt- cines are Western inventions aimed at that H.I.V. cannot cause AIDS. Duesberg ing,” his 1991 book about the discovery maiming Africans. In 2000, news reports grew up in Germany and was educated of AIDS. “Conversely, no H.I.V.—no said that Mbeki had hinted at C.I.A. in- there and in Switzerland. He was among AIDS.” Thousands of subsequent studies volvement in propagating the belief that the first to discover, in the nineteen- support this contention. Other illnesses, H.I.V. causes aids. seventies, that a particular class of vi- like malaria and tuberculosis, can hasten With government encouragement, ruses—a type of retrovirus—carries genes the decline of a person who is infected, clinics like Gwala’s are thriving. The day I capable of transforming normal cells into and so can poor nutrition. But if you was there, an old woman walked in carry- cancer cells. Duesberg’s research estab- don’t have H.I.V. you can’t have AIDS. ing a baby girl wrapped in a blanket, like a lished his international reputation and Just as most scientists became con- papoose, on her back. The baby’s mother helped him win tenure at the University vinced that H.I.V. was the cause of the died of AIDS shortly after giving birth. The of California at Berkeley. In 1986, he was epidemic, however, and as, for the first father died of AIDS before she was born. “I invited to join the National Academy of time, a drug, AZT, was shown to inter- am what she has left,’’ the woman—her Sciences, and he was even mentioned as a fere with the virus directly, Peter Dues- grandmother—told me. “Everyone else is possible recipient of the Nobel Prize. berg insisted that H.I.V. had nothing to

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TNY—2007_03_12—PAGE 34—133SC.—live art a11378 do with the disease. In his initial paper, forum, in Washington, D.C., on the or- and as many as twenty million have in 1987, and in more than a dozen since, igins of the epidemic. One after another, died—simply has no AIDS epidemic. In- Duesberg has argued that H.I.V. is researchers presented data linking the stead, they blame the absence of proper harmless, a mere “passenger” virus—one increase of H.I.V. infections around the nutrition or clean water—factors that of the thousands of organisms that live world to the growing number of AIDS certainly exacerbate the effects of AIDS within and among us, never causing dam- cases. Duesberg rejected the data com- but do not cause it. On the Internet, age or requiring us even to notice that pletely. This was at a time when in the where anyone can profess to be an expert, they exist. “To pretend to think that AIDS was still widely seen rumor sites can make all these theories H.I.V. causes aids is politically correct, as a death sentence, and people had even seem plausible, particularly to a new gen- socially attractive, and very, very fund- committed suicide after learning that eration that has not been educated prop- able,” Duesberg told an interviewer not they were infected. , the erly about the risks of H.I.V. One site, long ago, adding that even in “the freest federal government’s leading AIDS ex- virusmyth.net, has more than a thousand of all countries, as George Bush calls the pert, sat silently for hours. Usually the Web pages attached to it, and its open- U.S., nonconformists are excommuni- most circumspect of scientists, he finally ing page features an illustration of the cated at all social and scientific levels.” erupted. “This is murder,’’ he said after AIDS virus with dollars pouring out of it. Duesberg argues that recreational listening to Duesberg speak. “It’s really There is a photograph of Thabo Mbeki drugs are what destroy the immune sys- just that simple.” and a call to arms: “Support President tem, not a retrovirus. He believes that a Duesberg has come to expect re- Mbeki to find the truth about AIDS.” virus cannot be the cause of an illness if sponses like that. He was once asked how Duesberg’s influence gained new mo- the illness becomes evident only many long it might take for the scientific estab- mentum when Mbeki, shortly after suc- years after the initial infection. Viruses lishment to recognize that it was wrong ceeding Nelson Mandela as President, in typically make people sick shortly after about H.I.V. He replied, “It took the 1999, discovered his work while rooting infecting them, before their immune sys- highly established and affluent Catholic around on the Internet. Mbeki has re- tem can respond. With H.I.V., more Church four hundred years to ‘under- sponded harshly when people criticize than a decade can pass between the mo- stand’ Galileo.” He went on to say that it him for supporting Duesberg. “I am also ment