By Maggie Fox
The first time they met the 33 scientists meant to give South African President Thabo Mbeki the definitive answer on Aids could not even stay in the same room together.
The panel, made up of roughly even numbers of Aids "dissidents" who question the link between HIV and Aids and mainstream scientists who say it has been proved beyond doubt, had to break out into separate sessions.
Now, just days ahead of the 13th International Aids Conference, to be held in Durban, mainstream scientists are struggling to find a way to make Mbeki happy without giving into the hated dissidents - and without letting the controversy overshadow the conference.
They are furious that the first Aids conference to be held in a developing country is being hijacked by what they consider to be an inane debate of well-established facts, when it should be an opportunity to highlight the disaster that Aids has become in Africa.
"When we met as a panel, we all spent the first day and a half working through as much as we could together, but it came to a point where we were not able to make sufficient progress because the fundamental differences were too stark," Dr Salim Abdool-Karim, head of the HIV/Aids Research Unit at South Africa's Medical Research Council, said in a telephone interview.
"There had to be two different groups. The kinds of suggestions and recommendations that you make if you don't accept that HIV causes Aids are so dramatically different that there is no grey area. It is all black and white."
When Mbeki first started questioning the link between HIV and Aids, disbelieving scientists turned to their main link - the Internet.
Messages flew fast and furious between South Africa, Britain, the United States and elsewhere. One South African researcher called Mbeki's questioning attitude "idiotic".
An outraged John Moore, formerly of the Aaron Diamond Aids Research Centre at New York's Rockefeller University and now of Cornell University, sent out lists of Mbeki's new 33-member Aids advisory panel, which included virtually every known "dissident" who disputed the link between HIV and Aids.
Ironically, it was the Internet that first gave Mbeki the idea that he could challenge scientific orthodoxy. Known for his fondness for "surfing the Web", he had come upon the pages posted by Peter Duesberg of the University of California Berkeley, David Rasnick, a California-based molecular pharmacologist, and research editor Harvey Bialy of New York to a new Aids advisory panel.
The three men are members of the Group for the Reappraisal of the HIV/Aids Hypothesis, which argues that HIV does not always cause Aids and HIV drugs may do more harm than good.
Mbeki appointed them to his panel, along with some of the world's leading mainstream Aids researchers, including Karim, Dr Luc Montagnier, who co-discovered the HIV virus and Dr Helene Gayle, who heads the Aids centre at the United States Centres for Disease Control and Prevention (CDC) in Atlanta.
They are trying to be diplomatic while, at the same time, making their point. One member of the panel, who asked not to be named, said it was difficult because of strong pressure from Mbeki's office.
"The absurdity of this panel is without question but the political ramifications are serious," the panellist said. "The president (Mbeki) wants to know that we came to an agreement."
Some researchers say it is possible that Mbeki is acting out of desperation.
The latest report by the United Nations Programme on HIV/Aids (UNAIDS) says that nearly 20 percent of adult South Africans are infected with the Aids virus and predicts that half of all 15-year-olds will eventually die of it. The impact on South Africa's already struggling economy will be disastrous.
Up to one in four adults in central Johannesburg are infected, according to the city's Southern Metropolitan Local Council.
The expensive cocktails of drugs that keep so many HIV patients alive and well in rich countries are unavailable to the vast majority of Africans.
Even if they were to become freely available tomorrow, the facilities do not exist to test people for the virus, determine which drugs they should take and then monitor their progress to make sure the drugs, which require a complex dosing regimen, are working properly.
Faced with the collapse of his country's economy and the loss of millions of lives, Mbeki's best hope may be that there is some answer other than that an incurable and highly infectious virus is causing the devastation.
Some of the dissidents propose that so-called co-factors such as tuberculosis or malnutrition, are in fact the cause of Aids, and it is easier to feed someone or give the antibiotics that will cure TB than to treat them for HIV.
Earlier this week, more than 5 000 prominent scientists and doctors decided to disabuse Mbeki of this notion.
"The evidence that Aids is caused by HIV-1 or HIV-2 is clear cut, exhaustive and unambiguous, meeting the highest standards of science," the scientists wrote in a letter, called the Durban Declaration and published in the scientific journal Nature.
"It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives."
In case the point does not get across, on Sunday, when the conference officially opens, scientists backing the American Foundation for Aids Research (AmFAR), including former Dr Harold Varmus, former director of the US National Institutes of Health, will publish a full-page advertisement re-asserting this in The New York Times.
Mbeki's spokesman, Parks Mankahlana, is not happy. He denounced the "Durban declaration" and said he hoped the conference would not descend into "Mbeki-bashing".
"If the drafters of the declaration expect to give it to the president, or the government, it will find its comfortable place among the dustbins of the office," he said.
Mbeki's advisory panel held a second and final meeting in Pretoria this week. Members said they had come up with a compromise meant to save face for both sides.
"We do have a consensus agreement on treatment," one panellist said. It was to be presented to Mbeki on Wednesday. And a committee of the panel agreed that "co-factors" such as TB and poor nourishment must be taken care of.
A committee will also investigate whether the widely used Elisa test, an enzyme-linked assay used to check bodily fluids for the HIV virus, is, in fact, accurate.
Gayle was diplomatic in telling reporters about the decision. "People in South Africa are concerned about whether or not tests used in HIV are accurate and valid," she said. "We want to start at the first step which is the very basis of the data collected to clarify the scope of the problem."
Karim suggested he did not expect much more.
"I am not expecting to convince anybody that my view point is the correct view point," he said.
Karim, who chairs the scientific committee of the Aids Conference, said he was unhappy at the idea of debating the causes of Aids.
"Matters of scientific fact are not determined by panels voting and so on," he said. "If that were the case, we would have voted on whether the Earth was flat. It doesn't work like that. Issues of scientific fact are those that stand the test of time." - Reuters