a person becomes infected and the might take the scientific establishment, amazed at how many people, who claim time when he becomes visibly ill. Dues- “the Church of the twentieth/twenty- to be scientists, are determined that berg also has written that no virus can frst century,” at least that long. scientific discourse and inquiry should cause disease after the body starts to pro- cease, because ‘most of the world’ is of duce a neutralizing immune response. he aids dissident community may one mind,” Mbeki wrote in 2000. “By re- Duesberg contends that to prevent be small, but its impact has not been. sort to the use of the modern magic wand aids—and even to cure the disease—it is TheT climate in which medicine is prac- at the disposal of modern propaganda necessary only to eat properly and abstain ticed has changed dramatically since the machines, an entire regiment of eminent from harmful drug use. In 1998, he and beginning of the epidemic; medical au- ‘dissident’ scientists is wiped out from the one of his collaborators, David Rasnick, thority is no longer revered, and pharma- public view, leaving a solitary Peter Dues- wrote, “All infectious epidemics of the ceutical companies are increasingly por- berg alone on the battlefield, insanely past, such as polio, cholera, tuberculosis, trayed as criminals. The Internet has tilting at the windmills.” smallpox and syphilis, have long been made it possible for every conspiracy the- For Mbeki and many other South Af- brought under control, or even elimi- ory to flourish. There are three basic ver- ricans whose world views were defined nated, at a fraction of the cost of AIDS sions of the H.I.V.-denial credo. The by their struggle with apartheid, it is un- with technology that was far less sophis- first arises from Duesberg’s conviction derstandably hard to see white men in lab ticated than what is available now.” The that H.I.V. does not cause AIDS. The coats as people who want to help them. focus on H.I.V., Rasnick later argued, is second argues that, even if the virus is In the past, many drugs and vaccines “the biggest scientifc, medical blunder of harmful, the risks of antiretroviral drugs have been tested on Africans and proved the 20th century’’; the tens of thousands far outweigh the benefits: AIDS drugs are effective only with their help. But the of researchers who have devoted their poisons, pushed by doctors corrupted by drugs are often far too expensive for Af- lives to treating the virus have been wast- the pharmaceutical industry. The “poi- rican countries to acquire. Americans ing their time and billions of dollars. son” argument has been proved untrue in seek medical solutions to nearly every Through force of will, Peter Dues- hundreds of studies across the globe, health problem—whether it’s hair loss, berg essentially invented the AIDS dissi- among women, men, drug users, homo- cancer, AIDS, or one of the many diseases dent movement, and remains its most sexuals, and infants. Finally, and most that stem from the fact that we eat too prominent proponent. For years, he has perniciously, there are those who argue much. Mbeki argues that what his peo- maintained that, since antibodies are that sub-Saharan Africa—where nearly ple need is decent food and clean water. generally signs that our immune system two-thirds of H.I.V.-infected people live “You can’t say the response to a healthy is doing its job, anybody who tests pos- human body is drugs,’’ he told Parliament itive for H.I.V. ought to be happy. In in 2004. “Your first response is proper 1988, in an effort to put Duesberg’s the- feeding. The Minister of Health”— ories to rest, the American Foundation Tshabalala-Msimang—“repeats this for AIDS Research sponsored a scientific thing every day and what do they do,

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TNY—2007_03_12—PAGE 35—133SC.—live spot art r16004_A, pls inspect and report on quality they mock her. It’s like she’s some crazy ety has turned the scientific method into wonder if there is a social selection for this person of the moon!” a fetish. “Orthodox medicine has reached disease. Is it not a coincidence that Africa Mbeki rarely addresses scientific so- a dead end,” he told me. “There is walk- is the poorest continent in the world? Did lutions to the AIDS epidemic. Instead, ing evidence and evidence that comes you ever think that it’s in the interest of he focusses on politics and the injustices from a lab. There are plenty of people some people for it to stay that way?” done to Africans. In his frst years in of- who rely on walking evidence. A person fce, Mbeki was openly hostile to the idea has terrible arthritic pains. An old man ne morning, I took a short ride of H.I.V. In 2000, after he appointed a gives them herbs and they get relief. from Cape Town to the region’s Presidential advisory panel, which in- We can’t say that the only thing that largestO township, Khayelitsha, to visit cluded Duesberg and other denialists, to matters comes in reports from Western Marta Darder, a physician working there study the cause of aids, he was so bru- labs.’’ Nobody denies that traditional for Médecins Sans Frontières. It was a tally repudiated by world leaders and remedies play an important role in med- brisk day, and the flat expanse of Table public-health professionals that he essen- icine. Aspirin is a more modern form of Mountain was bathed in the cool light of tially ceased talking about the issue. But, willow bark, and thousands of other the Southern Hemisphere, and so was with Tshabalala-Msimang as his mouth- drugs have herbs as their base. Artemis- the harbor, which was full of tourist boats piece, Mbeki has since urged Africans to inin, which when used in combination and fishing trawlers. turn away from the medicine that most with other medicine is the best treat- For the past five years, Darder has of the world has come to rely upon. Re- ment available for malaria, is derived fought to make sure that the township’s cently, though, when he appeared to be from an herb that the Chinese have half-million residents have access to the stepping back, and public-health officials relied upon for thousands of years. H.I.V. medicines that the government were permitted to speak for the govern- Nonetheless, most researchers would promises to supply. “We have seen so ment, he also created a new commis- say that any potential medicine—herbal many people who claim to have a cure for sion on African traditional medicine, and or chemical—needs to be subjected to AIDS,’’ she told me. “Mostly, they were ig- chose as its leader Herbert Vilakazi, the the rigors of testing and analysis. Vilakazi nored. But there has never been anything South African academic who is notorious disagrees. “Take Gwala, for example,’’ here like Matthias Rath. His strategy, for his disdain for Western medicine. he said. Vilakazi, who has no medical power, and connections were incredible. training, helped arrange for the former He knew how to play the business and the ilakazi is a retired professor of soci- truck driver to meet senior government politics of South Africa.’’ ology who has taught at, among health officials, including Tshabalala- Rath is a German physician and health otherV places, the University of Cape Msimang. He has also testified before entrepreneur who urges people to substi- Town, and he dresses the part: crisp blue Parliament on ubhejane’s behalf. “I have tute remarkably high doses of multivita- blazer, button-down oxford shirt, light- personally seen hundreds of people who mins for proved therapies like AZT. He gray pants. He lives in a well-appointed, have taken ubhejane, and they get re- has offices in the United States, Germany, book-flled house in one of Pretoria’s more lief,’’ he told me. “All I am saying is let’s Holland, and South Africa. (Duesberg’s fashionable gated communities. He was look at the results of that, as well as co-author David Rasnick has worked born in Zululand, but spent his adolescent using drugs like A.R.V.s. with him in South Africa.) Rath believes years in Hartford, Connecticut, and re- “The situation in America is one of in- that huge doses of vitamins and micronu- ceived his undergraduate degree from Co- tolerance,’’ he continued, never raising his trients—which he sells on the Internet— lumbia University. Vilakazi believes that voice. “There are A.R.V.s. Only one ap- can treat aids (as well as heart disease, the long traditions of African medicine proach to treating this deadly illness is cancer, diabetes, and many other mala- have been ignored by Western scientists permitted. You are not allowed to talk dies). Rath has placed advertisements in because Africans are black—an assessment about anything else.’’ He said that people several newspapers, including the New that many scientists in and outside of Af- are obsessed with whether H.I.V. causes York Times and the International Herald rica share. He goes further, however. “The AIDS, but that he considered such argu- Tribune, railing against pharmaceutical West simply took it for granted that the ments “completely academic and not rel- companies and urging people to stop mind of humanity was full of nothing but evant for the treatment of sick people.” He using their products. His ads almost al- error, rubbish, nonsense, and superstition, went on, “Let us be honest. Who benefits ways appear beneath headlines like “Why until Whites emerged with a more supe- from A.R.V.s? Hundreds of millions of Should South Africans Continue to Be rior mind,’’ he wrote recently. “The West U.S. dollars have been spent on research Poisoned with AZT?” and “Stop aids then proceeded, with amazing folly, to and you have to get a return on your in- Genocide by the Drug Cartel.” On his start accumulating modern scientific vestment. It is the first rule of pharmaceu- Web site, which notes, “The End of the thought, using the famous ‘scientific tical companies, and they simply terrorize aids Epidemic Is in Sight,” he declares: method’ and the method of ‘experiment,’ their opponents. Very frankly, in America Never before in the history of mankind formulated during the ‘Scientific Revolu- there is an official literature—and there are was a greater crime committed than the geno- tion,’ without paying the least respect to, a lot of people in the African-American cide organized by the pharmaceutical drug cartel in the interest of the multibillion-dollar without building upon, the knowledge ac- community who feel maybe there is a con- investment business with disease. Hundreds cumulated by Africans, Asians, and Native spiracy and that racism has a lot to do with of millions of people have died unnecessarily Americans.” it. Why, for instance, is aids the biggest from aids, cancer, heart disease and other Vilakazi believes that Western soci- problem that exists in Africa? You start to preventable diseases and the only reason that

36 the NEW YORKER, MARCH 12, 2007

TNY—2007_03_12—PAGE 36—133SC. these epidemics are still haunting mankind is that they are the multibillion-dollar market- ment could have stopped him; it never before the law, whether he is a scientist or place for the pharmaceutical drug cartel. did.” Darder has spent many of her work- the President or a truck driver. You know ing hours struggling to convince Khaye- Gwala is not going to stop making ubhe- A couple of years ago, Rath began litsha residents who revere the A.N.C. jane and people are not going to stop distributing his multivitamin products that their leaders have misled them. “The using it. So we would have to put them in in some of the country’s poorest town- whole thing was disgusting,’’ she said. She prison to stop them, and how can you put ships, including Khayelitsha. According and her colleagues at Médecins Sans people in prison for doing what they have to doctors there, staff members advised Frontières did what they could to coun- a right to do?” Once again, he rose from H.I.V.-positive patients to refrain from teract the government’s false information. his seat. “I am African, and I will never taking antiretroviral drugs, and claimed “It took months, and we were trying to condemn him,” he said. I asked whether that Rath’s vitamins would cure them or help people,” she said. “For us, it was an merit might help decide whether a medi- prevent further illness. Rath has been incredible distraction, an amazing waste cal treatment was valuable, and suggested criticized in public statements by many of time. And it cost lives. But we had to that training—as a doctor, for instance, organizations, including unaids, the defeat him, and at least here we did.” rather than as a truck driver—would serve South African Medical Association, South Africa’s Director-General of as a better guide to who should practice and the Southern African H.I.V. Clini- Health, Thami Mseleku, sees the whole medicine. cians Society. In the United States, the episode as one in which a good man was “That is because you come from the F.D.A. has informed Rath that it con- driven from providing the type of health West, with one perspective,” he replied. siders advertisements on his Web site to care that Africans really need. “What, ex- “And you think it’s the only perspective be misleading. actly, was Rath’s crime?” Mseleku asked one can have. But in South Africa we are I visited Rath’s ofces in Cape Town, when I visited him in his office, adjacent more open than that.” which occupied two floors in one of the to Parliament. A week earlier, there had city’s most expensive buildings. He wasn’t been hearings there on the state of aids uarraisha Abdool Karim, a hand- there. I have tried to reach him on three treatment in South Africa. A number of some woman with gray threading continents, but neither he nor any of his prominent researchers testified, and so throughQ her black hair, is a professor of associates has returned my calls or made did Zeblon Gwala and Herbert Vilakazi. epidemiology at the Nelson R. Mandela him available for interviews. Shortly be- When Vilakazi launched into his stan- School of Medicine, in Durban. She is fore this article was published, however, dard speech about how the great promise also on the faculty at Columbia Univer- Rath began to place a series of lengthy of traditional medicine had been hindered sity, and is an adviser to the World letters to the editor of The New Yorker on by “scientists and other economically in- Health Organization, UNAIDS, and his main Web site. In them, he asserts, terested parties,” many legislators nodded many similar groups. When Nelson inaccurately, that most antiretroviral enthusiastically. Mandela became President, he placed drugs are derivatives of drugs used for “This chap Gwala has a right to be Abdool Karim at the head of South Af- cancer chemotherapy. He also continues heard in Parliament just as much as any rica’s AIDS program, and she spent nearly his attack on the pharmaceutical indus- doctor,’’ Mseleku told me. “And it is not two years in Pretoria. By the time Mbeki try, and in one letter claims, despite his promoting democracy to believe other- was elected, however, she had returned unwillingness to speak to me, that “the wise.” Mseleku is a huge, pear-shaped to academic life. She and her husband, possibility for the natural control of the man with short curly hair. He was wear- also an epidemiologist at the university, aids epidemic triggered’’ a historic “pub- ing a yellow checked shirt and a blue suit, run a clinic and research facility in a vil- lic debate between Dr. Rath and The and several times during our conversation lage west of Durban. New Yorker,” which, he says, “has gener- he leaped nimbly from his desk to stroll Abdool Karim’s progressive policies ated global interest.’’ about the office: “Every citizen is equal came into question soon after Mbeki Rath no longer seems to spend much time in South Africa. In early 2005, he conducted a medically unsupported clin- ical study on patients in Khayelitsha who were using his multivitamins. That June, he held a press conference in Cape Town and claimed that the study demonstrated that “the course of aids can be reversed naturally.” Soon after Rath showed up in South Africa, Marta Darder told me, “everyone knew who he was and what he did. It was amazing. His pills look like A.R.V.s. They are the same color and shape. He would tell people to take fifteen or more a day.” (Rath has denied these accusa- tions.) Darder went on, “The govern-

TNY—2007_03_12—PAGE 37—133SC—live art a12016 assumed office. Tshabalala-Msimang Last September, while I was in Cape She said that she tried to comply, but that took a delegation to Uganda and looked Town, eighty-one of the world’s most in the end she had a greater responsibility: at a study, called H.I.V.NET, which accomplished scientists sent a letter to “It is important that I say the truth, be- found that just a few doses of Nevira- Mbeki, demanding that Tshabalala- cause that is what sustains me. This is not pine, an antiretroviral given to the Msimang be fired. Mbeki has ignored my truth. But it is the truth. The values mother at the beginning of labor, and such demands before. that taught us it is possible to fight an then to the infant within the first three “We should be acting on what we enemy like apartheid, which appeared im- days of life, dramatically reduced the risk know,’’ Abdool Karim told me. “And possible to defeat. It is that truth. of passing on the virus. The regimen what we know is very grave.’’ Not only has “You hear people talking all the time is cheap and easy to use, and the death rate risen sharply but the about traditional science as opposed to is now in place throughout the age of those who are dying keeps Western science,’’ she went on. “This de- developing world. In just a few falling. For the first time, deaths bate does not need to happen in a way that years, it has saved the lives of hun- among people in their thirties or stops people from taking medicine that dreds of thousands of infants. forties have exceeded those of peo- will save their lives. But it is killing large But not in South Africa. “When ple in their sixties or seventies. In numbers of our citizens.’’ That week, the Tshabalala-Msimang came back, that her studies, Abdool Karim found that country’s statistical agency had announced was when we started to hear the Dues- thirty per cent of women under the age of that between nine hundred and a thousand berg-type pronouncements,” Abdool twenty are infected. “For those between people were dying every day from AIDS. Karim recalled. “It was the beginning of ages twenty and twenty-five,’’ she pointed “This is the reality we live with,’’ she said. our downward spiral’’—which ended in out, “the rate is fifty-four per cent. Then “I have lost relatives to AIDS. We all have. disaster at the XIII International AIDS it keeps rising: sixty-six per cent of the So let us not, as officials, say to people that Conference, held in Durban in 2000. women between twenty-five and thirty they may go and use untested traditional “That was our lowest point,’’ she said. years old are infected.’’ She took her glasses medicine to treat their disease. Because it In response to the many denialist state- off and wiped her eyes. “When you look is killing them. It is killing all of us.” ments issued by Mbeki and others, more past thirty, they are all dead.’’ The recent decision to permit No- than five thousand researchers who had zizwe to speak out about AIDS was met, gathered for the conference prepared hat month, Nozizwe Madlala- like the government’s previous turn- one of the saddest documents in modern Routledge, the deputy health min- abouts, with wariness. Shortly before scientific history, the Durban Declaration, ister,T came to see me in Cape Town. She Tshabalala-Msimang, who had been ill which stated that the evidence that H.I.V. and her boss, Tshabalala-Msimang, for months, returned to work, she un- causes AIDS is “clear-cut, exhaustive and could not disagree more on how to re- leashed an attack, clearly aimed at her unambiguous,” and meets the “high- spond to the epidemic. A former deputy deputy, through the A.N.C. Web site, est standards of science.” Tshabalala- defense minister, Nozizwe, as she is condemning those who were using her Msimang called it an élitist document, called by everyone, is a large, warm illness “as an opportunity to turn others and Mbeki’s spokesman said that it would woman, who immediately placed a into champions of a campaign to rid our quickly fnd its way to “the dustbins of the beaded AIDS ribbon on my lapel. “You government of the so-called H.I.V. and ofce.” “It was so very, very depressing,’’ are from New York and today is 9/11,’’ AIDS denial at the highest level.’’ Two Abdool Karim said. “Here was the world she said. “So you are our brother.’’ weeks ago, she was hospitalized again, in Durban for this amazing event. But it We went to a lounge in my hotel, and and it is not clear what will happen next. had come to a desert. as soon as we sat down she dumped a giant For now, Mbeki has appointed the coun- “Mbeki couches his opposition to document in my lap, entitled “Operational try’s transport minister to act in her place. H.I.V. in ways that some would say are Plan for Comprehensive H.I.V. and AIDS Some believe that Tshabalala-Msimang’s racist,” she continued. “I would prefer to Care, Management and Treatment for illness may provide the President with a say that he wants to be seen as an Afri- South Africa.” “This is the official policy politically acceptable way to step away canist—and that can mean many things. of our nation,’’ she said. “And it is a very from his most extreme views, and that But part of it is to seek indigenous solu- good policy. Before we say anything else, state support for AIDS denialism is wan- tions to what appear to be indigenous it is important to recognize that the policy ing. On February 9th, Mbeki, in his an- problems. That is fine, but our health of this country is not at fault.’’ The plan, nual State of the Nation speech, declared system is built on the foundations of first published at the end of 2003, was not that the government “commits itself to in- Western medicine. We have the same adopted until more than a year later. By tensify the campaign against H.I.V. and immunization program for children then, a ffth of South African women were aids.” Nozizwe was not yet ready to de- that you have. Ours may even have testing positive for H.I.V. clare victory. But she is more optimistic better coverage. We manage hyperten- When we met, Nozizwe had been than she was last fall. “I never lose hope,’’ sion, cardiac problems, and cancers in prohibited from speaking about aids for she told me recently. “I went to jail during the same way that you do. We read The more than a year. “I won’t ever forget the apartheid. I fought injustice and I know New England Journal of Medicine. We day,’’ she said. “It was on Nelson Mande- how to fight. We are a country in pain. I have t.b. We have malaria. We don’t la’s birthday, July 18th. They told me that think that has to be said. A country in hear him saying, Where are the in- I was not to talk about aids. And that I great pain and mourning. But I still believe digenous solutions for these illnesses?” was not to disagree with my minister.’’ the truth will win.” 

38 the NEW YORKER, MARCH 12, 2007

TNY—2007_03_12—PAGE 38—133SC.—live spot art r16004_B, pls inspect and report on quality